The gap between evidence-based clinical guidelines and their use in medical settings is well recognised. There is a need for studies on the implementation of clinical guidelines in psychiatric care and there is specifically a lack of studies of long-term effects.

The aim of this study was to measure the compliance to clinical guidelines for depression and suicide attempters 6, 12- and 24 months after implementation.

Clinical guidelines for depression and suicidal patients were implemented at two multidisciplinary psychiatric outpatients clinics and two psychiatric emergency clinics. At two control units the clinical guidelines were only administered.

2 165 records from patients with an ICD-10 or DSM-IV diagnose of depression and persons appraising the clinics after a suicide attempt were included. Compliance to the guidelines was studied using documentation of quality indicators.

The presences of the quality indicators in the patient records improved from baseline in the four clinics where an active implementation was done, whereas there were no changes, or a decline, in the control clinics. The increase was recorded at 6 months and persisted over 12 and 24 months.

After implementation there was a significant increase in the documentation of the suggested quality indicators 6, 12 and 24 months after implementing clinical guidelines. These results demonstrate that quality indicators can be used as measures of sustainable compliance to clinical guidelines.