Date of Completion

Spring 4-21-2024

Document Type

Open Access Capstone

Degree Name

Doctor of Nursing Practice (DNP)

Faculty Advisor

Eileen Stuart-Shor, PhD, ANP-BC, FAHA, FAAN

Site Advisor

Cathleen Goebel, MSN, RN

Second Reader

Julia McDougal-Ronconi, DNP, APRN, PMHNP-BC



BACKGROUND: Depression in adults is a leading cause of disability, morbidity and mortality worldwide with an estimated prevalence of 20% in the US population. Despite estimates that one out of every five Americans suffers from depression, less than 50% of adult primary care patients with depression are identified, and less than 5% of all adult primary care patients are screened. To increase early detection and management of depression, the United States Protective Service Task Force (USPSTF) recommends routine depression screening for adults older than 18 years in primary care settings.

LOCAL PROBLEM: This project site was a rural, free, primary care clinic in New England serving uninsured and under-insured adults. Research indicates there is an increased incidence of depression in at risk populations, including this disadvantaged population. The clinic provides medical care delivered by licensed volunteer clinicians and limited counseling services through a community grant. However, there was no routine adult depression screening in place at the clinic.

METHODS: This quality improvement (QI) project implemented universal depression screening in a two-tiered approach using the validated PHQ2 and PHQ-9 depression screening tools. Quantitative methods were utilized to organize and describe the data. Qualitative methods including a post-implementation survey and interviews were used to evaluate the staffs’ improvement in knowledge and satisfaction with the intervention.

RESULTS: Participants (n-119) comprised a group of adult primary care patients in rural Maine that reflected the regional demographics. A total of 101 participants were screened for a total of 85% over a 9-week period utilizing a universal depression screening tool administered by clinic staff. There was a positivity rate of 3% on the PHQ-2 and a completion rate of 100% on the PHQ-9. 100% of patients with a PHQ-9 positive score of 10 or greater were referred for follow-up mental health services.

CONCLUSIONS: This QI project demonstrated that it is possible to introduce universal adult depression screening in a “free” rural primary care medical clinic with existing resources that was not time prohibitive. The successful project implementation by staff during patient rooming while obtaining vital signs revealed it was both efficient and effective to provide routine screening. This intervention did not pose an extra burden to clinic staff and reinforced the importance of a more integrated clinical approach to mental health screening during primary care medical visits. Utilizing a depression screening protocol demonstrated an increase in depression screening documentation, staff satisfaction, and patient referrals to mental health specialists.

Community Engaged/Serving

Part of the UMass Boston Community-Engaged Teaching, Research, and Service Series. //