Implementation of Depression Protocol in Rural Nebraska Pediatric Clinic

Abstract

Problem: The prevalence of depression among adolescents in the U. S. is 20%. Homicide, substance abuse, suicide, selfinjury, and low academic performance are linked to adolescent depression. There are not enough mental health providers or access to treat these adolescents, Background: It is often difficult for adolescents to understand their own feelings and navigate social pressures. The COVID-19 pandemic only exacerbated that. Most adolescents (90%) see a primary care provider annually for physicals, immunizations, or illness. However, mental health screenings are often not initiated, and depression is not addressed. Through this avenue, we propose that depression treatment be initiated in the primary care setting. Methods: We proposed a project to initiate screening and treatment using the Glad-PC guidelines by primary care. Our first steps were to 1) discuss the need for this measure with facility providers 2) plan for data collection 3) obtain IRB approval 4) implementation. Findings: We were met with great reception from providers, who both recognized the problem of adolescents with untreated depression and were willing to help find a solution. The percentage of clients referred from pre-intervention was 34%, while the percentage referred post intervention was 53%. There was a dramatic decrease in the number of PHQ-9s completed in the post intervention phase, yet the number of patients screening positive for depression doubled from pre-intervention to post-intervention. Conclusion: The dramatic increase in those screening positive for depression highlights the importance of this project and the need for providers to use the Glad-PC guidelines in primary care to recognize, begin treatment and refer the affected adolescents.