There is increasing debate in the healthcare literature about the ‘efficacy gap’ and assessment of the ‘relative effectiveness’ of healthcare interventions, especially for publicly funded healthcare systems where demand always exceeds available resources and where physicians and decision-makers must choose between different treatments. By providing further information about the management of depressed patients in real life settings, observational studies complement randomised controlled trials (RCTs) findings and provide information about the benefits of different treatments on patient outcomes

Although the efficacy of antidepressant medications and psychotherapeutic treatments are well established, their effectiveness in improving a broad range of outcomes is less clear. The goal of treatment is to achieve remission (generally defined as no or minimal symptoms and a return to normal functioning) as this is associated with a lower risk of relapse. Various factors have been reported to influence the likelihood of achieving remission: severity and chronicity of depression, demographic factors, anxiety symptoms, painful physical symptoms, co-morbidities and adherence to treatment.

Remission is assessed by prospective studies, particularly RCTs. The generalisability of these results is often limited by the selectivity of the participating patients. Many patients taking part in observational studies have comorbidities that would have excluded them from randomised controlled trials, but who represent the "real-world" population of patients with depression. Observational longitudinal studies can determine outcomes in a heterogeneous group of patients and they reflect the routine care of depression in clinical practice.

FINDER was supported by Eli Lilly and Company Limited & Boehringer Ingelheim GmbH