Major depressive disorder (MDD) is a leading cause of disability worldwide, in part due to its high prevalence and high rates of comorbidities, recurrence, chronicity and treatment-resistance. These indicate that MDD is treated suboptimally despite a multitude of effective interventions and well-regarded best-practice treatment guidelines. To improve the management of MDD, the nature and extent of ‘gaps’ in care pathways need to be understood.

We aimed to: 1. Identify ‘treatment gaps’ and patient needs along the care pathway, and determine the extent of these gaps (i.e. discrepancy between best- and current-practice). 2. Propose policy recommendation on how minimise treatment gaps for MDD.

Care pathway analysis: A set of relevant treatment gaps were agreed upon, a priori, based on gold-standard stepped-care guidelines. Data was gathered from a variety of sources in six countries (UK, Sweden, Germany, Italy, Portugal, Hungary). Policy recommendations: To attain expert consensus on proposed recommendations, a modified-Delphi approach was undertaken with a multidisciplinary panel of experts across Europe.

Taken together, data indicated that: ˜50% of episodes are undiagnosed, lifetime delay to treatment averages ˜4 years, ˜25-50% of patients are treated at any one time, ˜30-65% are followed up within 3 months of treatment, ˜5-25% can access psychiatric services. 28 specific recommendations to optimise pathways were made to enhance MDD detection (pathway entry), increase multimodal treatment, facilitate continuity of follow-up after treatment and increase access to specialist care.

There are concerning treatment gaps in depression care across Europe, from the proportion of people not being diagnosed to those stagnating in primary care with impairing, persistent illness.

No significant relationships.

Schizophrenia is a leading cause of disability. People living with schizophrenia (PLWS) present unemployment, social isolation, excess mortality and morbidity, and poor quality of life. Early recognition and appropriate treatment reduce the risk of chronicity and comorbidity. Personalization and integration of pharmacological and psychosocial interventions, as well as accurate identification and management of psychiatric and somatic comorbidities, can significantly improve mental and physical health of PLWS, promoting recovery.

A three-step Delphi approach was used to explore consensus on the essential components of early recognition and intervention, personalization, and integration of care to improve schizophrenia outcome, and on barriers and challenges to close treatment gaps. The consensus involved 8 Italian experts of schizophrenia, 100 psychiatrists from academic and nonacademic settings, including representatives of Italian Society of Psychiatry, and 65 trainees in psychiatry.

A strong consensus (from mostly agree to totally agree) emerged on the importance of early diagnosis (97%), standardized assessments (91%), correct management of somatic and psychiatric comorbidities (99%), and personalization and integration of care (94%). Lack of time, human resources, and training were identified as the main barriers and challenges to the translation of knowledge into clinical practice.

The results of this Delphi study demonstrated a strong consensus on main components of schizophrenia care, as well as on unmet needs to promote best practice and gaps between knowledge and clinical practice. The involvement of a large group of professionals and trainees in this in-depth consensus process might contribute to raise awareness and stimulate innovative strategies to improve the outcome of PLWS.