Clinical prediction instruments available for clinicians treating major depressive disorder: A systematic review

Background: Responses to treatment for Major Depressive Disorder (MDD) vary widely, complicating clinical decision-making. Various clinical prediction instruments are available to support this process and potentially improve treatment outcomes. However, a systematic review to guide clinicians in choosing among these instruments is lacking. Objective: To provide an overview of statistically evaluated clinical prediction instruments that are currently available for clinicians to assist in their decision-making processes. This review focuses on instruments accessible online or in print. Methods: A systematic search following PRISMA/CHARMS guidelines in Medline, Embase, and PsycINFO databases was conducted from January 1, 2010, to March 1, 2023 (PROSPERO: CRD42021261469). Original studies in English reporting on prediction instruments for adults with MDD, available online or in print, were included. The risk of bias in these studies was evaluated using the Prediction model Risk Of Bias Assessment Tool (PROBAST). Results: Of the 5879 records screened, 111 full-text records were reviewed for eligibility, resulting in 15 original studies that reported on 16 unique prediction instruments. Most instruments (12 out of 16) were designed for use at the beginning or during treatment, while four specifically assessed outcomes after treatment. All studies had a high risk of bias. Conclusion: This systematic review provides a comprehensive overview of 16 prediction instruments immediately available for clinicians to support decision-making in depression treatment. For use at treatment initiation, we recommend instruments assessing prior treatments and clinical characteristics, such as the Maudsley Staging Method (MSM) or the Dutch Measure for quantification of Treatment Resistance in Depression (DM-TRD).