Objectives Upon completion of this presentation, participants will be - PDF document

APNA 29th Annual Conference Session 2036.1: October 29, 2015 Screening for Depression at a Nurse ‐ Managed Diabetic Community Health Center: A Retrospective Study Beth King, PhD, RN, PMHCNS ‐ BC Eugenia Millender, PhD, RN, MSN, PMHFNP, CDE David Newman, PhD, MA, MS The speaker has no conflicts of interest to disclose. Objectives Upon completion of this presentation, participants will be able to: 1. Discuss the value of depression screening in nursing and community health centers. 2. Describe the relationship between the Patient Health Questionnaire (PHQ ‐ 9) and selected demographic and bio ‐ marker variables. 3. Explain the use of theoretical frameworks to develop culturally sensitive interventions. Background & Significance of Study  Depression is recognized as a critical disorder in the United States, impacting the lives, productivity and mortality rates of those suffering from the disease (CDC, 2013).  In 2002, the U.S. Preventative Services Task Force (USPSTF) recommended screening of adults for depression occur when staff ‐ assisted depression care supports are in place to assure accurate diagnosis, effective treatment, & follow ‐ up (USPSTF, 2009/2015).  Approximately 15.7 million or 6.7percent of adults aged 18 or older in the U.S. have experienced at least one major depressive episode in the past year (National Institute of Mental Health [NIMH], 2013).  Yet, routine depression screening remains largely unexamined. King 1

APNA 29th Annual Conference Session 2036.1: October 29, 2015 Purpose of the Study  Understand the value of screening for depression in community health clinic populations  Investigate the relationship between the Patient Health Questionnaire (PHQ ‐ 9), a self ‐ reporting instrument measuring the severity of symptoms for depression and selected demographic and bio ‐ markers variables  To provide information for development of interventions to meet the mental health needs of culturally diverse, underserved community populations Description of Study  Design: Descriptive correlational design; a retrospective chart review.  Setting : A nurse-managed community health center serving an underserved, diverse population with diabetes in south Florida.  Sample: 265 health care records of adults, 18-85 years of age  Instrument: Patient Health Questionnaire (PHQ-9), a 9-item self- reporting instrument measuring the severity of symptoms of depression over a period of time; based on the DSM-IV criteria for major depression. Internal reliability Cronbach’s alpha range: 0.86-0.89 (Spitzer, Kroneke, & Williams, 2001)  Data Analysis: Descriptive (central tendency & variability) and correlational statistics (Pearson r & ANOVA) of sample and PHQ-9 scores. Theoretical Framework  Guide the development of culturally sensitive nursing interventions.  Leininger’s Theory of Cultural Care Diversity and Universality Theory  Core values and beliefs, Social Structure Factors, Professional and Generic Care  Sunrise Enabler Model  Leventhal’s Self ‐ Regulation Theory  Mental representation of depression  Coping strategies King 2

APNA 29th Annual Conference Session 2036.1: October 29, 2015 Sample Demographics SAMPLE CHARACTERISTICS (N=265) AGE GENDER MARITAL RACE STATUS Range 25 ‐ 84 F=160 S=95 White=104 Mean=40 M=101 M=69 Black=130 SD=14.6 Missing=4 D=14 Indian=3 W=4 Asian=2 Missing=84 Missing=26 Research Question 1  What is the incidence of depression for this population as identified by the scores on the PHQ ‐ 9? Question #1 Findings DEPRESSION SEVERITY ( N = 265) Moderately No Minimal Mild Moderate Severe Severe Depression Depression Depression Depression Depression Depression PHQ ‐ 9 Score PHQ ‐ 9 Score PHQ ‐ 9 Score PHQ ‐ 9 Score PHQ ‐ 9 Score PHQ ‐ 9 Score 0 1 ‐ 4 5 ‐ 9 10 ‐ 14 15 ‐ 19 20 ‐ 27 21% 29.4% 25.6% 12.2% 6.9% 5% (n= 55) (n=77) (n=67) (n=32) (n=18) (n=13) King 3

APNA 29th Annual Conference Session 2036.1: October 29, 2015 Research Question 2  What is the relationship between scores on the PHQ ‐ 9 and age?  Findings:  r = ‐ .11 and p =.037 Research Question 3  Are there differences between PHQ ‐ 9 scores and gender, marital status, race? ANOVA Results of Demographic and PHQ ‐ 9 Female Male Variable M SD M SD F(1,256) p η 2 Gender 6.58 6.54 98 6.01 0.47 0.492 0.002 White Black Variable M SD M SD F(1,231) p η 2 Race 6.73 0.64 6.02 0.57 0.69 0.408 0.003 Single* Married Divorced Variable M SD M SD M SD F(2,174) p η 2 Marital 7.30 0.67 4.64 0.78 5.50 1.73 2.56 0.032* 0.039 Note. * indicated Single was significantly higher than Married and Divorced. King 4

APNA 29th Annual Conference Session 2036.1: October 29, 2015 Research Question 4  What is the relationship between scores on the PHQ ‐ 9 and biomarkers reported at first visit: body mass index (BMI), weight (Wt.), height (Ht.), and fasting blood glucose levels (FBS)? Correlation Between PHQ ‐ 9 & Biomarkers M SD 1 2 3 4 (1) PHQ ‐ 9 6.32 6.36 ‐ (2) BMI 30.28 7.54 ‐ 0.04 ‐ (3) Height 65.22 7.69 ‐ 0.032 ‐ 0.107 ‐ (4) Weight 184.48 52.55 ‐ 0.064 0.862** 0.334** ‐ (5) FBS 169.87 114.19 0.174* ‐ 0.033 0.016 ‐ 0.007 * p<.05 **p<.01 Implications for Practice  The value of screening for depression at health care visits was validated by the results of this study.  Through early detection and treatment, psychiatric mental health nurses have the opportunity to ameliorate the impact of depression for clients. King 5

APNA 29th Annual Conference Session 2036.1: October 29, 2015 Implications for Future Research  The findings of this study guide further nursing research and development of culturally sensitive nursing interventions.  Leininger’s Cultural Care Universality and Diversity Theory is useful to explore client’s cultural beliefs related to depression.  Leventhal’s Self ‐ Regulation Theory is useful to explore culturally acceptable self management behaviors.  Qualitative Methodology: Exploration of client’s cultural health beliefs ‐ the meaning of (depression) symptoms, understanding of origin of symptoms, and what helps manage symptoms. References Centers for Disease Control and Prevention (2013). Burden of mental illness. Retrieved from http://www.cdc.gov/mentalhealth/basics/burden.htm Leventhal, H., Difenbach, M. A., Leventhal, E. A. (1992). Illness cognition: Using common sense to understand treatment adherence and affect cognition interactions. Cognitive Therapy and Research, 16 , 143 ‐ 163. National Institute of Mental Health. (2013). Major depression among adults. Retrieved from http://www.nimh.nih.gov/health/statistics/prevalence/major ‐ depression ‐ among ‐ adults.shtml Spitzer, R. L., Kroenke, K., & Williams, J. B. (2001). PHQ ‐ 9: Validation of a brief depression severity measure. Journal of General Internal Medicine, 16 , 606 ‐ 613. U.S. Preventative Services Task Force (2009/2015). Depression in Adults Screening. Retrieved from http://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/depression ‐ in ‐ adults ‐ screening Wehbe ‐ Alamah, H. (2015). Madeline Leininger’s theory of culture care diversity and universality. In M. C. Smith & M. E. Parker (Eds.), Nursing theories & nursing practice (4 th ed., pp. 303 ‐ 319) . Philadelphia, PA: F.A. Davis. King 6