Posted Apr 17 , 2017 03:34 PM

Implementation of a Depression Screening Protocol and Tools to Improve Screening for Depression in Patients With Diabetes in the Primary Care Setting

Bajracharya P, et al. Journal for Nurse Practitioners 2016;12(10): 690

What were the findings (excerpted from the Abstract)?

The authors incorporated depression screening questionnaires/tools and a screening protocol into primary care practice. The effectiveness of the intervention was evaluated in establishing depression screening practice in the clinic. Implementation of the depression screening questionnaires in patients’ electronic health records along with the depression screening protocol resulted in increased screening. Using this approach led to increased detection of depression risk in adult patients with chronic medical conditions. Both selected depression screening questionnaires, the PHQ-2 and PHQ-9, were incorporated in the patients’ EHRs, and the screening protocol was distributed to providers. Of the 378 patients in the study, nearly 85% were screened with the PHQ-2 questions. Of the 312 patients screened with PHQ-2, a total of 78 (25.6%) were found to be positive for depression. The study findings show that integration of the intake screening questionnaires into the electronic health record makes the screening process easier and more efficient in the primary care setting, and helps identify patients who may need further assistance with depression.

Why is this important?

With the update to the American Diabetes Association Standards of Medical Care in Diabetes ( comes a number of new recommendations updating the standards to address psychosocial issues in all aspects of care including self-management, mental health, communication, complications, comorbidities, and life-stage considerations. Section 3 of the standards contains a number of new recommendations for psychological screening. One important recommendation is:

“Providers should consider annual screening of all patients with diabetes, especially those with a self-reported history of depression, for depressive symptoms with age-appropriate depression screening measures, recognizing that further evaluation will be necessary for individuals who have a positive screen.”

Clearly, inclusion of this new recommendation is recognition that depression is a significant ‘co-morbidity’ that can affect several facets of diabetes care. Incorporation of a brief, validated depression-screening tool in patients’ EHRs significantly improved the depression screening rate at the project site. The providers felt increasingly comfortable with the screening questionnaires. The questionnaires were easy to administer and required a minimal amount of time. Do you routinely screen your patients for depression? With this new Standard, do you intend to?

Read the Abstract: