Screening for Adolescent Depression in a Rural Primary Care Clinic

In the United States, 11.4% of adolescents between the ages of 12-17 are diagnosed with depression each year (Leslie & Chike-Harris, 2017). Unfortunately, research shows that as many as two in three youth with depression are not identified by their primary care providers and fail to receive any kind of treatment (Zuckerbrot, Cheung, Jensen, Stein, & Laraque, 2018). The burden of depression is high during adolescence, including high rates of recurrence and elevated risk of suicide (Forman-Hoffman & Viswanathan, 2018). According to the CDC, from 2014-2016, North Dakota had a significant overall suicide rate increase of 57% throughout the state. Death rates from suicide were higher in rural areas than in urban areas during this time. As of 2016, the United States Preventative Service Task Force recommends routinely screening all adolescents, age 12-18, for depressive disorder. The purpose of this project was to increase the rates of adolescent depression screening, detection, and intervention by rural primary care providers. Providers at the Washburn and Underwood, ND clinics participated in the project, routinely utilizing the Patient Health Questionnaire-9 modified for Adolescents (PHQ-A) screening tool and Guidelines for Adolescent Depression in Primary Care (GLAD-PC) to assist in detecting and managing depression in adolescents aged 12-18. The project included a co-investigator led educational session in which the PHQ-A screening tool and the GLAD-PC recommendations were introduced. Screening tool and guideline implementation occurred over the following six months. Lastly, a post-implementation provider survey was conducted to further assess provider confidence and likelihood of continued use of the PHQ-A and GLAD-PC as well as any barriers encountered during the implementation period. All of the project objectives were achieved. Rates of screening for depression in adolescents aged 12-18, using the PHQ-A screening tool, increased from 0% in the 6 months preceding the implementation period to 94% during the implementation period. Results of the post-implementation provider survey indicated increased provider confidence using the PHQ-A and GLAD-PC as well as high likelihood of continued use following the project