Improving Depression Screening and Follow-Up for Adolescents

AbstractBackground: Adolescent depression is a major problem in the United States. The incidence of depression in 12 to 17-year-old adolescents is estimated to be 1 in 5. The American Academy of Pediatrics recommends routine screening of depression for the 12 to 21-year-old population. The lack of use of approved screening tools, and lack of follow-up, has been identified as a gap in care which could improve the detection of depression in adolescents. Methods: This quality improvement (QI) project was developed to increase screening, recognition, and follow-up for adolescents with depression in a suburban pediatric clinic. A chart review was conducted to assess the number screened for depression during their annual well-child visit. Screening was performed using the validated patient health questionnaire for adolescents (PHQ-A). If the screening resulted in moderate to severe depression follow-up was carried out by clinic staff. With the use of the Plan-Do-Study-Act framework, a plan was developed to improve the use of the PHQ-A questionnaire. The plan was created and implemented to improve depression detection and follow-up. After project execution, a retrospective chart review was conducted to measure improvement. Results: Over the course of this QI project, 503 charts were reviewed of 11 to 17-year-old patients presenting for well-child visits. Post-intervention questionnaires delivered improved from 83% (n=219) to 95.6% (n=239). The total number that scored 10 or more on the PHQ-A, indicating moderate to severe depression, was 15.5% (n=78). Follow-up rates increased from 20% (n=6) to 62% (n=30). Conclusion: Implementation of the validated PHQ-A depression questionnaire, using a QI project, appears to improve depression screening, and follow-up rates. Measuring the improvement of PHQ-A results after the intervention, and determining clinical significance, should be considered for future projects.