Implementation of Universal Adolescent Depression Screening: Quality Improvement Outcomes

Abstract

Introduction Despite the increasing incidence of adolescent depression, suicide and evidence-based recommendations for adolescent depression screening, 70% of teens report not discussing depression with their provider. The aim of this quality improvement project was to improve the identification and management of adolescent depression by implementing a practice-based, universal depression screening. Method The Patient Health Questionnaire-9 modified for Adolescents was implemented during annual wellness visits for adolescents aged 12–18 years over 3 months. Retrospective chart reviews were conducted to determine a change in the rates of depression screening, depression diagnoses, referrals to mental health, and pharmaceutical treatment of depression. Results Pre/postimplementation data were compared. Documented adolescent depression screening increased from 0% to 74.5%. Increased rates of diagnosed depression (12.1%), mental health referrals (8%), and pharmaceutical treatment of depression (4.9%) were clinically and statistically significant. Discussion Adopting evidence-based recommendations for universal depression screening in pediatric primary care can improve the early diagnosis and management of adolescent depression. Despite the increasing incidence of adolescent depression, suicide and evidence-based recommendations for adolescent depression screening, 70% of teens report not discussing depression with their provider. The aim of this quality improvement project was to improve the identification and management of adolescent depression by implementing a practice-based, universal depression screening. The Patient Health Questionnaire-9 modified for Adolescents was implemented during annual wellness visits for adolescents aged 12–18 years over 3 months. Retrospective chart reviews were conducted to determine a change in the rates of depression screening, depression diagnoses, referrals to mental health, and pharmaceutical treatment of depression. Pre/postimplementation data were compared. Documented adolescent depression screening increased from 0% to 74.5%. Increased rates of diagnosed depression (12.1%), mental health referrals (8%), and pharmaceutical treatment of depression (4.9%) were clinically and statistically significant. Adopting evidence-based recommendations for universal depression screening in pediatric primary care can improve the early diagnosis and management of adolescent depression. Jeff Bose, Nurse Practitioner, Kiddie West Pediatric Center, Columbus, OH. Rosie Zeno, Assistant Professor of Clinical Nursing and Director of MS in Nursing Program, The Ohio State University, Columbus, OH. Barbara Warren, Professor of Clinical Nursing and Psychiatric Mental Health Nursing Across the Lifespan Specialty Track Director, The Ohio State University, Columbus, OH. Loraine T. Sinnott, Research Statistician, The Ohio State University, Columbus, OH. Elizabeth A. Fitzgerald, Associate Professor of Clinical Nursing, The Ohio State University, Columbus, OH.