Refining contextual inquiry to maximize generalizability and accelerate the implementation process

Abstract

Purpose: Implementation of routine Patient Health Questionnaires (PHQ-9) screening among adolescents aged 12–18 year, accessing school-based pediatric primary care clinic services for identification of adolescents at potential risk for Major Depressive disorder (MDD). Design and Methods: Retrospective chart review (N = 256 cases) documented PHQ-9 depression screening outcomes among adolescents accessing school-based pediatric primary care clinic services for episodic illness and wellness visits. Data analyses included descriptive statistical methods. Results: Chart review included 137 (53.5%) females and 119 (46.5%) males. PHQ-9 depression screening was identified for 56.3% (n = 144) of charts with scores ≥ 10 for 12.5% (n = 18) among those screened. Mental health referrals were made for 83.3% (n = 15) with PHQ-9 scores ≥ 10. Dysthymia related concerns were reported among 20.1% (n = 29) of which 55.2% (n = 16) received mental health referrals. Female adolescents reported more sleep problems (χ2 = 9.174, p = 0.002) and tiredness (χ2 = 6.165, p = 0.013) than males. The 15–18 year age group (χ2 = 5.443, p = 0.020) was more likely to experience sleep problem and low self-esteem than 12–14 year age group (χ2 = 5.143, p = 0.023). Conclusion: Implementation of PHQ-9 depression screening protocol identified MDD among adolescent accessing pediatric school-based primary care clinic services facilitating referrals to mental health providers, potentially improving morbidity and mortality among adolescents. Practice Implications: MDD is common among adolescents and associated with functional impairments and increased morbidity and mortality. Due to its high prevalence, it is imperative to improve screening and treatment access in this population via school-based clinics.