Patient Health Questionnaire-9 Depression Screening Research Articles

Implementation of Depression Screening with the Patient Health Questionnaire-9 (PHQ-9) at a Radiation Oncology Department.

Introduction Depression is the leading cause of disease burden and disability in adults in the United States and worldwide. Cancer patients with unidentified and/or untreated depression are at increased risk for adverse health outcomes that contribute to poor prognosis and mortality. Inadequate depression screening and referral practices were observed and verbalized as a concern by internal stakeholders at a Radiation Oncology Department (ROD). Retrospective chart audits revealed depression screening compliance was less than two percent. Thus, the purpose of this Quality Improvement (QI) project was to implement and evaluate the Patient Health Questionnaire (PHQ-9) depression screening tool with subsequent psychosocial referrals for all positive screens. It is anticipated these interventions will improve early identification of depression in adult cancer patients and increase patient access to psychosocial services for formal evaluation. Methods There is considerable evidence of the high internal consistency, reliability and validity with the PHQ-9. Eligible adult cancer patients at the ROD were screened for depression with the PHQ-9 during their first treatment visit. Patients with positive screens (score of ≥10) were provided resources and referred to an Oncology Social Worker for further evaluation. Weekly retrospective chart reviews were conducted to collect the number and percentage of completed PHQ-9 screening and referrals. Staff compliance results were summarized in frequency counts and plotted on run charts to monitor implementation progress. Results A total of 117 cancer patients attended their first treatment appointment. Of these, 61% (n=71) were screened for depression with the PHQ-9 instrument, and 13% screened positive for depression. Of those positive screens (n=9), 100% were referred to the Oncology Social Worker, and 100% received follow-up care. Staff pre/post-education survey data were analyzed statistically with a Wilcoxon signed-rank test. The results demonstrated improved competency in the new process (V = 17.00, z = -6.31, p < .001). Conclusions After fifteen weeks of data collection and analysis, the plan is to discuss the brevity, efficacy, and feasibility of the PHQ-9 depression screening and psychosocial referrals for cancer patients undergoing radiotherapy at the ROD. The impact of the practice change, significance of results, and sustainability measures will also be covered. Depression is the leading cause of disease burden and disability in adults in the United States and worldwide. Cancer patients with unidentified and/or untreated depression are at increased risk for adverse health outcomes that contribute to poor prognosis and mortality. Inadequate depression screening and referral practices were observed and verbalized as a concern by internal stakeholders at a Radiation Oncology Department (ROD). Retrospective chart audits revealed depression screening compliance was less than two percent. Thus, the purpose of this Quality Improvement (QI) project was to implement and evaluate the Patient Health Questionnaire (PHQ-9) depression screening tool with subsequent psychosocial referrals for all positive screens. It is anticipated these interventions will improve early identification of depression in adult cancer patients and increase patient access to psychosocial services for formal evaluation. There is considerable evidence of the high internal consistency, reliability and validity with the PHQ-9. Eligible adult cancer patients at the ROD were screened for depression with the PHQ-9 during their first treatment visit. Patients with positive screens (score of ≥10) were provided resources and referred to an Oncology Social Worker for further evaluation. Weekly retrospective chart reviews were conducted to collect the number and percentage of completed PHQ-9 screening and referrals. Staff compliance results were summarized in frequency counts and plotted on run charts to monitor implementation progress. A total of 117 cancer patients attended their first treatment appointment. Of these, 61% (n=71) were screened for depression with the PHQ-9 instrument, and 13% screened positive for depression. Of those positive screens (n=9), 100% were referred to the Oncology Social Worker, and 100% received follow-up care. Staff pre/post-education survey data were analyzed statistically with a Wilcoxon signed-rank test. The results demonstrated improved competency in the new process (V = 17.00, z = -6.31, p < .001). After fifteen weeks of data collection and analysis, the plan is to discuss the brevity, efficacy, and feasibility of the PHQ-9 depression screening and psychosocial referrals for cancer patients undergoing radiotherapy at the ROD. The impact of the practice change, significance of results, and sustainability measures will also be covered.

Pilot Study Using Neurofeedback as a Tool to Reduce Surgical Resident Burnout

Burnout is prevalent among surgical residents. Neurofeedback is a technique to train the brain in self-regulation skills. We aimed to assess the impact of neurofeedback on the cognitive workload and personal growth areas of surgery residents with burnout and depression. Fifteen surgical residents with burnout (Maslach Burnout Inventory [MBI] score > 27) and depression (Patient Health Questionnaire-9 Depression Screen [PHQ-9] score >10), from 1 academic institution, were enrolled and participated in this institutional review board-approved prospective study. Ten residents with more severe burnout and depression scores were assigned to receive 8 weeks of neurofeedback treatments, and 5 others with less severe symptoms were treated as controls. Each participant's cognitive workload (or mental effort) was assessed initially, and again after treatment via electroencephalogram (EEG) while the subjects performed n-back working memory tasks. Analysis of variance (ANOVA) tested for significance between the degree of change in the treatment and control groups. Each subject was also asked to rate changes in growth areas, such as sleep and stress. Both groups showed high cognitive workload in the pre-assessment. After the neurofeedback intervention, the treatment group showed a significant (p < 0.01) improvement in cognitive workload via EEG during the working memory task. These differences were not noted in the control group. There was significant correlation between time (NFB sessions) and average improvement in all growth areas (r= 0.98) CONCLUSIONS: Residents demonstrated high levels of burnout, correlating with EEG patterns indicative of post-traumatic stress disorder. There was a notable change in cognitive workload after the neurofeedback treatment, suggesting a return to a more efficient neural network.

Clinical associations of quarterly Patient Health Questionnaire-9 depression screening results in adolescents with type 1 diabetes.

Awareness of comorbid depression in type 1 diabetes (T1D) patients is necessary to optimize health and diabetes care. Depression can occur or recur requiring regular review for depression symptoms. A validated tool to screen adolescents for symptoms of depression is the Patient Health Questionnaire (PHQ)-9 Modified for Teens (PHQ91-9 ). PHQ91-9 depression screen results, depression-related ICD-codes, demographic data, and information on complications and comorbidities of adolescents ≥11 years old with T1D were obtained. Longitudinal and single observation multivariable analyses identified associations of covariates with positive PHQ91-9 depression screens. 5032 PHQ91-9 surveys were completed by 1225 unique participants. Overall, 6% (286/5032) of the PHQ91-9 depression screens were positive, and 60% (171/286) of the positive screens occurred in 107 unique patients without documented depression. In the longitudinal analysis, positive PHQ91-9 screens were associated (P < .05) with a diagnosis of depression listed in the medical record (OR 9.8), diabetic retinopathy (OR 4.3), female sex (OR 1.9), and use of an insulin pump (OR 0.5), while the single observation analysis at the time of a positive PHQ91-9 indicated presence of depression in the medical record (odds ratio 12.1), female sex (OR 1.9), and obesity (OR 1.8) were significantly (P < .05) associated with positive PHQ91-9 results. Quarterly PHQ91-9 depression screening of adolescents with T1D during routine clinic visits can immediately inform care, and previous diagnosis of depression is the most strongly associated covariate, highlighting the importance of documenting depression in the medical record. Additionally, awareness for higher odds of positive PHQ91-9 depression screens in females, obese adolescent, and patients on insulin injections is important.

P008 EVALUTING THE EFFECTIVENESS OF TRANSITION OF CARE FOR PEDIATRIC INFLAMMATORY BOWEL DISEASE PATIENTS USING A STANDARDIZED TRANSITION PROCESS

Abstract Significance The incidence of inflammatory bowel disease (IBD) is rising around the globe. As pediatric IBD patients approach adulthood, they are in jeopardy of a lapse in care. We developed a standardized a health maintenance transition visit (HMV) to supplement standard medical care visits (SMV) to prepare patients for transition. Our aim was to assess the effectiveness of the structured HMV using the Transition Readiness Assessment Questionnaire (TRAQ) to predict readiness at time of transfer to an adult gastroenterologist. Methods A retrospective chart review was conducted including demographics and clinical data from HMV visits and pediatric or adult SMV visits. Clinical variables included scheduling, providers, TRAQs, Patient Health Questionnaire-9 (PHQ9), health maintenance goals, and disease status. The effectiveness of the HMV was accessed by attendance, PHQ9 screening, adherence to health recommendations, and TRAQ scores. Results 140 patients completed at least one HMV. The patient cohort was 80% white and 59% male. Mean age was 18 ± 2 years old at the time of their first HMV. The majority of patients had a primary IBD diagnosis of Crohn’s disease (75%), followed by ulcerative colitis (21%), and unclassified IBD (4%). Most patients had inactive disease (68%) around the time of the first HMV, while a minority had mild (20%) or moderate (12%) disease activity based on PGA. The average TRAQ score at the first HMV visit was 66 ± 17. Patients who completed at least 1 prior HMV (n=8) scored significantly higher on the TRAQ when transferring to the adult care compared to patients (n=29) who were transferred at their first HMV visit (92 vs 83, p&amp;lt;0.05). Of the 56 patients who completed the PHQ9 depression screen, 22 had a positive screen. Of the patients with no prior diagnosis of depression, 36% had a positive screen with the severity of depression ranging from mild to severe. Across all visits, 45 patients were transferred into adult care following a HMV. Conclusions This study demonstrated that a structured HMV prior to transfer may increase transition readiness as assessed by the TRAQ. In addition, new diagnosis of depression was made in a significant portion of patients screened, emphasizing the importance of regular screening for psychological issues. Future studies are needed to validate these findings and potentially move towards a standard template for transition readiness in pediatric IBD patients.

An Educational Intervention to Improve the Sleep Behavior and Well-Being of High School Students.

The objective of this study was to determine whether a sleep education intervention improves knowledge of sleep, sleep behaviors, and depression in high school freshmen. We recruited student volunteers at a single magnet high school in Los Angeles, California through their health class. Twenty-four freshmen participated and 18 students (17 female, 1 male) completed pre- and postsurveys. Curriculum consisted of 4 hours of after-school interactive lectures emphasizing sleep physiology, benefits of sleep, what impacts sleep, and methods to improve sleep, followed by a 9-week sleep behavior change journal. Pre- and postsurveys measuring both sleep behaviors and knowledge, and a Patient Health Questionnaire-9 depression screening were administered to participants prior to and after the intervention. We used t tests and χ 2 tests to analyze knowledge and behavior change. Subjects improved in average sleep hours per night (preintervention 6.9 hours to postintervention 7.8 hours, P=.0134), and average weekend night bedtime (11:36 pm to 10:54 pm, P=.0307). This school sleep behavior intervention demonstrated students' average sleep hours per night and weekend bedtime improved after the lecture and sleep journal intervention. This suggests a sleep education intervention may benefit this population. Further studies are needed to demonstrate effectiveness of this education over time, across sexes, and in high-risk students.

37-Year-Old Man With Fatigue and Erectile Dysfunction

37-Year-Old Man With Fatigue and Erectile Dysfunction

Association Between Depression and Metabolic Syndrome in Korean Adults: Data From the 2014 and 2016 Korea National Health and Nutrition Examination Survey.

This study aimed to examine the association of depression with metabolic syndrome and to investigate levels of awareness and treatment of depression in Korean adults. We analyzed data extracted from the Korea National Health and Nutrition Examination Survey (2014 and 2016) using the Patient Health Questionnaire-9 depression screening instrument. Among the survey participants, 10 459 were selected for data analysis. Of them, 7.2% had depression, 24.4% had metabolic syndrome, and 10.0% had both depression and metabolic syndrome. Among those with depression, 33.1% were aware of their condition and 25.7% received treatment, with significant differences found between those with and without metabolic syndrome. The mean Patient Health Questionnaire-9 scores significantly increased with the number of metabolic syndrome components ( F = 6.06, P = <.001). In logistic regression analysis, the odds ratio (OR) for depression with metabolic syndrome was 1.41 (95% confidence interval [CI] = 1.12-1.76). For the number of metabolic syndrome components, having 2 (OR = 1.37, 95% CI = 1.01-1.86), 3 (OR = 1.57, 95% CI = 1.12-2.21), 4 (OR = 1.95, 95% CI = 1.32-2.87), and 5 (OR = 2.18, 95% CI = 1.38-3.46) conditions significantly increased the OR for depression. Including depression in the management of metabolic syndrome could help make people with depression more aware of their condition.

Characterization of Patient Interest in Provider-Based Consumer Health Information Technology: Survey Study.

BackgroundConsumer health information technology can improve patient engagement in their health care and assist in navigating the complexities of health care delivery. However, the consumer health information technology offerings of health systems are often driven by provider rather than patient perspectives and inadequately address patient needs, thus limiting their adoption by patients. Consideration given to patients as stakeholders in the development of such technologies may improve adoption, efficacy, and consumer health information technology resource allocation.ObjectiveThe aims of this paper were to measure patient interest in different health system consumer health information technology apps and determine the influence of patient characteristics on consumer health information technology interest.MethodsPatients seen at the Cleveland Clinic Neurological Institute were electronically surveyed on their interest in using different consumer health information technology apps. A self-efficacy scale, Patient Health Questionnaire-9 depression screen, and EuroQol 5 dimensions health-related quality of life scale were also completed by patients. Logistic regression was used to determine the influence of patient characteristics on interest in consumer health information technology in the categories of self-management, education, and communication.ResultsThe majority of 3852 patient respondents had an interest in all technology categories assessed in the survey. The highest interest was in apps that allow patients to ask questions of providers (3476/3852, 90.24%) and to schedule appointments (3211/3839, 83.64%). Patient interest in consumer health information technology was significantly associated with greater depression symptoms, worse quality of life, greater health self-efficacy, and smartphone ownership (P<.001 for all listed).ConclusionsPatients should be viewed as active stakeholders in consumer health information technology development and their perspectives should consistently guide development efforts. Health systems should consider focusing on consumer health information technologies that assist patients in scheduling appointments and asking questions of providers. Patients with depression should also be considered for targeted consumer health information technology implementation. Health self-efficacy is a valid predictor of consumer health information technology interest and may play a role in the utilization of consumer health information technologies. Health systems, broadly, should put forth greater effort to understand the needs and interests of patients in the consumer health information technology development process. Consumer health information technology design and implementation may be improved by understanding which technologies patients want.

Selective Cutoff Reporting in Studies of Diagnostic Test Accuracy: A Comparison of Conventional and Individual-Patient-Data Meta-Analyses of the Patient Health Questionnaire-9 Depression Screening Tool.

In studies of diagnostic test accuracy, authors sometimes report results only for a range of cutoff points around data-driven "optimal" cutoffs. We assessed selective cutoff reporting in studies of the diagnostic accuracy of the Patient Health Questionnaire-9 (PHQ-9) depression screening tool. We compared conventional meta-analysis of published results only with individual-patient-data meta-analysis of results derived from all cutoff points, using data from 13 of 16 studies published during 2004-2009 that were included in a published conventional meta-analysis. For the "standard" PHQ-9 cutoff of 10, accuracy results had been published by 11 of the studies. For all other relevant cutoffs, 3-6 studies published accuracy results. For all cutoffs examined, specificity estimates in conventional and individual-patient-data meta-analyses were within 1% of each other. Sensitivity estimates were similar for the cutoff of 10 but differed by 5%-15% for other cutoffs. In samples where the PHQ-9 was poorly sensitive at the standard cutoff, authors tended to report results for lower cutoffs that yielded optimal results. When the PHQ-9 was highly sensitive, authors more often reported results for higher cutoffs. Consequently, in the conventional meta-analysis, sensitivity increased as cutoff severity increased across part of the cutoff range-an impossibility if all data are analyzed. In sum, selective reporting by primary study authors of only results from cutoffs that perform well in their study can bias accuracy estimates in meta-analyses of published results.

Women Veterans with Depression in Veterans Health Administration Primary Care: An Assessment of Needs and Preferences

ObjectiveDepression is the most prevalent mental health condition in primary care (PC). Yet as the Veterans Health Administration increases resources for PC/mental health integration, including integrated care for women, there is little detailed information about depression care needs, preferences, comorbidity, and access patterns among women veterans with depression followed in PC. MethodsWe sampled patients regularly engaged with Veterans Health Administration PC. We screened 10,929 (10,580 men, 349 women) with the two-item Patient Health Questionnaire. Of the 2,186 patients who screened positive (2,092 men, 94 women), 2,017 men and 93 women completed the full Patient Health Questionnaire-9 depression screening tool. Ultimately, 46 women and 715 men with probable major depression were enrolled and completed a baseline telephone survey. We conducted descriptive statistics to provide information about the depression care experiences of women veterans and to examine potential gender differences at baseline and at seven month follow-up across study variables. ResultsAmong those patients who agreed to screening, 20% of women (70 of 348) had probable major depression, versus only 12% of men (1,243 of 10,505). Of the women, 48% had concurrent probable posttraumatic stress disorder and 65% reported general anxiety. Women were more likely to receive adequate depression care than men (57% vs. 39%, respectively; p < .05); 46% of women and 39% of men reported depression symptom improvement at the 7-month follow-up. Women veterans were less likely than men to prefer care from a PC physician (p < .01) at baseline and were more likely than men to report mental health specialist care (p < .01) in the 6 months before baseline. Conclusion and Implications for PracticePC/mental health integration planners should consider methods for accommodating women veterans unique care needs and preferences for mental health care delivered by health care professionals other than physicians.

Impact of the Breast Cancer Care Measures Pilot Study on Quality-Improvement Initiatives

As a participant in the ONS Foundation-supported Breast Cancer Care Quality Measures Set in 2010, the Edward Cancer Center (ECC) identified gaps in patient assessment. Sleep-wake disturbance and distress were two common areas that were lacking consistent assessment when nurses saw patients during their visits. Another issue is the lack of standard methods of practice or a standardized tool. The ECC, in collaboration with Edward Diabetes Center, Linden Oaks Hospital, and other outpatient offices, adopted the use of the Patient Health Questionnaire-9 depression screening tool. The ECC also modified the intervention recommendations to meet the needs of the oncology population. As a result of the findings in the pilot, the ECC was able to implement an evidence-based practice change to improve the overall quality of patient care and provide earlier intervention in an effort to further improve patient outcomes.

An examination of prenatal and postpartum depressive symptoms among women served by urban community health centers

We characterized depressive symptoms in the prenatal and/or postpartum periods and examined associated risk factors among 594 women who received care at community health care centers. Women were screened with comprehensive risk assessments, which included the Patient Health Questionnaire-9 depression screen, during pregnancy and at least 4weeks after delivery. Fifteen percent had depressive symptoms in the prenatal period only; 6% in the postpartum period only, and 8% had depressive symptoms in both periods. Risk markers varied for women who reported depressive symptoms at one period only compared with those who reported persistent depressive symptoms. Age (25years versus younger), having experienced abuse, not living with the infant's father, and cigarette smoking were associated with depressive symptoms at both periods; being US-born, lacking social support, and experiencing food insecurity were associated with reporting symptoms only in the prenatal period, and lack of phone access was associated with risk only in the postpartum period. Our findings confirm the importance of repeated screenings for depressive symptoms during the perinatal period. The variability in risk markers associated with periods of reported depressive symptoms may reflect their varying associations with persistence, new onset, or recovery from depressive symptoms.

Identifying Depression in an Adolescent Diabetic Patient: A Case Study Depicting the Use of the Patient Health Questionnaire-9 Depression Screen

Identifying Depression in an Adolescent Diabetic Patient: A Case Study Depicting the Use of the Patient Health Questionnaire-9 Depression Screen

“Facebook Depression?” Social Networking Site Use and Depression in Older Adolescents

To evaluate the association between social networking site (SNS) use and depression in older adolescents using an experience sample method (ESM) approach. Older adolescent university students completed an online survey containing the Patient Health Questionnaire-9 depression screen (PHQ) and a week-long ESM data collection period to assess SNS use. Participants (N = 190) included in the study were 58% female and 91% Caucasian. The mean age was 18.9 years (standard deviation = .8). Most used SNSs for either <30 minutes (n = 100, 53%) or between 30 minutes and 2 hours (n = 74, 39%); a minority of participants reported daily use of SNS >2 hours (n = 16, 8%). The mean PHQ score was 5.4 (standard deviation = 4.2). No associations were seen between SNS use and either any depression (p = .519) or moderate to severe depression (p = .470). We did not find evidence supporting a relationship between SNS use and clinical depression. Counseling patients or parents regarding the risk of "Facebook Depression" may be premature.