Graduation Semester and Year




Document Type


Degree Name

Doctor of Philosophy in Nursing



First Advisor

Jennifer R Gray


Depression is a common mental health concern for adolescents that , if not treated, may lead have lifelong consequences. Yet, many in this population are not diagnosed and thus remain untreated. Advanced practice nurse practitioners, in their places of employment, have opportunities to interact with adolescents. They are skilled and trained in health promotion and disease prevention practices. No studies were found that examined screening practices for adolescent depression of nurse practitioners, factors affecting their screening practices, and their management of adolescents whom they determine are depressed. The purpose of this study was 1) to describe the background factors of age and years in practice, attitudes, behavioral beliefs, normative beliefs and control factors that lead to the behavior of screening adolescents for depression by family and pediatric nurse practitioners, and 2) to correlate these constructs with one another and the behavior of adolescent screening and 3) to describe the screening instruments they use and what they do with positive depression screening. This study was guided by the constructs of the Theory of Reasoned Actions. The study participants were pediatric and family nurse practitioners (n=166) who practice in the state of Texas. The nurse practitioners ranged in age from 27 to 68 years of age (M = 45.8, SD=10.9). Length of time in practice as nurse practitioners ranged from 3 months to 33 years (M=9.5, SD=7.7). The method was a researcher created survey that was administered on- line through SurveyMonkey. A 2.4% response rate was obtained. The nurse practitioners were practicing across the state of Texas in 75 different counties in both urban and rural areas of the state. All geographic regions of the state of Texas were represented. Results showed that the majority of family and pediatric nurse practitioners screen for depression, but fail to screen at every type of visit they have with adolescents. Only during 48% of their contacts with adolescents were they screening for depression, indicating that perhaps they are missing some opportunities to screen adolescents for depression. The conclusions of this study supported the Theory of Reasoned Action. The constructs of the study were moderately to strongly associated with the behavior of screening, and mildly to strongly correlated with one another. Possible barriers to screening included lack of training in screening and adolescent depression issues, insurances that do not reimburse for screening adolescents, and feeling incompetent to screen adolescents for depression Participants most often selected the Home, Education, Environment, Activities, Diet, Drug Use, Depression, and Sexuality, Spirituality and Safety (HEADDSS) to guide their screening of adolescents for depression. Though not a specific screening instrument, the HEADDSS mnemonic is a broad psychosocial inventory often used to helped guide the clinician interview of adolescents. The Patient Health Questionnaire-9 (PHQ-9) and the Beck Depression Inventory (BDI) were the most frequently selected screening instruments chosen. Many reported they also use a subjective, likert scale assessment, known as Subjective Units of Distress (SUD), that can be compared from visit to visit to monitor patient progress. The majority of these nurse practitioners do not prescribe antidepressants, but most of them refer adolescents for psychotherapy and specialty psychiatric care providers when a positive depression screen is found. This study was limited by the small sample size and the homogeneity of the population. The survey was created by the researcher and had a high content validity index but low internal consistency reliability alpha on each of the subscales. This study is the first to look at depression screening practices of nurse practitioners and a replication is recommended following further development and improved psychometric characteristics of the instrument.


Medicine and Health Sciences | Nursing


Degree granted by The University of Texas at Arlington

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Nursing Commons