According to the World Health Organization, depression affects about 350 million people worldwide. In 2014, only 50% of the adult patients were screened for depression in the community-based Federally Qualified Healthcare Center (FQHC) for which this doctorate of nursing practice (DNP) project was developed. In an effort to meet the 100% benchmark set nationally for the screening of adult patients in the primary care settings, the FQHC's quality improvement team now requires that 80% of adult patients in the clinic be screened for depression. Framed within the Iowa model of evidence-based practice, the purposes of this project were to: (a) identify an evidence-based protocol and clinical guidelines to direct the use of the Patient Health Questionnaires (PHQ)-2 and PHQ-9 depression screening tools currently available for staff, and (b) develop an educational curriculum for the staff about depression, the use of the protocol, and clinical guidelines for the tools. Two DNP educators served as content experts to evaluate the curriculum plan using a dichotomous nine-item format that revealed that the content met the objectives of the curriculum. The experts also conducted content validation of each of the 15-pretest/posttest items using a Likert scale ranging from 1(not relevant) to 4 (highly relevant). A content validation index of 1.00 showed that the experts strongly agreed that the items reflected the content of the curriculum. Recommendations were made for item construction of the pretest/posttest. The project speaks to social change through promotion of the PHQ-2 and PHQ-9 depression screening tools to facilitate appropriate diagnosis and treatment, thus promoting the health of clients, families, and the community.

Objectives: Identifying reliable, practical and easy to use tools to assess depression in patients with traumatic brain injury (TBI), is a necessary first step to addressing a high incidence problem. The intention of this study is to validate depression screening measures with a criterion-based structured interview among people with TBI. The final outcome will identify which measure is the best indicator of depression diagnosis in this population. Methods: 112 participants with TBI were administered the Beck Depression Inventory (BDI), Neurobehavioral Functioning Inventory (NFI), The Hamilton Rating Scale for Depression (Ham-D), and the Structured Clinical Interview for DSM-IV TR Axis I Disorders (SCID) in an outpatient neuropsychology clinic at a university medical center, outpatient physical medicine and rehabilitation clinics, and a long-term specialized living assistance program. Screening measure results were compared with SCID results to determine sensitivity, specificity, positive predictive value and negative predictive value of each screening measure.Results: The prevalence of depression as measured by the SCID was 3 1.53%. Depression was more likely among those who were unemployed, within 12 months of their injury, experienced a length of coma between 1-6 days following injury, and had an acute care stay between 2-6 days. The BDI showed sensitivity of 86% and specificity of 79%. Calculated sensitivity and specificity for the NFI was 62% and 92%, respectively. Based on specificity and sensitivity, the Ham-D missed the most cases in this sample, showing 46% sensitivity. However, the specificity for the Ham-D was highest of the three at 99%. The BDI had a positive predictive value (PPV) of 65%, highlighting the fact that 16 of the cases that the BDI identified as depressed were not actually depressed according to the SCID. The negative predictive value (NPV) for the BDI was 92%. The Ham-D showed the highest PPV at 94%, indicating that of those that tested positive on the Ham-D, 94% were rated as depressed on the SCID. NPV for the Ham-D was 80%. The NFI showed a PPV of 78% and NPV of 84%.Conclusions: Sensitivity was considered the most important aspect to evaluate, due to the need to minimize the number of cases of depression missed. From the results of the sensitivity and specificity calculations, the BDI appears to be the most appropriate screening measure for identifying cases needing further clinical evaluation.

Abstract The prevalence of diabetes in the United States in 2015 was 30.3 million people; which is the equivalent of 9.4% of the population. It is a major contributor to morbidity and mortality. Depression is often underdiagnosed in these patients, which contributes to poor self-management and poor health outcomes. In a large primary-care practice on the East Coast, there is no guideline for depression screening in the diabetic population. Focusing on this specific primary care setting, the research question addressed the underdiagnoses of depression in diabetic patients. The project evaluated the prevalence of depression among patients diagnosed with diabetes by using the U.S. Preventative Services Task Force (USPSTF) depression screening tool called the Patient Depression Questionnaire. The Grove Model for Implementing Evidence-Based Guidelines in Practice Framework was used in systematically integrating the new practice guideline of screening all diabetes patients for depression. The framework involves identifying the practice problem, locating, and collecting the most well-founded evidence, and evaluating the quality of the evidence-based guideline of screening all diabetes patients for depression. To answer the project question, 135 diabetic patients in a primary care outpatient setting completed the Patient Depression Questionnaire. Descriptive statistics was used to describe the sample and determine the frequency of scores throughout the sample of patients. Ranges of scores and percentages were computed using frequency distribution. Of these 135 diabetic patients, 63.7% showed some level of depression ranging from mild to severe, which was undiagnosed prior to the administration of the screening tool. As a result of the project, recommendations were made to the site to implement the use of the depression screening tool as policy.

Objectives: The primary objective of this research was to inform the criterion validity of the single self-report depression screening question in the interRAI-Contact Assessment (CA) against the validated Depression Rating Scale (DRS) in the RAI-Home Care (HC) instrument. To achieve this objective, two overarching research questions were addressed: 1) What is the DRS cut-point best suited for the detection of a possible depressed mood state?; and 2) What are the consistencies in the prevalence rates of the CA’s single self-report depression question and the HC’s DRS detection measure? A secondary objective of this research was to explore the relationships of multiple depression-related outcomes with selected possible predictor variables to indirectly aid in the identification of a possible depressed mood state. Methods: Four datasets were obtained from the interRAI organization to inform this research. Three datasets, which house and concurrently administer both the self-report item and the DRS, were used to determine the best-suited DRS detection threshold through both univariate and bivariate analyses. The validity of the CA’s self-report item was informed through bivariate analyses with the HC’s DRS measure using the phi-correlation and the c statistic from the bivariate logistic regression model. Spearman and point biserial correlations and bivariate logistic regression modeling informed the relationships of the possible predictor variables with the depression-related outcomes. Results: The DRS one-plus threshold was determined to be the cut-point best-suited for the detection of a possible depressed mood state. Several predictor variables proved statistically significant but were not consistent across the three datasets. The CA’s single question did not evidence a strong association with the HC’s DRS measure. Conclusions: According to the resulting significance of the predictor variables, the experience and expression of depression across the three explored samples differ; the results from one sample cannot be generalized to explain the experience of the other samples. The DRS one-plus threshold is supported for the detection of a possible depressed mood state. However, the validity of the single self-report question in comparison to the DRS measure cannot be supported with the study’s results. However, due to recognized study limitations, the overall validity of the measure is not conclusive. Future research directions are recommended.

Objectives: The primary objective of this research was to inform the criterion validity of the single self-report depression screening question in the interRAI-Contact Assessment (CA) against the validated Depression Rating Scale (DRS) in the RAI-Home Care (HC) instrument. To achieve this objective, two overarching research questions were addressed: 1) What is the DRS cut-point best suited for the detection of a possible depressed mood state?; and 2) What are the consistencies in the prevalence rates of the CA’s single self-report depression question and the HC’s DRS detection measure? A secondary objective of this research was to explore the relationships of multiple depression-related outcomes with selected possible predictor variables to indirectly aid in the identification of a possible depressed mood state. Methods: Four datasets were obtained from the interRAI organization to inform this research. Three datasets, which house and concurrently administer both the self-report item and the DRS, were used to determine the best-suited DRS detection threshold through both univariate and bivariate analyses. The validity of the CA’s self-report item was informed through bivariate analyses with the HC’s DRS measure using the phi-correlation and the c statistic from the bivariate logistic regression model. Spearman and point biserial correlations and bivariate logistic regression modeling informed the relationships of the possible predictor variables with the depression-related outcomes. Results: The DRS one-plus threshold was determined to be the cut-point best-suited for the detection of a possible depressed mood state. Several predictor variables proved statistically significant but were not consistent across the three datasets. The CA’s single question did not evidence a strong association with the HC’s DRS measure. Conclusions: According to the resulting significance of the predictor variables, the experience and expression of depression across the three explored samples differ; the results from one sample cannot be generalized to explain the experience of the other samples. The DRS one-plus threshold is supported for the detection of a possible depressed mood state. However, the validity of the single self-report question in comparison to the DRS measure cannot be supported with the study’s results. However, due to recognized study limitations, the overall validity of the measure is not conclusive. Future research directions are recommended.

Postpartum depression is an illness that is frequently unreported and undetected for a variety of reasons and may be potentially devastating for the mother affected as well as her family. Routine screening of postpartum women enables health practitioners to detect symptoms of PPD early and provides an opportunity for early intervention which may improve the outcome and increase the mother’s chances of an earlier recovery. It is therefore important that reliable and convenient screening tools are available to health practitioners who have contact with postpartum women. The primary objective of this research was to make an Afrikaans version of an existing screening scale available – the Postpartum Depression Screening Scale (PDSS), designed specifically to encompass the multifaceted phenomenon of PPD. In accordance with this objective, the validity and reliability of the PDSS and its Afrikaans version was investigated in English- and Afrikaans-speaking South African mothers. A further objective of this study was to compare the performance of the PDSS with the Edinburgh Postnatal Depression Scale (EPDS) and the Quick Inventory of Depressive Symptomatology (QIDS-SR16). Various factors have been reported to be associated with the development of PPD. The final objective of this study was to explore the relationship between known risk factors for PPD and high scores on the PDSS amongst women in South African. A total of 365 South African mothers, between 4 and 16 weeks postpartum participated in this study. English-speaking mothers (n = 187) completed the PDSS, EPDS, QIDS, and a demographic and psychosocial questionnaire, while Afrikaans speaking mothers (n = 178) completed the respective Afrikaans versions of these questionnaires. A multiple translation method – Brislin’s back-translation method and the committee approach – was used to translate the PDSS and the QIDS into Afrikaans. An item response theory (IRT), Rasch analysis, was used to examine dimensionality, item difficulty, differential item functioning, and category functioning of the PDSS and the Afrikaans PDSS. Results reveal excellent person reliability estimates for the Afrikaans PDSS as well as for the PDSS in a South African sample. Both language versions performed reasonably well and the majority of items in the PDSS dimensions and the Afrikaans PDSS dimensions demonstrated fit statistics that supported the underlying constructs of each dimension. Some items were identified as problematic, namely Item 2, Item 25, Item 28, and Item 30. The item person construct maps show reasonably good spread of items. There were, however, persons that scored higher than the items could measure and an overrepresentation of items at the mean level. The Likert response categories proved to be effective for all the Afrikaans PDSS items and almost all the PDSS items. Results indicate that 49.7% of mothers screened positive for major PPD using the PDSS. A further 17.3% of mothers obtained scores indicating the presence of significant symptoms of PPD. Statistically significant correlations were obtained between total scores on the PDSS, the EPDS, and the QIDS-SR16. Stepwise multiple regression analysis identified 11 variables that were significantly associated with a high PDSS total score. These were a history of psychiatric illness, postpartum blues, feeling negative or ambivalent about expecting this baby, fearful of childbirth, infant temperament, antenatal depression in recent pregnancy, lack of support from the baby’s father, concern about health related issues regarding the infant, lack of support from friends, difficulty conceiving, and life stress. / Thesis (PhD)--University of Pretoria, 2012. / Psychology / unrestricted

The diploma thesis deals with problems of depression in older people. Mainly the work is focused on identifying and analyzing the role of nurses in screening for depression in older people in primary care, acute care, long-term care and home care. This thesis was focused on theoretical direction and was used the method of design and demonstration. In this thesis was set one main goals with five research questions. The main goal was to identify and analyze the role of nurses in screening for depression in the elderly. RQ 1: What is the role of the nurse in screening for depression in the elderly? RQ 2: What is the role of the nurse in the primary care in screening for depression in the elderly? RQ 3: What is the role of the nurse in screening for depression in hospitalized patients in acute care? RQ 4: What is the role of the nurse in screening for depression in seniors in long-term and home care? RQ 5: What rating scales and methods are used in screening for depression in the elderly? The thesis introduce the concept of depression. The following are specified the causes of and the important factors that affect depression in the elderly. It also deals the differences in the clinical symptomatology of depression in old age. It explains possibilities and various barriers in the diagnosis of depression. Another chapter introduces complete geriatric examination, diagnostic classification systems, possible screening methods and scales for detection of depression in the elderly population. It also deals methods of pharmacological and non-pharmacological treatment and its possible complications associated with older age. By reason of increased suicide rate caused by depressive disorder the issue of suicidal behavior in the elderly is introduced. The next chapter deals with the nursing process, which is used by nurses in practice. It consists of the evaluation of the patient's health condition, making nursing diagnosis, creating nursing plan and subsequent implementation and evaluation. The nursing process is also needy for providing quality care. The nursing process in the stage of nursing diagnosis, introduces possible nursing diagnosis for a patient suffering from depression, which are based on the latest classification. Finally is described the role of nurses in screening for depression in the elderly in different health facilities and their contribution to the timely evaluation of depression in the elderly. This chapter introduces the role of nurses, nursing screening and collaboration with a physician. The role of nurses in screening for depression in different medical facilities is based on the first phase of the nursing process of assessment. On the basis of objective and subjective information, the nurse will assess the overall health and mental condition of the patient. Primarily, it was investigated what is the role of the nurse in screening for depression. On the basis of content analysis and synthesis it was necessary to used and processed domestic and foreign literature. A number of relevant sources are the results of various studies and Meta-analyzes, mostly from abroad, but also from the Czech Republic. The thesis can serve as a basis for nurses. The result of this thesis is to create e-learning material available for students in the Faculty of Health and Social Sciences of South Bohemia in Ceske Budejovice in the tutorial called Moodle.