Introduction and overview

Introduction and overview

This quality standard covers the assessment and clinical management of persistent subthreshold depressive symptoms, or mild, moderate or severe depression in adults (including people with a chronic physical health problem).

Note: NICE is aware that there is a wider social context to depression that this quality standard does not directly address but which is acknowledged in the development of this standard. The focus of the standard is on clinical assessment and management as described above.


Depression is a broad and heterogeneous diagnosis. Central to it is depressed mood and/or loss of pleasure in most activities. Severity of the disorder is determined by both the number of and severity of symptoms, as well as the degree of functional impairment. Mild depression accounts for 70%, moderate depression 20% and severe depression 10% of all cases. Estimates of the incidence of depression within the population range from 3‑6% of adults and the number of people identified with and requiring treatment for depression is estimated to increase by 17% to 1.45 million in 2026. It is estimated that depression is two to three times more common in people with a chronic physical health problem (such as cancer, heart disease, diabetes or a musculoskeletal, respiratory or neurological disorder), occurring in about 20% of this population. The annual service costs to treat people with depression in 2007 were estimated to be £1.7 billion, far less than the cost to the economy attributed to depression (£7.5 billion).

This quality standard describes markers of high-quality, cost-effective care that, when delivered collectively, should contribute to improving the effectiveness, safety and experience of care for people with depression in the following ways:

  • Preventing people from dying prematurely.

  • Enhancing quality of life for people with long-term conditions.

  • Helping people to recover from episodes of ill health or following injury.

  • Ensuring that people have a positive experience of care.

  • Treating and caring for people in a safe environment and protecting them from avoidable harm.

The NHS Outcomes Framework 2011/12 is available from


The quality standard for depression in adults requires that services should be commissioned from and coordinated across all relevant agencies encompassing the whole depression care pathway. An integrated approach to provision of services is fundamental to the delivery of high quality care to people with depression.

It is also noted that patient preference and choice need to be taken into account, and practitioners should offer appropriate evidence-based interventions in their consultations with individual service users. Reflecting patient choice will be particularly important when measuring achievement against statements using the process measures. However, the quality standard uses the term 'receive' so as to facilitate measurability, audit and reporting.