Medical Record Review Methodology for Assessing Child and Adolescent Depression Healthcare Quality: A Systematic Review and Thematic Synthesis

BackgroundEarly-onset depression contributes significantly to long-term disability and suicide, making high-quality healthcare for young people with depression a critical concern. Medical record review (MRR) is widely used to assess healthcare quality. However, its application to depression care for children and adolescents appears underexplored, with no consensus on conceptualising or measuring quality. This systematic review aimed to evaluate how quality was operationalised in primary studies using MRR in this context.MethodsA structured search in PubMed, CINAHL, and PsycInfo following PRISMA guidelines identified 1,690 unique articles. Studies using MRR to evaluate outpatient depression healthcare quality for patients ≤17 years were included. Thematic synthesis was applied, focusing on methods, indicator themes, and quality framework alignment.ResultsSix studies published in 2005-2022 were included. These used 3-32 indicators covering risk assessments, diagnostic assessment, treatment, and monitoring, but indicators and operationalisation methods varied widely. Two studies reported using consensus methods. None incorporated the Institute of Medicine or World Health Organization quality frameworks. Binary opportunity indicator assessments were standard, but methods for deriving composite measures differed.ConclusionsDespite shared themes, heterogeneity and lack of framework alignment limit comparability. Robust operationalisation methods ensuring indicator reliability and validity would strengthen future measurement of depression healthcare quality.