Quality of depression assessments in child and adolescent psychiatry: Findings from a nationwide Swedish outpatient medical record review.

Background: Early-onset depression is an increasing concern, contributing to long-term disability and suicide. Diagnostic assessments are essential for effective treatment. However, research suggests that Child and Adolescent Psychiatry practices remain inadequate. Knowledge of healthcare processes is limited, with no consensus on conceptualising or measuring quality. This study aimed to investigate depression assessments in Swedish outpatient Child and Adolescent Psychiatry, including associations with predictors and diagnostic timeliness. Methods: Medical records (n = 284) from patients aged 8-17 with depression were collected from 10 services. Quality indicators for depressive symptoms, suicidality, comorbidities, and functioning were developed from guidelines. Indicator occurrences were assessed, summarised into components, and analysed using regression and correlations. Results: Indicator occurrences ranged from 8% to 84%, averaging 49%. Documentation varied considerably for risk aspects (57%). Distinct depressive characteristics (63%) occurred nearly twice as often as subtler symptoms (35%). Comorbidities (13%-22%) were rarely documented, whereas functioning and life situation (69%) were well-recorded. Predictors explained up to 28% of variance, with unidentified service-related factors explaining 10%. Better documentation weakly correlated with earlier diagnoses. Conclusions: Findings indicate the need for guideline implementation and further investigation into assessment inequities. Improving quality might promote earlier diagnoses. The indicators may be applicable in similar settings.