Measurement-based care for depression

What is measurement-based care (MBC)?

Measurement-based care (MBC) describes the process of routinely using outcome measurement to guide treatment decisions. MBC is equivalent to measuring blood pressure when treating hypertension and measuring blood glucose and hemoglobin A1c when treating diabetes. For psychiatry, MBC is accomplished by using validated rating scales to measure outcomes including symptoms, side effects, functioning, and quality of life. MBC for depression consists of using routine outcome assessment in clinical care, timely adjustments of medication and counseling based on outcome assessments, and timely changes in treatments when outcomes are not achieved.

Watch a video of Dr. Lam talking about the usefulness of MBC for depression

What rating scales are useful for MBC for depression?

We recommend using simple patient-rated scales for efficiency in busy clinical settings. Patient-rated scales are highly correlated with clinician-rated scales but take less time and training to complete. The scales can be completed and scored by the patient in the waiting room or at home before appointments. The scales we recommend are brief, free or inexpensive to use in clinical care, and available in several languages. For more clinical tips on incorporating MBC into clinical practice, check our 2021 paper in Neuropsychiatric Disease and Treatment .

    • Quick Inventory of Depressive Symptomatology, Self-Rated (QIDS-SR) for depressive symptoms;
      (alternate) Personal Health Questionnaire (PHQ-9)
    • Generalized Anxiety Disorder (GAD-7) scale for anxiety symptoms
    • Perceived Deficits Questionnaire – Depression (PDQ-5) for cognitive complaints;
      (alternate) British Columbia Cognitive Complaints Inventory (BC-CCI)
    • Sheehan Disability Scale (SDS) for functional disability
    • Lam Employment Absence and Productivity Scale (LEAPS) for work impairment
    • Frequency, Intensity, Burden of Side Effects Rating (FIBSER) for medication side effects.

For more information about scales that we have developed or revised (LEAPS, BC-CCI, PDQ-D, FIBSER), check our Rating Scales page.

The package of free scales and monitoring form that we use can be downloaded here.

Note that the SDS is licensed by Dr. David Sheehan and may have a cost for clinical use (inquire at eProvide).

How do I keep track of outcomes?

A simple monitoring form can help track scores over time. The one we use in the Mood Disorders Centre is available here.

Are there online tools for tracking outcomes for MBC?

Yes! Try out, our free easy-to-use web app (optimized for mobile devices) that allows patients to track their own outcomes. MoodFX uses these validated scales to allow screening and tracking of scores. Users can set reminders to complete the questionnaires and subscribe to weekly self-management tips via email or SMS. Available in English et Français! For more information, check our Overview of MoodFX and our MoodFX for Clinicians.

Stay tuned! MoodFX will soon be available as a smartphone app in iOS and Android.

Dr. Lam’s Public talk on Workplace Depression and MoodFX

Slides from a public talk on workplace depression presented by Dr. Raymond Lam at the Mood Disorders Centre Clinical Day. Provides important facts about workplace depression and measurement-based care for depression.

Check out our EMBED project

This Canada-China team grant was jointly funded by the Canadian Institutes of Health Research (CIHR) and the National Science Foundation of China (NSFC) to implement technology-enhanced measurement-based care for depression in the mental health centres in Shanghai. We are using WeChat apps similar to MoodFX to track mood and to deliver an evidence-based self-management program. More info on our EMBED page here.

NEW! For EMBED, we developed an MBC Training Program for physicians in China!

Our peer-reviewed papers on MBC for depression:

Cheung B, Murphy JK, Michalak EE, Liu J, Yang X, Wang X, Chen J, Lam RW. Barriers and facilitators to technology-enhanced measurement-based care for depression among Canadian clinicians and patients: Results of an online survey. Journal of Affective Disorders, Sep 23 320:1-6, 2022. Online ahead of print.
We conducted a survey on MBC and eMBC in Canada.

Zhu M, Hong RH, Yang T, Yang X, Liu J, Murphy JK, Michalak EE, Wang Z, Yatham LN, Chen J, Lam RW. The efficacy of measurement-based care for depressive disorders: A systematic review and meta-analysis of randomized controlled trials. Journal of Clinical Psychiatry 82:21r14034, 2021.
We synthesize the rigorous studies of MBC to show that using MBC improves depression symptoms and remission rates.

Murphy JK, Michalak EE, Liu J, Colquhoun H, Burton H, Yang X, Yang T, Wang XR, Fei Y, He Y, Wang ZW, Xu Y, Zhang P, Su Y, Huang J, Huang L, Yang L, Lin X, Fang Y, Liu T, Lam RW*, Chen J* (*co-senior authors). Barriers and facilitators to implementing measurement-based care for depression in Shanghai, China: A situational analysis. BMC Psychiatry 21:430, 2021.
We examined the barriers and challenges from the perspective of patients, physicians, and administrators, and found overall support for MBC for depression.

Hong RH, Murphy JK, Michalak EE, Chakrabarty T, Wang Z, Parikh SV, Culpepper L, Yatham LN, Chen J*, Lam RW* (*co-senior authors). Implementing measurement-based care for depression: Practical solutions for psychiatrists and primary care physicians. Neuropsychiatric Disease and Treatment 17:79-90, 2021.
We provide easy ways to incorporate MBC into clinical practices.

Lam RW, McIntosh D, Wang JL, et al. CANMAT 2016 clinical guidelines for the management of adults with major depressive disorder. 1. Disease burden and principles of care. Canadian Journal of Psychiatry 61: 510-523, 2016.
The CANMAT guidelines recommend measurement-based care as a foundational principal for depression treatment.

Lam RW, Kennedy SH. STAR*D and measurement-based care: Don’t toss out the baby! Canadian Journal of Psychiatry 60:6-8, 2015.

Lam RW, Filteau MJ, Milev R. Clinical effectiveness: The importance of psychosocial functioning outcomes. Journal of Affective Disorders 132:S9-S13, 2011.

Lam RW, Michalak EE, Swinson RP. Assessment Scales in Depression and Anxiety. [revised] London UK, Informa Healthcare, 2006, 194 pages. ISBN 10: 0-415-41495-4.