Evaluation of an electronic clinical algorithm to improve screening and evaluation of college students for depressive symptoms.

Abstract

Depression is higher among college students compared with the general population, and lesbian, gay, bisexual, transgender and questioning/queer (LGBTQ+) persons have higher rates than heterosexuals. Evidence supports the implementation of automated depressive symptoms screenings to improve provider compliance. A student health clinic at a private, catholic university did not consistently collect Patient Health Questionnaire 2 (PHQ-2) and Patient Health Questionnaire 9 (PHQ-9) depressive screening scores or sexual orientation and gender identity (SOGI) data. The Plan-Do-Study-Act method of quality improvement was used to improve depressive symptom screenings and SOGI data collection. Baseline assessment included a review of patient medical records during a 10-week period before the intervention. Patient Health Questionnaire 2 data were collected electronically and PHQ-9 data were collected automatically when indicated. Sexual orientation and gender identity data were added to the electronic intake form. The project was evaluated by: (1) comparing preimplementation and postimplementation compliance of PHQ-2 and PHQ-9 screenings; (2) assessing SOGI data collection; and (3) comparing LGBTQ+ and heterosexual student's PHQ-2 scores. Preimplementation data revealed a PHQ-2 compliance rate of 44.3%, with 0% PHQ-9 compliance, and no self-reported SOGI data collection. Postimplementation, PHQ-2 and PHQ-9 compliance increased to 93.2% and 100%, respectively. Patient Health Questionnaire 2 scores did not differ between LGBTQ+ and heterosexual students. The electronic clinical algorithm increased PHQ-2 and PHQ-9 data collection, supporting automated screenings for depressive symptoms. Collection of SOGI data also improved, thus potentially improving health outcomes. No differences between LGBTQ+ and heterosexual student's depressive symptoms were identified.