Reply to the following

  1. Depression is a debilitating mental illness characterized by a change in mood, particularly feelings of sadness, hopelessness, helplessness, and in severe cases, thoughts of suicide. Worldwide, depression affects approximately 3.8% of the population, with 700,000 deaths by suicide (World Health Organization, 2021). In the U.S.A., the number of people diagnosed with depression is approximately 21 million; however, the number could be higher due to unreported cases of depression. Implementing PHQ-9 (Patient Health Questionnaire) – a depression screening tool composed of 9 questions – in the primary care setting will help detect depression and treat or make referrals to specialty providers.  
  2. PICOT Question

In primary care settings is implementation of a depression screening tool, such as PHQ-9, compared to non-implementation, beneficial in diagnosing and treating depression in adults over a period of 3 months.

  1. Quantitative research studies

  • Last, B. S., Buttenheim, A. M., Futterer, A. C., Livesey, C., Jaeger, J.,      Stewart, R. E., Reilly, M., Press, M. J., Peifer, M., Wolk, C. B., & Beidas, R. S. (2021). A pilot study of participatory and rapid implementation approaches to increase depression screening in primary care. BMC Family Practice, 22, 1–26.

This research article is a 3-phased study developed by Penn Medicine and implemented in 90 primary care practices. The phases were as follows phase I: solicited ideas and barriers for increasing depression screening; phase II: deliberation over and ranking the ideas; phase III: pilot the new idea in primary care practice using rapid prototyping for strategies designs. The patients completed a PHQ-2 form before the visit, and the clinicians evaluated the results. If PHQ-2 was positive (>2), the patient was directed to complete PHQ-9 or referred to a mental health clinician, give a prescription for treatment, or the clinician completes a depression follow-up plan or documentation of results. Quantitative outcomes revealed that PHQ-2 rates were similar to usual care; however, tablets automatically directing to PHQ-9 after a positive PHQ-2 increased the rates of PHQ-9 screenings. The qualitative outcomes consist of an increased rate of depression due to automatic generation of PHQ-9 after a positive PHQ-2 while before required manual human intervention. The conclusion: implementing PHQ-9 in a primary setting presents positive results with increased rates of detection of depression compared to non-using PHQ-9.

  • Pfoh, E. R., Janmey, I., Anand, A., Martinez, K. A., Katzan, I., & Rothberg, M. B. (2020). The Impact of Systematic Depression Screening in Primary Care on Depression Identification and Treatment in a Large Health Care System: A Cohort Study. JGIM: Journal of General Internal Medicine, 35(11), 3141–3147.

This is a retrospective pre-post study analyzing 259,411 patients in 37 internal and family medicine clinics in Northeast Ohio during May, June, and July of 2016. The patients included had at least one primary care visit. Prior to implementation, the screening was at the clinician’s discretion. The intervention consisted of implementing PHQ-2 prior to the visit through the patient’s portal. If the PHQ-2 has a score >2, then the patient would complete the remaining seven questions included in PHQ-9; if the PHQ-9 score >10 (moderate symptoms of depression), then the patient will complete PHQ-9 at each sub-visit until score < 5. If PHQ-9 <9, then the patient may complete the assessment annually. The study results revealed that 59% of patients received screening PHQ-2; 3% of them scored moderate-severe depression; the rate of depression increased by 1.2% immediately after the systematic screening. The rate of patients diagnosed with depression who received treatment within 90 days increased from 64% to 69%. Additionally, the adjusted odds of treatment increased by 20% after implementation. The conclusion: implementation of PHQ in a primary setting with future PHQ-9 assessment when required increased the rates of detected depression compared to non-use.

  1. Clinical Practice Guideline

      U.S. Preventive Services Task Force. (2016, January 26). Final                               Recommendation Statement Depression in Adults: Screening. U.S. Preventive          Services Task Force; Journal of the American Medical Association.      

  1. Governmental and non-governmental support

Various governmental and non-governmental are involved in programs meant to help people experiencing depression, fight the social stigma and offer the appropriate support. Some of the organizations are:

  • Mental Health America
  • Anxiety and Depression Association of America
  • 7 Cups of Tea
  • Depression and Bipolar Support Alliance
  • NAMI Connection
  • Postpartum Support International
  • Substance Abuse and Mental Health Services Administration
  • Suicide Prevention Resource Center
  • National Institute of Mental Health
  • Centers for Disease Control and Prevention
  • Texas Health and Human Services

  1. Strategies to narrow down literature

The search for resources included databases such as CINAHL and MEDLINE through the Midwestern State University library website. The articles were selected to be peer-reviewed and published in reliable journals within the last six years. Additionally, the studies must be primary research with quantitative data and measurable outcomes. 


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