Figure 1.

Schematic of stepped care pathway for major depressive disorder.

Depiction of stepped care model for recognizing and managing depression. This reflects the stepped care model presented in the NICE depression guideline (2009). Adaptations from the original are only in the following respects: (a) level of detail (minimized here for clarity), (b) addition of a “Step 0,” which we have developed in this project as the preceding stage to entering the stepped care pathway itself, and (c) in structure of presentation, as the NICE guideline does not explicitly show the setting(s) that each step takes place in. Here, the top row displays the title/summary of that step, the middle row shows the setting within which it should be managed, and the third summarizes details of management guidelines for each step. Note that Step 5 is not considered in the current treatment gaps as this is reserved for a minority of urgent or complex cases, often following the failure of previous treatment steps.