Inclusion Criteria in the patient study:  severe depression has received inpatient care in the County of Gavleborg during two given time-periods  Exclusion Criteria in the patient study:  stress-related exhaustion disorder substance use disorder neuropsychiatric disorder psychosis postpartum depression.  Inclusion Criteria in the staff study:  healthcare staff from all clinical areas in the County of Gavleborg staff with permanent employment  Exclusion Criteria in the staff study:  administrative staff managers staff on long term leave staff on long term sick leave staff on parent leave staff expected to retire or resign within a year