Routine Depression Screening Increases Identification, Diagnosis, and Management: Part 1

Though mental illness rates are on the rise in the United States, lack of screening for and under-diagnosing of depression and major depressive disorder remains a significant challenge in mental health care.

Psych Congress Network connected with Susan Montgomery, DNP, FNP-BC, assistant professor, University of South Alabama, Mobile, and Lauren Sharp, FNP, NextCare Urgent Care, to dive more deeply into their study “Improving Screening for Major Depressive Disorder” published this year in the Journal of the American Association of Nurse Practitioners.

In Part 1 of this video Q&A, Dr Montgomery and Nurse Sharp explain their project design for researching the rate at which patients are being screened for depression and MDD, and provide an overview of their major findings.

Part 2 coming soon! In the meantime, visit our Major Depressive Disorder Excellence Forum for more expert insights for your practice.

Read the Transcript

Susan Montgomery, DNP, FNP-BC: Hello. I'm Dr. Susan Montgomery. I'm a family nurse practitioner and also an educator. I'm an assistant professor at the University of South Alabama in Mobile, Alabama.

Lauren Sharp, FNP: Hello. I am Lauren Sharp and I'm a family nurse practitioner and staff provider at NextCare Urgent Care in Dumfries, Virginia.

Question Card: What inspired you and your colleagues to research the rate at which patients were being screened for depression and major depressive disorder using a validated, reliable tool? What were the project goals?

Nurse Sharp: Depression is such a pervasive issue. The individual and societal burden of depression is huge. And even though we have tools to be able to screen for it, many clinics aren't utilizing those tools. We were inspired to implement this project in order to see firsthand what a difference depression screening would make in this clinic. Our goal, of course, was to improve depression screening and management in our clinic.

Question Card: Can you briefly describe the project methods and setting?

Dr Montgomery:  The project setting is a suburban primary care clinic. The methods were the project participants were chosen by a convenience sample of the adult patients at the clinic during the days of the project implementation. Those patients were given a depression screening and management protocol based on the USPS guidelines.

Question Card: What were the main outcomes of the study and were any of them particularly surprising?

Nurse Sharp: We had several main outcomes. One main outcome was that the number of patients screened for depression was significantly increased after implementing the project. We were able to increase the percent of patients screen from 0% before implementation to 94% of patients after implementation. Another outcome was that the number of patients diagnosed with depression was significantly increased. Before we implemented the project, only 1% of patients seen in the clinic were newly diagnosed with depression. After implementation, almost 6% of patients were newly diagnosed with depression. One surprising outcome was that of the patients newly diagnosed with depression, we didn't significantly increase the number of those patients who were treated with medication or therapy.

In fact, a greater percent[age] of pre-implementation patients with newly diagnosed depression were either started on an antidepressant or referred to therapy than the post-implementation patients with newly diagnosed depression. Everyone diagnosed with depression was offered treatment, but using shared decision-making, many patients decided against receiving medication or therapy referral. We think the surprising finding was likely because before we implemented our project, only the more severely depressed patients were being diagnosed with depression. Patients who self-reported depression are likely more interested in treatment. Once we started screening all patients for depression, we started identifying even patients with mild depression who might not have been as willing to seek treatment or more willing to monitor their symptoms first before starting medications or therapies.

Question Card: Routine depression screening at the primary care clinic increased the identification, diagnosis, and management of depression. How was this sustained after the project’s completion?

Dr Montgomery:  Sustainability will be maintained by continuing to screen those patients using the validated and reliable tool. Management protocol has been developed for this clinic to continue using or our future patients.

Susan L. Montgomery, DNP, FNP-BC, is an associate professor in Community/Mental Health MSN and DNP FNP programs at the University of South Alabama. She is an experienced FNP with varied experiences including teaching and practicing. 

Lauren Sharp, MS, FNP, DNP, is a family nurse practitioner at NextCare Urgent Care.