Evaluation of a Depression Screening Initiative in a Rural Virginia School System

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PROBLEM STATEMENT: An estimated 3.1 million adolescents in the United States experience depression episode each year. Adolescents experiencing depression are prone to poor academic performance, impaired social functioning, increased incidence of substance abuse, and increased risk for suicide. Primary care providers often do not conduct depression screenings during healthcare visits for various reasons. Southwest Virginia school system does not have a depression screening protocol making depression symptoms often unidentified. SUMMARY OF EVIDENCE: Depression screenings should be conducted during well child exams. Missed screenings place adolescents at risk for poor healthcare outcomes. DESCRIPTION OF PRACTICE OR PROTOCOL: The pediatric nurse practitioner health services coordinator for southwest Virginia schools conducts well-child exams for adolescents. Depression screening was an area for practice improvement. VALIDATION OF EVIDENCE: The Patient Health Questionnaire (PHQ)-2 was administered during the health service coordinators’ well child visit and aggregate data was collected on a handwritten form relaying the PHQ-2 score, PHQ 9 score, and referral to parent. RELEVANCE OF PMH NURSING: All students receiving a well child visit over 8 weeks were screened for depression (n=44). There were 16 (35.5%) of students who screened positive on the PHQ-2 and were administered the PHQ-9. There were 13 (81.3%) (n=16) students who were administered the PHQ-9 and scored greater than 4. The number of referrals to parents generated were 10 (76.9%) (n=13). FUTURE IMPLICATIONS: Southwest Virginia schools need a policy and procedure describing the administration of the PHQ-2 and PHQ-9 screening instrument.


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