Evaluation of Comprehensive Screening to Support Initial Depression Diagnosis Among Military Adolescent Beneficiaries

Friday, 28 July 2017

Chelsea M. Cruz, BSN, RN
School of Nursing, University of South Florida, Tampa, FL, USA
Alicia Rossiter, DNP
VCARE, Undergraduate Program, Academic Programs Assistant Professor, College Of Nursing Nursing, Military Liaison, University of South Florida, Tampa, FL, USA
Catherine G. Ling, PhD, FNP-BC, FAANP
FNP Concentration Director College of Nursing, University of South Florida, Tampa, FL, USA

Problem Statement: Due to the unique life circumstances associated with military service, greater burdens are placed on a military member’s family increasing stress and risk for mental illness, especially among pediatric dependents. Symptoms of adolescent depression vary by individual and often go undiscovered by those closest to the individual. 90% Of adolescents seen within primary care in the United States have an undiagnosed mental health illness (NAMI, 2016). when an adolescent is facing a mental illness or attempting suicide, it prevents our military members both stateside and deployed from completing their missions adequately. Adolescent patients who are presently seen at a Military Healthcare Facility for primary care are screened using the Patient Health Questionnaire- 2 (PHQ-2) only at annual visits and when presenting with a psychosocial chief complaint. The PHQ-2 is not a comprehensive questionnaire and is not required to be completed at all visits with the physician. With 80% of families visiting their primary care physicians throughout the year it is imperative that screening for depression improves (Arroll et al., 2011). In the absence of a routine comprehensive screening 50% of adolescent depression cases are being overlooked (Arroll et al., 2011). Purpose: The PHQ-2 presently promoted by military pediatric primary care providers is not identifying over half of adolescent military beneficiaries at risk and/or presently suffering from symptoms of depression. Clinical recommendation for this study is to screen all military adolescent beneficiaries with the comprehensive Patient Health Questionairre-9 Modified on a routine basis to support identification and initial diagnosis of depression. This study will explore the use of a standardized comprehensive depression screening tool (PHQ-9 Modified) among military adolescents for initial suggestive diagnosis. Methods: A voluntary anonymous online survey will be available for completion by parents of military adolescent beneficiaries who are stationed at MacDill Air Force Base in Tampa, Florida. The scoring of surveys will be completed following required methods established by the PHQ-9 Modified and PHQ-2 questionnaires. Evaluation of the survey results will reveal a comprehensive screening assessment tool’s ability to support initial diagnosis of military adolescents at risk for depression. This will be reflected through supported data of the comprehensive screening questions derived from the PHQ-9 Modified identifying more individual military adolescents scoring at risk for depression that were not found at risk using questions derived from the PHQ-2. Significance: Adolescent depression is a serious disorder which often goes undiagnosed and has the ability to lead to suicidal attempts. Despite this fact and numerous supporting studies, practice guidelines have not wavered and continue to diagnose less than 50% of adolescents with depression prior to adulthood, with less being diagnosed within the military adolescent population. Our goal is to identifying and support the need for a routine comprehensive screening tool. With this study’s support, education initiatives will be provided to not only to clinical staff at MacDill Air Force Base but also to the United States Military’s health care providers across the nation and worldwide so that not only the adolescents at MacDill are screened properly, but those overseas as well.