Graduation Semester and Year
Fall 2025
Language
English
Document Type
DNP Project
Degree Name
Doctor of Nursing Practice
Department
Nursing
First Advisor
Dr. Kim Siniscalchi, DNP, RN, FNAP, FAAN
Second Advisor
Dr. Yungfei Kao, PHD
Abstract
Depression affects 21 million American adults (8.4%), yet only 28% receive appropriate screening. In Texas, where 20.8% of adults experience depression, systematic screening remains inconsistent. This quality improvement project addressed a critical gap at an outpatient mental health clinic in the Dallas-Fort Worth metroplex, where Patient Health Questionnaire-9 (PHQ-9) screening occurred in only 40% of psychiatric evaluations, resulting in missed diagnoses and inconsistent treatment. Using the Plan-Do-Study-Act framework, the project implemented a comprehensive PHQ-9 screening bundle consisting of staff training, electronic health record integration, and a treatment algorithm based on severity thresholds. The intervention targeted adults, aged 18-65, scheduled for initial or follow-up psychiatric evaluations. Pre- and post-intervention data were collected from 50 patients in each phase over eight weeks. Implementation was associated with a 50% increase in screening completion rates, from 40% to 90% (p < 0.001, Cohen's d = 1.25). Provider screening compliance (combining documentation, algorithm application, and treatment modification) similarly improved from 40% to 90% (all p < 0.001, d = 1.25). Post-implementation screening identified 30% of patients requiring immediate intervention, including 20% with severe depression. Follow-up planning declined modestly from 100% to 90% (p = 0.023), indicating a need for workflow refinement. Results suggest that systematic PHQ-9 screening can be feasibly integrated into clinic settings through structured process during initial implementation periods. The large effect sizes suggest this model may be replicable across similar settings, though longer-term research is needed to assess sustainability and patient health outcomes.
Keywords
depression screening, PHQ-9, mental health, quality improvement, outpatient care, PDSA, nursing practice.
Disciplines
Psychiatric and Mental Health Nursing
License
This work is licensed under a Creative Commons Attribution 4.0 International License.
Recommended Citation
Djoumessi, Olivier Bertrand, "Implementing a Routine Patient Health Questionnaire-9 (PHQ-9) Screening Bundle for Adults (18-65 years) Scheduled for a Psychiatric Evaluation" (2025). Doctor of Nursing Practice (DNP) Scholarly Projects. 114.
https://mavmatrix.uta.edu/nursing_dnpprojects/114