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1. Depression is
   a debilitating mental illness characterized by a change in mood,
   particularly feelings of sadness, hopelessness, helplessness, and in
   severe cases, thoughts of suicide. Worldwide, depression affects
   approximately 3.8% of the population, with 700,000 deaths by suicide
   (World Health Organization, 2021). In the U.S.A., the number of people
   diagnosed with depression is approximately 21 million; however, the
   number could be higher due to unreported cases of depression.
   Implementing PHQ-9 (Patient Health Questionnaire) – a depression
   screening tool composed of 9 questions – in the primary care setting
   will help detect depression and treat or make referrals to specialty
   providers.  
2. PICOT Question

In
primary care settings is implementation of a depression screening tool,
such as PHQ-9, compared to non-implementation, beneficial in diagnosing
and treating depression in adults over a period of 3 months.

3. Quantitative research studies

• Last,
  B. S., Buttenheim, A. M., Futterer, A. C., Livesey, C., Jaeger,
  J.,      Stewart, R. E., Reilly, M., Press, M. J., Peifer, M., Wolk, C.
  B., & Beidas, R. S. (2021). A pilot study of participatory and rapid
  implementation approaches to increase depression screening in primary
  care. BMC Family Practice, 22, 1–26. https://doi-org.databases.msutexas.edu/10.1186/s12875-021-01550-5

This
research article is a 3-phased study developed by Penn Medicine and
implemented in 90 primary care practices. The phases were as follows
phase I: solicited ideas and barriers for increasing depression
screening; phase II: deliberation over and ranking the ideas; phase III:
pilot the new idea in primary care practice using rapid prototyping for
strategies designs. The patients completed a PHQ-2 form before the
visit, and the clinicians evaluated the results. If PHQ-2 was positive
(>2), the patient was directed to complete PHQ-9 or referred to a
mental health clinician, give a prescription for treatment, or the
clinician completes a depression follow-up plan or documentation of
results. Quantitative outcomes revealed that PHQ-2 rates were similar to
usual care; however, tablets automatically directing to PHQ-9 after a
positive PHQ-2 increased the rates of PHQ-9 screenings. The qualitative
outcomes consist of an increased rate of depression due to automatic
generation of PHQ-9 after a positive PHQ-2 while before required manual
human intervention. The conclusion: implementing PHQ-9 in a primary
setting presents positive results with increased rates of detection of
depression compared to non-using PHQ-9.

• Pfoh,
  E. R., Janmey, I., Anand, A., Martinez, K. A., Katzan, I., &
  Rothberg, M. B. (2020). The Impact of Systematic Depression Screening in
  Primary Care on Depression Identification and Treatment in a Large
  Health Care System: A Cohort Study. JGIM: Journal of General Internal
  Medicine, 35(11), 3141–3147. https://doi-org.databases.msutexas.edu/10.1007/s11606-020-05856-5

This
is a retrospective pre-post study analyzing 259,411 patients in 37
internal and family medicine clinics in Northeast Ohio during May, June,
and July of 2016. The patients included had at least one primary care
visit. Prior to implementation, the screening was at the clinician’s
discretion. The intervention consisted of implementing PHQ-2 prior to
the visit through the patient’s portal. If the PHQ-2 has a score >2,
then the patient would complete the remaining seven questions included
in PHQ-9; if the PHQ-9 score >10 (moderate symptoms of depression),
then the patient will complete PHQ-9 at each sub-visit until score < 5. If PHQ-9 <9, then the patient may complete the assessment annually. The study results revealed that 59% of patients received screening PHQ-2; 3% of them scored moderate-severe depression; the rate of depression increased by 1.2% immediately after the systematic screening. The rate of patients diagnosed with depression who received treatment within 90 days increased from 64% to 69%. Additionally, the adjusted odds of treatment increased by 20% after implementation. The conclusion: implementation of PHQ in a primary setting with future PHQ-9 assessment when required increased the rates of detected depression compared to non-use.

4. Clinical Practice Guideline

     
U.S. Preventive Services Task Force. (2016, January 26). Final
                              Recommendation Statement Depression in
Adults: Screening. U.S. Preventive          Services Task Force; Journal
of the American Medical Association.      

5. Governmental and non-governmental support

Various
governmental and non-governmental are involved in programs meant to
help people experiencing depression, fight the social stigma and offer
the appropriate support. Some of the organizations are:

• Mental Health America https://www.mhanational.org/
• Anxiety and Depression Association of America https://adaa.org/
• 7 Cups of Tea https://www.7cups.com/
• Depression and Bipolar Support Alliance https://www.dbsalliance.org/
• NAMI Connection https://www.nami.org/home
• Postpartum Support International https://www.postpartum.net/
• Substance Abuse and Mental Health Services Administration https://www.samhsa.gov/
• Suicide Prevention Resource Center https://www.sprc.org/
• National Institute of Mental Health https://www.nimh.nih.gov/
• Centers for Disease Control and Prevention https://www.cdc.gov/
• Texas Health and Human Services https://www.hhs.texas.gov/

6. Strategies to narrow down literature

The
search for resources included databases such as CINAHL and MEDLINE
through the Midwestern State University library website. The articles
were selected to be peer-reviewed and published in reliable journals
within the last six years. Additionally, the studies must be primary
research with quantitative data and measurable outcomes. 

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