Document Type
Final Project
Graduation Date
Spring 5-10-2025
Degree Name
Doctor of Nursing Practice
First Advisor
Nick Guenzel, PhD, APRN-NP
Abstract
Background: Throughout the United States, mental health concerns have been steadily increasing, which has created a significant impact for caregivers, overburdened healthcare facilities, and patients. In fact, a large number of those experiencing mental health issues are unidentified and thus more likely to experience mental health crises, suicidal ideation, or suicide attempts. Rural adolescents are significantly more vulnerable than their urban counterparts related to disparities in both mental health services and preventative screening. Coordination with a critical access hospital (CAH) emergency department revealed that there was no universal adolescent depression screening in place, and patients were potentially going undiagnosed and untreated.
Objectives: Objectives of this quality improvement project included increasing staff knowledge and competence with administration of the PHQ-2/PHQ-9 through an educational in-service, providing universal adolescent depression screening in a CAH ED through administration of the PHQ-2/PHQ-9 to all presenting patients ages 12-18, and using depression screening results to increase the provision of mental health referrals in this setting.
Methods: This quality improvement project was a prospective cohort study design, which was initiated by a rural CAH in the ED setting. Retrospective chart review pre- and post- project implementation involving three months prior to implementation and three months after implementation was conducted. Additionally, staff education related to depression screening was provided prior to project implementation and its effectiveness was measured through pre- and post- test result comparisons. Universal depression screening using PHQ-2/PHQ-9 tools was then completed on patients presenting to the CAH who were within the designated 12-18 year old age range.
Results: There were 24 staff members that completed the educational training along with pre- and post- tests. Pre-test scores demonstrated a mean of 71.92 (SD=10.50), and post-test scores had an increased mean of 82.88 (SD=4.76). A paired t-test showed that the mean difference between pre- and post- test scores was -10.96 (CI: -15.22 to -6.70) with a significant t-value of -5.319 (p
Conclusion: Universal adolescent depression screening has the potential to increase identification and treatment rates as well as providing the opportunity for mental health referrals. Early intervention has been shown to prevent financially and emotionally costly mental health crises, and universal screening can aid in the identification that leads to early intervention. Although this study was limited by small sample sizes, staff knowledge and adolescent screening rates increased after education and project implementation. This demonstrated that further studies with larger sample sizes and more diverse settings are needed to demonstrate full practice implications.
Recommended Citation
Cooper, Cherry and Powell, Juan Zhou, "Universal Adolescent Depression Screening and Implications for Identification of Adolescent Depression and Mental Health Referrals" (2025). Doctor of Nursing Practice Projects: College of Nursing. 44.
https://digitalcommons.unmc.edu/con_dnp/44
Included in
Child Psychology Commons, Psychiatric and Mental Health Commons, Psychiatric and Mental Health Nursing Commons
