Evaluation of Depression Screening Implementation in the Adult Inpatient Heart Failure Population: A Process Outcomes Evaluation

BACKGROUND: Extensive study has found depression in heart failure (HF) patients to be a significant risk factor which has been associated with poor outcomes and increased medical cost for this population. It is highly recommended to screen HF patients for depression to identify this important risk factor. The PHQ-9 depression screening instrument (sensitivity 70% specificity 92%) has been identified as a valid measure to detect depression in the HF population. Implementing a depression screening protocol in an inpatient environment requires education of providers to establish awareness of best practice and foster confidence in their application of the screening instrument. OBJECTIVE: To determine if a correlation exists between provider knowledge of depression screening in the HF population, and adherence to a depression screening protocol. METHODS: A literature review was conducted to determine appropriate depression screening instruments for use in the HF population. Results were utilized to develop an education plan with pre-posttest, and depression screening protocol for implementation. A pilot study was conducted in the critical care unit of Norton Brownsboro Hospital (NBH) from September 27, 2017 through October 30, 2017. RESULTS: Adherence to the screening protocol was 40.6 percent. Pre-post assessment of provider knowledge following provider education was correct and unchanged for three out of four knowledge items. Significant (P \u3c .05) increase of knowledge (P= .002) for the remaining item. Perceptions of the burden of untreated/undetected depression in the HF population increased significantly (P= .001, P= .04, P= .09). CONCLUSIONS: No association between knowledge and adherence to a depression screening protocol was found. Provider knowledge showed significant increase after an education intervention. These results indicate that more is required beyond effective education of providers to achieve the goal of depression screening in the inpatient HF population

Implementation of a Depression Screening Protocol Specific to Implantable Cardioverter Defibrillator Patients; A Quality Improvement Project

Background: Depression in patients with implantable cardioverter defibrillators (ICD) is a problem that has not been well addressed by providers. In 2012 the American Heart Association (AHA) released a scientific statement that recommended structured and routine depression screening of these patients. The AHA statement also recommended further research on depression screening instruments and their use with this population. Aims: 1.) To develop and implement an evidenced based depression screening protocol appropriate for patients with an ICD seen in an outpatient setting. 2.) Evaluate provider knowledge about depression screening (? Is this what you mean) and depression screening practices before and after the depression screening protocol implementation. 3.) Determine the efficacy of protocol implementation by evaluating provider screening practices and recommendation for treatment. Setting: A small cardiology clinic affiliated with the University of Kentucky Cardiology Fellowship program. Participants: 18 general cardiology fellows who conduct clinic hours on Monday and Wednesday afternoons in the specified clinical setting. Methods: An evidenced based depression screening protocol was created using the Patient Health Questionaire-9 (PHQ-9). Participants were asked to use this screening instrument to evaluate all patients with an ICD who were seen in their clinic over a 14-week period. Participants were to document the screening in the clinic note and bill appropriately for the diagnosis of ICD. Participants also were surveyed on their knowledge and depression screening practices within this patient population before and after implementation of the protocol. A chart review was conducted at the end of the pilot study to evaluate provider adherence with the protocol. Process evaluation was conducted at the mid and end points of the pilot study. Results: The pre and posttest data showed an increase in formal depression screening, use of depression screening instruments, and knowledge base after protocol implementation. Posttest data showed that 64% of participants reported that they formally screened ICD patients compared to only 11% stating they screened pre protocol. Pre test data suggests that 89% of participants used a formal instrument 0/10 encounters compared to posttest data which suggests that 93% used an instrument at least 1-10/10 encounters. There was also a 38% increase in knowledge base about depression in the ICD population post protocol implementation. The primary barrier to depression screening identified by participants was lack of time. Chart review data was influenced by potential billing inconsistencies and poor attendance of ICD patients to the clinic during the pilot period. This led to little documented evidence of provider adherence to the protocol in the study setting. Of the charts available for analysis, 50% contained proper execution of the depression screening protocol. It is important to note that participating physicians have interactions with ICD patients in settings outside the study clinic and may have incorporated depression screening practices in other patient encounters. This may explain the improved scores of the pre/post test that are not reflected in the chart review data. Process evaluation data suggested that participants were equally prepared and satisfied with the process at the mid and end points of the pilot study. Conclusions: This quality improvement project was successful in creating and implementing a depression screening protocol in a small cardiology outpatient clinic. There was also marked success in provider knowledge and depression screening practices based on the results of pre/post test. In accordance with the scientific statement by the AHA, further research is recommended on best practice for depression screening of the ICD population

Screening for Generalized Anxiety Disorder in inpatient psychosomatic rehabilitation: pathological worry and the impact of depressive symptoms

Objective: Pathological worry is considered to be a defining feature for Generalized Anxiety Disorder (GAD). The Penn State Worry Questionnaire (PSWQ) is an instrument for assessing pathological worry. Two earlier studies demonstrated the suitability of the PSWQ as screening instrument for GAD in outpatient and non-clinical samples. This study examined the suitability of the PSWQ as a screening instrument for GAD in a German inpatient sample (N=237). Furthermore, a comparison of patients with GAD and patients with depression and other anxiety disorders regarding pathological worry and depression was carried out in a sub-sample of N=118 patients

Validation of the Edinburgh Postnatal Depression Scale on a cohort of South African women

Posmatal depression occurs in 10 - 15% of women. The Edinburgh Postnatal Depression Scale (EPDS) is a ID-item self-report scale designed specifically as a screening instrument for the postnatal period. It was initially validated for use in the UK, but has subsequently been validated for other communities. It has not been validated for an African community.Objective. To determine whether the EPDS is a valid screening scale for depression in a Joharmesburg community cohort. Participants and setting. 103 women attending the posmatal clinic at Coronation Hospital, Johannesburg, South Africa.Method. The EPDS was validated against the· Diagnostic and Statistical Manual (DSM-IV) criteria for depression. It was administered verbally to participants and translated into one of six South African languages where necessary.Results. A threshold of 11/12 on the EPDS identified 100% of women with major depression and 70.6% of women with minor depression. For major and minor depression combined, sensitivity was 80%, specificity 76.6%, positive predictive value 52.6% and negative predictive value 92.2%.Conclusion. The EPDS, administered verbally, is a valid screening instrument in this urban South African community

Comparing and Contrasting Depression Screening Instruments for Use Among Adolescents in Primary Care

Comparing and Contrasting Depression Screening Instruments for Use Among Adolescents in Primary Care Mary Clinton1, SN-CCC Julie Kaszuba2, MSN, RN 1 Research Scholar-LVPG Clinical Services, Student Nurse at Cedar Crest College 2 LVPG Clinical Procedure & Products Nurse Specialist, Research Scholar Mentor Abstract This discussion encompasses 18 research articles focusing on instruments used for depression screening of adolescent patients. Early detection of depression is a crucial step for stopping the progressive course of a depressive disorder. Effective screening mandates a reliable, valid, and brief tool is used. Lehigh Valley Physician Group (LVPG) is seeking to identify and implement a depression screening instrument aligned with the Lehigh valley health network (LVHN) Triple Aim. Better care, better cost, and better health for adolescent patients in primary care can be measured post implementation of a standard depression screening instrument. Four depression screening instruments and one set of guidelines were reviewed. The Patient Health Questionnaire-9 (PHQ-9), the Patient Health Questionnaire for Adolescents (PHQ-A), the Beck Depression Inventory-II (BDI-II), the Beck Depression Inventory for Primary Care (BDI-PC), and the Guidelines for Adolescent Preventive Services (GAPS) are evaluated. Evidence illustrates the instruments have comparable characteristics, including language translations, statistical analysis, and gender bias, but differ on cost, purpose of design, and time to administer. Collaboration with subject matter experts prior to use of a standard depression screening instrument in primary care is recommended. Keywords: adolescence, adolescent depression, depression screening, Patient Health Questionnaire, PHQ, Patient Health Questionnaire-9 Item, PHQ-9, Patient Health Questionnaire for Adolescents, PHQ-A, Beck Depression Inventory, BDI, Beck Depression Inventory for Primary Care, BDI-PC, Beck Depression inventory-II, BDI-II, Guidelines for Adolescent Preventive Services, GAPS, primary care, and standardization Background Adolescence is a time of emotional, physical, and mental growth. In the midst of this transformational period, an estimated 30% of children age 12 to17 are more prone to depressive symptoms (Dolle et al., 2012). Depression prevention is vital to improving a patient’s quality of life. “Depressive illness is projected to have significant public health and economic costs: major depression is expected to be the second leading cause of death and disability and to impose the greatest burden of ill health worldwide by 2020” (Huang, Chung, Kroenke, Delucchi, & Spitzer, 2006, p. 547). The Centers for Medicaid and Medicare Services (CMS) and The U.S. Preventive Services Task Force (USPSTF) encourage annual depression screenings. Notably, “The U.S. Preventive Services Task Force (USPSTF) recommends screening adolescents (12 to 18 years of age) for major depressive disorder (MDD) when systems are in place to ensure accurate diagnosis, psychotherapy (i.e., cognitive behavioral or interpersonal) and follow up” (U.S. Preventive Services Task Force, 2010, p. 178). Lehigh Valley Physician Group (LVPG) is investigating an age appropriate depression screening instrument that accurately detects adolescent depression in primary care settings. Improved patient outcomes can be achieved by applying measures reflecting better cost, better care, and better health to patients served. Selecting a depression screening instrument that is reliable, valid, and “should ideally have both a high sensitivity and a high specificity in order to reduce the number of false-negatives and false-positives” is necessary (Wittkampf, Naeije, Schene, Huyser , & van Weert, 2007, p. 388). Effective instruments, “must be valid, reliable, brief, and easy to use” (Gilbody, Richards, Brealey, & Hewitt, 2007, p.1596). Four depression screening instruments are evaluated in this paper. These include the Patient Health Questionnaire-9 Item (PHQ-9), the Patient Health Questionnaire for Adolescents (PHQ-A), the Beck Depression Inventory-II (BDI-II) and the Beck Depression Inventory for Primary Care (BDI-PC). In addition, the usefulness of the Guidelines for Adolescent Preventive Services (GAPS) in screening for adolescent depression is critiqued. Methodology From June 8, 2015-July 13, 2015, literature addressing instruments used for adolescent depression screening instruments were retrieved for analysis. Databases searched include: CINHAL, HAPI, Medline, PubMed, EBSCO, Pediatrics, and Science Direct. Key search terms included: adolescence, adolescent depression, depression, depression screening, depression measurement, mood module, Patient Health Questionnaire, PHQ, Patient Health Questionnaire-9 Item, PHQ-9, Patient Health Questionnaire for Adolescents, PHQ-A, Beck Depression Inventory, BDI, Beck Depression Inventory for Primary Care, BDI-PC, Beck Depression inventory-II, BDI-II, Guidelines for Adolescent Preventive Services, and GAPS. Initially, search settings were not placed for patient race or ethnicity, culture, type of care setting, nor age of patients aged 12 to 17 years. Limiting age and type of care setting searched was necessary to acquire additional evidence specifically aimed at screening for adolescent depression. Two Lehigh Valley Health Network (LVHN) medical librarians were consulted as experts for refining the search. Furthermore, this author collaborated with the LVPG Clinical Quality Educator to review data reflecting compliance with annual depression screening in primary care. Subsequent discussions emphasized the need for standardized annual depression screening in LVPG primary care practices. An evidence table was constructed. Rating the level of evidence assisted in identifying the most valid and reliable data. This author and mentor met weekly to review research and examine findings. Review of Literature The PHQ-9 is a self-administered mood module. The contents of this depression screening instrument are extracted from the Patient Health Questionnaire (PHQ), which is a self-administered version of the Primary Care Evaluation of Mental Disorders (PRIME-MD) that detects depressive and mental disorders in primary care (Wittkampf et al., 2007). The instrument “consists of nine items taken directly from the depression criteria” listed in the Diagnostic and Statistical Manual Fourth Edition (DSM-IV) (Kung et al., 2013, p.341). It is used for the adult population in a variety of medical settings and is the current standard adult depression screening instrument in LVPG primary care practices. Patients rate symptoms experienced over a period of two weeks prior to administration of the screening. In particular, one question assesses difficulty performing tasks (Kroenke, Spitzer, & Williams, 2001). Scoring the instrument is completed by physicians using either a diagnostic algorithm or a recommended cut-off score (Kroenke et al., 2001). Although the PHQ-9 can be scored using either method, the algorithm method has reported a low sensitivity and is not recommended. “A cut-off score of 10 or above on the summed-item score has been recommended as a method for screening for major depressive disorder” (Manea, Gilbody, & McMillan, 2015, p. 68). Calculating scores using a method reporting a higher sensitivity meets the criteria for a depression screening instrument described by Wittkampf et al. (2007). The PHQ-A is an instrument specifically constructed to screen the target age range, patients age 12 to 17. This instrument is a “67 item questionnaire that can be entirely self-administered by the patient in 5 minutes or less” and was “developed for the assessment of mental disorders among adolescent primary care patients” (Johnson, Harris, Spitzer, & Williams, 2002, p. 197). Answers are scored using a diagnostic algorithm. The PHQ-9 Modified for Adolescents (PHQ-A), has been extracted from the full version of the PHQ-A to screen for adolescent depression according to DSM-IV criteria. Symptoms experienced by the patient in the two weeks prior to screening are measured. Like the PHQ-9, the PHQ-A includes a question that measures functional impairment. It also inquires about suicidal ideation and suicide attempts (Johnson et al., 2002). Evidence demonstrates it is common for brief depression screening instruments to evolve from original, lengthier, screeners. Following this trend, the BDI-II was developed in the late 1990’s from the Beck Depression Inventory (BDI) to detect depressive symptoms as listed in the DSM-IV (Kung et al., 2013). Considering its revision, the BDI is not discussed. The BDI-II consists of 21 questions and has proven to be valid for detecting depression in patients 13 and older (Dolle et al., 2012). Seven questions from the BDI-II were taken to create the BDI-PC, a self-administered screening instrument for primary care that places greater importance on assessing a patient’s affect and mentality. The instrument uses a scale to gauge severity of depression according to DSM-IV criteria (Winter, Steer, Jones-Hicks, & Beck, 1999). Dolle et al. report the BDI-II has patients rate symptoms experienced in the last 14 days, including the day of the screening (2012). The BDI-PC states the same timeframe for rating symptoms experienced (Steer, Cavalieri, Leonard, & Beck, 1999). Reviewing the American Academy of Family Physicians’ (AAFP) recommendations for depression screening instruments across the lifespan, Sharp and Lipsky noted neither the BDI-II nor the BDI-PC was designated for use in the target population, although the BDI was recommended (2002). While The above questionnaires are defined as depression screening instruments, a set of guidelines, the GAPS, has been listed as resource for primary care. GAPS contains a series of questionnaires used to assess adolescent risk, including depressed mood (Gadomski, Scribani, Krupa, & Jenkins, 2014). Evidence illustrates the GAPS’ were designed to assist healthcare professionals in providing immunizations, conducting annual screenings, detecting behavioral problems, and promoting healthy living among adolescents (Levenberg, 1998). Thus, this set of recommendations has been eliminated from this discussion based on the absence of supporting data. Cost According to Kung et al., there is no cost to administer the PHQ-9 (2013). Furukawa noted the BDI-II must be purchased due to copyright (2010). A single screen costs about two dollars (Kung et al., 2013). The BDI-PC must also be purchased, although no cost was listed (Sharp & Lipsky, 2002). It is not determined whether the PHQ-A is free for use or has to be purchased. Time Johnson et al. report the PHQ-A takes approximately five minutes to complete (2002). Completing and scoring the PHQ-9 takes less than two minutes (Furukawa, 2010). Different times have been listed for the completion of the BDI-II. Although it consists of 21 questions, the BDI-II can be completed by the patient in a short amount of time. According to Kung et al., the instrument can be answered in five minutes (2013). In comparison, Furukawa states the 21 questions from the BDI-II can be completed in a minimum of five minutes but may take up to ten minutes (2010). Reported by the AAFP, the BDI-PC is completed in “fewer than 5 minutes” (Sharp & Lipsky, 2002). Language According to the AAFP, the BDI-II, and BDI-PC are available in Spanish (Sharp & Lipsky, 2002). The PHQ-9 has been translated into several languages, including German, Portuguese, Thai, Dutch, Malay, and Konkani (Manea et al., 2012). Johnson et al. did not report if any translated versions of the PHQ-A exist (2002).Reading Level No reading levels for any of the instruments was reported. Race/Ethnicity Among a primary care population, no relationship was identified between BDI-II scores and race or ethnicity among “Caucasian”, “African American”, “Hispanic”, “Asian American/Pacific Islander”, “Other,” and “Unreported” primary care patients (Arnau, Meagher, Norris, & Bramson, 2001, p. 113-114). Also proven useful for screening among a diverse patient population, the BDI-PC scores were not influenced by a patient’s ethnicity (Winter et al., 1999). After administering the PHQ-9 to a group of primary care patients, it was concluded “in African American, Chinese American, Latino, and non-Hispanic white patient groups the PHQ-9 measures a common concept of depression and can be effective for the detection and monitoring of depression in these diverse populations” (Huang et al., 2006, p. 547). Gender Bias No gender bias was reported in the literature gathered for evaluating the PHQ-A. More women than men were diagnosed with depression using the PHQ-9, BDI-II, and BDI-PC. Sensitivity and Specificity Statistics were compared among studies using the cutoff value of 10 and higher for the PHQ-9. In one meta-analysis, the PHQ-9 revealed a sensitivity of 0.77 and a specificity of 0.94 (Wittkampf et al., 2007). It was not identified whether this data represented an adolescent, adult, or mixed population. Measuring sensitivity and specificity, a second meta-analysis found the PHQ-9 to have a sensitivity of 0.85 and specificity of 0.89 at a cutoff of 11. In this case, the screening instrument was administered to an adult population (Manea et al., 2012). Screening for depression in an adolescent population, a sensitivity of 0.895 and specificity 0.775 was recorded at a cutoff score of 11 (Richardson et al., 2010). In comparison to the PHQ-9, the PHQ-A identified a sensitivity of 0.73 and a specificity of 0.94 in adolescents with major depressive disorder (Johnson et al., 2002). The BDI-II has measured a sensitivity 1.0 and specificity 0.70 at a cutoff of 10 in a primary care population (Arnau et al., 2001). The BDI-PC was found to have sensitivity 0.91 and specificity 0.91 in adolescent medical outpatients (Winter et al., 1999). A sensitivity of 0.97 and specificity of 0.99 was reported for a cutoff of 11 in an adult primary care population (Steer et al., 1999). See Table 1 for details: Depression Screening Instrument Statistics Area Under the Curve (AUC) Assessing validity of the PHQ-9 for diagnosing major depression in adults revealed the PHQ-9 to have an area under the curve of 0.95 (Kroenke et al., 2001). Conducting a study among an adolescent population, Richardson et al. discovered the PHQ-9 to have an AUC of 0.88 at a cutoff of 11 (2010). The BDI-II was found to have an accuracy of 0.96 in an adult primary care population (Arnau et al., 2001). The instrument also has an AUC of 0.93 when used among German adolescent mental health patients (Dolle et al., 2012). Winter et al. discovered the BDI-PC has an AUC of 0.98 when screening is conducted among adolescent medical outpatients (1999). At a cutoff of 4, Steer et al. reported an AUC of 0.99 for the same instrument when it was used in an adult primary care population (1999). See Table 1 for details: Depression Screening Instrument Statistics Discussion The PHQ-A, PHQ-9, BDI, and BDI-PC have proven to be valid and reliable instruments available to screen for adolescent depression. Having comparable completion times and statistics gives health networks various instruments to choose from. Translated versions of the BDI-II, BDI-PC, and the PHQ-9 do exist. Each of these screening instruments has been used among patients of different race and culture. Each instrument reports higher rates of depression in females. A few differences exist among these instruments. The full version of the PHQ-A takes more time to complete. Nine of its questions assessing depression have been placed into a questionnaire, the PHQ-9 Modified for Adolescents (PHQ-A), to reduce completion time. The BDI-II takes several more minutes to complete than the other instruments. Free to use, the PHQ-A and PHQ-9 may be preferable since the screening is performed annually. The BDI-II and BDI-PC must be purchased. The benefit of using the PHQ-A is its development for an adolescent population and inclusion of a question about suicidal ideation and suicide attempts. Although it was not designed specifically for adolescents, the PHQ-9 is the current standard depression screening instrument for adults in LVPG primary care. Medical professionals are already familiar with this depression screening instrument and may require less time to develop competency when applying the PHQ-9 to the adolescent population.. However, one might argue that although medical professionals may be more familiar with the PHQ-9, the BDI-PC has fewer questions. This instrument would take less time to complete and score. Limitations While database searching proved to be thorough, a minimal amount of literature was found using the PHQ-A, PHQ-9, BDI-II, and BDI-PC depression screening instruments in adolescents. Only one article, by the instrument’s creator, was found to report the use of the PHQ-A in adolescents. A significant amount of articles were found for use of the BDI rather than the BDI-II or BDI-PC, despite these being updated versions of the BDI. Although the BDI-II has been the updated version of the BDI since the late 1990’s, there leaves to be some speculation why the original BDI is recommended for use in adolescents by the AAFP (Sharp & Lipsky, 2002). Recommendations Consulting subject matter experts, including adolescent health, behavioral health, and pediatric healthcare professionals is advised before implementing a standard adolescent depression screening instrument in LVPG primary care. Collaborating with these healthcare professionals can provide additional insight into providing quality care for the target age range, patients age 12 to 17. Expert advice, time restraints, and languages spoken by the population served, among other factors, may influence the selection of the instrument chosen for LVPG primary care. References Arnau, R. C., Meagher, M. W., Norris, M. P., & Bramson, R. (2001). Psychometric evaluation of the Beck Depression Inventory-II with primary care medical patients. Health Psychology : Official Journal of the Division of Health Psychology, American Psychological Association. 20(2), 112-119. Dolle, K., Schulte-Korne, G., O\u27Leary, A. M., von Hofacker, N., Izat, Y., & Allgaier, A. K. (2012). The Beck Depression Inventory-II in adolescent mental health patients: Cut-off scores for detecting depression and rating severity. Psychiatry Research. 200(2-3), 843-848. Furukawa, T. A. (2010). Assessment of mood: Guides for clinicians. Journal of Psychosomatic Research. 68(6), 581-589. Gadomski, A. M, Scribani, M. B., Krupa, N., & Jenkins, P. L. (2014). Do the Guidelines for Adolescent Preventive Services (GAPS) facilitate mental health diagnosis? Journal of Primary Care & Community Health. 5(2), 85-89. Gilbody, S., Richards, D., Brealey, S., & Hewitt, C. (2007). Screening for Depression in Medical Settings with the Patient Health Questionnaire (PHQ): a Diagnostic Meta-Analysis. Journal of General Internal Medicine. 22(11), 1596-1602. Huang, F. Y., Chung, H., Kroenke, K., Delucchi, K.L., & Spitzer, R. L. (2006). Using the Patient Health Questionnaire-9 to measure depression among racially and ethnically diverse primary care patients. Journal of General Internal Medicine. 21(6), 547-552. Johnson, J. G., Harris, E. S., Spitzer, R. L., & Williams, J. B. W. (2002). The Patient Health Questionnaire for Adolescents - Validation of an instrument for the assessment of mental disorders among adolescent primary care patients. Journal of Adolescent Health : Official Publication of the Society for Adolescent Medicine. 30(3), 196-204. Kroenke, K., Spitzer, R. L., & Williams, J. B. W. (2001). The PHQ

Depression Screening and Patient Outcomes in Cancer: A Systematic Review

Several practice guidelines recommend screening for depression in cancer care, but no systematic reviews have examined whether there is evidence that depression screening benefits cancer patients. The objective was to evaluate the potential benefits of depression screening in cancer patients by assessing the (1) accuracy of depression screening tools; (2) effectiveness of depression treatment; and (3) effect of depression screening, either alone or in the context of comprehensive depression care, on depression outcomes.Data sources were CINAHL, Cochrane, EMBASE, ISI, MEDLINE, PsycINFO and SCOPUS databases through January 24, 2011; manual journal searches; reference lists; citation tracking; trial registry reviews. Articles on cancer patients were included if they (1) compared a depression screening instrument to a valid criterion for major depressive disorder (MDD); (2) compared depression treatment with placebo or usual care in a randomized controlled trial (RCT); (3) assessed the effect of screening on depression outcomes in a RCT.There were 19 studies of screening accuracy, 1 MDD treatment RCT, but no RCTs that investigated effects of screening on depression outcomes. Screening accuracy studies generally had small sample sizes (median = 17 depression cases) and used exploratory methods to set sample-specific cutoff scores that varied substantially across studies. A nurse-delivered intervention for MDD reduced depressive symptoms moderately (effect size = 0.37).The one treatment study reviewed reported modest improvement in depressive symptoms, but no evidence was found on whether or not depression screening in cancer patients, either alone or in the context of optimal depression care, improves depression outcomes compared to usual care. Depression screening in cancer should be evaluated in a RCT in which all patients identified as depressed, either through screening or via physician recognition and referral in a control group, have access to comprehensive depression care

Norms and screening utility of the Dutch version of the children's depression inventory in clinical and nonclinical youths

This study aimed to (a) assess relationships between the Children's Depression Inventory (CDI) and DSM-oriented depression and anxiety scales of the Youth Self Report, (b) develop reliable norms for the CDI, and (c) determine CDI cutoff scores for selecting youngsters at risk for depression and anxiety. A total of 3,073 nonclinical and 511 clinically referred children and adolescents from The Netherlands and Belgium were included. Results showed that CDI scores were significantly related to DSM-oriented symptoms of both depression and anxiety. CDI scores correlated highly with depression symptoms and moderately with anxiety symptoms. Norms for the CDI were determined by means of multiple regression analysis and depended on sex, age, and country. CDI cutoff scores for selecting individuals at risk for depression and anxiety as measured by the DSM-oriented depression and anxiety scales of the Youth Self Report were determined by means of multiple regression analysis and receiver operating characteristic analysis. A CDI score of 16 was found to have the most optimal balance between sensitivity and specificity for depression, whereas a score of 21 provided the best sensitivity and specificity for anxiety in a subsample of children. We conclude that the CDI is an effective instrument for screening depression and to a lesser extent anxiety in primary and secondary care centers, before applying further assessment of high-risk individuals

Assessment of Depression Screening in Women’s Primary Care Clinic

Purpose: The purpose of this practice inquiry project was to evaluate provider adherence to depression screening documentation in the ambulatory electronic health record (AEHR) before and after changing locations of the depression screening questions within the AEHR. Provider knowledge about depression screening and barriers related to depression screening were also examined. Methods: A retrospective chart review was completed for patients seen for an annual exam by a physician provider in a women’s primary care clinic. Data collected included demographic data, co-morbid conditions, depression screen documentation (PHQ-2 & PHQ-9), and interventions documented. A questionnaire was sent to providers in the primary care clinic to assess knowledge about depression and identification of barriers related to depressions screening. Results: The retrospective chart review indicated that 2% of the patients were screened for depression before the screening tool was moved in the AEHR, and 78% were screened after the screening tool was moved. There were no significant differences in the two population samples. Only one patient out of 50 was screened before the screening tool was moved, but 13 patients were given prescriptions for medications for the treatment of depression. Provider knowledge of the location of the screening tool has increased. Furthermore, time was identified as the greatest barrier to screening for depression. Conclusion: Depression screening improved after changing the AEHR placement of the depression screening questions in the areas in which providers document prevention. “Yes” responses from the patient on the PHQ-2 indicated a positive screen for depression, and these positive responses on the PHQ-2 automatically directed the provider to the PHQ-9, a more extensive instrument for depression that measures symptom severity. Time was the most significant barrier to screening for depression. Primary care providers may be the only healthcare professional that are able to screen for depression since these providers are most easily accessible to patients. Treating depression helps improve overall health, but can also impact the management of other chronic diseases as well

Evaluation of Depression Screening Practices for College Women in a Primary Care University Health Clinic

Mental disorders, including depression, are increasing in frequency and intensity in the college student population. College-aged women appear to be particularly vulnerable to depression. Primary care providers play an important role in addressing this issue, as they are the principal health care contacts for more than 50% of patients with mental illnesses. Guidelines from the 2009 United States Preventative Services Task Force recommend screening all adults (age 18+) for depression in primary care when depression care supports are in place. However, current screening rates for depression in the primary care setting from are estimated at only 1.6 to 3.3% (United States Department of Health and Human Services, 2012a). This capstone report presents three manuscripts which focus on depression screening practices for college women in the primary care setting. The first manuscript presents a literature review pertaining to depression in college women, including risk factors for depression, consequences of depression, and depression screening practices in this population. The second manuscript presents a critical analysis of the United States Preventative Services Task Force’s guideline recommendations for screening for depression in adults in primary care, using a modified version of the Appraisal of Guidelines for Research and Evaluation (AGREE) Instrument (2001). The literature obtained from these first two manuscripts led to a descriptive study, which examined depression screening practices and barriers at a primary care university health clinic in the southeastern United States. The third and final manuscript details this study, and presents practical implications for improving depression screening rates in this at-risk population

Development of an Instrument to Identify Depression in College Freshman

The incidence of depression in college students is increasing at an alarming rate. Unidentified and untreated depression can lead to significant difficulties adjusting to college life. The goal of this research project is to develop an instrument to identify depression in college freshmen. The development of this instrument is still in the working phase. Qualitative data, collected through interviews with students who experienced depression as college freshmen, provided the basis for the initial draft of items for the instrument. These items reflect the unique experience of depression as experienced by college freshmen. The initial draft of items was reviewed during four focus groups composed of current university students for clarity. These items were revised based upon the valuable feedback received from the focus groups. We are currently recruiting individuals who experienced depression during their freshman year in college to review the instrument draft during one-to-one interviews with the lead investigator. The goal of these interviews is to ensure the items on the instrument are representative of their experience with depression during this time of transition. We plan to continue our work next fall and hope to begin initial screening of freshmen students within the next year