In the home health setting of patients age range between 60-75 years old with depression symptoms does the PHQ-2 depression screen versus the GDS-15 assist in early identification of symptom severity and monitor symptoms changes for clinical depression by 100% of patients over a period of 6 months?

Question:

P: In the home health setting of patients age range 60-75 with depression symptoms.

I: Does the PHQ-2 depression screen versus the GDS-15 assist in early identification of symptom severity and monitor symptom changes for clinical depression.

C: Using GDS screening tool VS PHQ-2 SCREEN

O: to improve identification of the clinical depression in the elderly by 100%.

T: in the initial office visit and over a 6 month period?

This week’s assignment is STEP 2 – Project Purpose Statement, Background & Significance and PICOt Formatted Clinical Project Question.

Provide a title that conveys or describes the assignment.
Project Purpose Statement – Provide a declarative sentence or two which summarizes the specific topic and goals of the project.
Background and Significance – State the importance of the problem and emphasize what is innovative about your proposed project. Discuss the potential impact of your project on your anticipated results to the betterment of health and/or health outcomes.
PICOt formatted Clinical Project Questions – Provide the Population, Intervention, Comparison, Expected Outcomes and timeframe for the proposed project.
References – Cite references using APA 7th ed format.

ANSWER

Project Purpose Statement, BackgroAund & Significance and PICOT Formatted Clinical Project QuestioN

Project Purpose Statement

The evidence-based practice intervention aims to improve the identification and monitoring of clinical depression by 100% among the elderly. Therefore, evidence-based research will examine two different depression screening scales and determine the most effective identification and monitoring of clinical depression. The project will improve an understanding of the most effective screening scales in terms of performance, reliability, and validity.

Background and Significance

The impact of suffering from depression is substantial. Clinical depression has been associated with increased mortality and morbidity. Both recurrence and chronicity of depressive illness have played a great role in the heavy burden of depression (Levis et al., 2019). Ideally, the more severe a depression becomes, the longer it lasts with a greater possibility of becoming chronic. Early recognition and effective management of depressive illness will lower the morbidity linked to depression and lower the likelihood that it becomes chronic with additionally linked morbidity.  Homecare workers have continued to offer community-based medical services to some old and most vulnerable individuals within the society. Depression has been high among the medically ill homecare elderly. Clinical depression is a chronic medical condition linked to significant functional decline, high healthcare costs, and low life quality (Maurer, Raymond, and Davis, 2018). In terms of burden, the World Health Organization has ranked depression as the second to heart disease determined by the disability-adjusted impact.

The home healthcare settings have played an essential role in the management and assessment of depressive illness. Home healthcare settings, depression has been twice prevalent as compared to primary settings. However, despite the high prevalence, recent studies suggest that the percentage of homecare elderly being assessed and receiving treatment is very low even though screening and treatment alternatives for depression exist. This has been a good indicator that depression is under-diagnosed and undertreated among home healthcare patients.

Evidence from primary healthcare settings indicates that system-level interventions have played a great role in improving depression outcomes (Tsoi, Chan, Hirai, and Wong, 2017). The system-level intervention includes collaborative treatment that integrates the mental health therapists into primary care. However, in the case of home healthcare settings, it has been costly to have specialty mental healthcare, which has prevented home-based care services. Occasionally, home healthcare workers have failed to recognize depression. This has led to a high risk for negative consequences due to the low treatment rate. This means that interventions for identification and monitoring of depression among the elderly within home healthcare settings are required. The U.S Preventive Services Task Force, in a report, has recommended that screening for depression among old adults if there is an effective mechanism for diagnosis, follow-up, and treatment.

Depression screening has been a significant part of the identification, treatment, and referral of patients to mental health professionals. Depression screening entails the utilization of screening scales and tools to examine the symptoms and monitor patients that might have depression (Maurer, Raymond, and Davis, 2018). Healthcare professionals have responded to the needs of different individuals through understanding the importance and reliability of self-reported screening tools to enable them to evaluate how these tools can contribute to the general recognition of depression. There are various depression screening and monitoring scales that have been utilized for diagnosis and treatment. Tools such as Hamilton rating scales, Zung self-rating depression scale, Patient Health Questionnaire, and Geriatric Depression Scale have been utilized for screening depression among the elderly people within the healthcare settings (Tsoi, Chan, Hirai and Wong, 2017).

Considerably, integrated depression screening tools have been considered as the initial step in examining depression. Depression screening reduces the barriers of depression and offers direct patient access to the necessary treatment services. Early identification and monitoring of symptoms will lower the cost of accessing external mental health care services (Tsoi, Chan, Hirai, and Wong, 2017). Routine diagnostic screening can improve the identification and recognition of depression among the elderly. For instance, clinical depression has been present among the elderly without showing any depressive moods. Old adults with clinical depression have overlooked the symptoms linked to old age, such as cognitive and physical limitations. Therefore, it is important for depression screening tools to be utilized in facilitating early intervention and monitoring of symptoms among the elderly.

Screening tools, if utilized properly, may enable the home healthcare workers to accurately identify elderly patients with depression and depressive symptoms, which will enable them to initiate appropriate management (Maurer, Raymond, and Davis, 2018). There are various diagnostic and screening tools that are available to identify depression. However, not all instruments are suitable for use in home healthcare settings. Utilizing some diagnostic and depression tools is limited by the time and cost required to administer the tools accurately.

Depression screening tools must be accurate to identify a large proportion of untreated and unrecognized depression cases and rule out noncases to prevent unnecessary mental health assessment. Despite the fact that screening cannot improve mental health outcomes, it would lead to scarce resources. Scarce resources lead to financial struggles in the mental healthcare system. Most of the depression screening tools have relied on a number of questionnaires that have been developed over the last two decades and designed to identify diabetes. The diagnostic quality, accuracy, and performance of screening tools vary in terms of sensitivity and specificity of the depression screening. Ideally, for screening to be effective, then it has to have a feasible, accurate, reliable, and acceptable screening tool.

The evidence-based practice aims at comparing GDS and HPQ-2 as screening tools. GDS-15 was developed 30 years ago as a self-report instrument that is used to screen for clinical depression among the elderly. The instrument does not include somatic symptoms, which might be due to the medical illness, and ensure the use of a simple response format that is utilized to examine cognitive functions. The instrument generates scores from the endorsed items to classify the patient as non-depressed or depressed.

The 15-item GDS version is a depression assessment tool that is designed to assess depression for older people. It comprises 15 questions about the client over the past few weeks. High scores indicate more depressive signs and symptoms. Scores above 6 indicate the presence of depression and the demand for further assessment. These 15 questions have been used to assess the affective symptoms and behavioral symptoms, which prevent the scale from being valid. GDS-15 has offered an ideal test for examining depression severity and monitoring symptoms for depression.

PHQ-2 is one of the screening instruments that were introduced to improve the detection of mental health disorders. PHQ-2 was established in 2003 and comprised of the first two items of the PHQ-9. This has been an effective self-administered instrument used to screen depression, inquiring about the degree to which a person has encountered depressive mood over the last two weeks (Manea et al., 2016).  The tool has included DSM-IV depression criteria and major depressive symptoms that are utilized to make a brief report that is used for identification, screening, and monitoring treatment. PHQ-2 only inquires about anhedonia and frequency of depressive moods over the last two weeks. The purpose of PHQ-2 is not to offer the final diagnosis or monitor depression but acts as the first-step approach.

This study will improve an understanding of the most effective screening instruments in terms of accuracy and performance in depression screening. Understanding the psychometric performance of a depression screening tool is essential in determining the best tool to use for early identification and monitoring of clinical depression for the elderly within home healthcare settings. GDS-15 and PHQ-2 are the most commonly used tools for detecting depression.

The evidence-based practice will evaluate the two tools and compare the psychometric performance to determine the most suitable for early identification and monitoring of clinical depression. Considerably, using validated scales in diagnosis, screening, and measuring response to depression therapy is an essential part of offering appropriate care.  The EBP will improve the identification of depression, thus lowering the rate of morbidity and mortality. Most of the elderly people in home healthcare settings are diagnosed with most of the depressive symptoms going undetected. Therefore, it is important to improve screening practices by utilizing the most effective depression screening instrument.

PICOT formatted Clinical Project Questions

P: In the home health setting of patients aged range 60-75 with depression symptoms.
I: Does the PHQ-2 depression screen versus the GDS-15 assist in early identification of symptom severity and monitor symptom changes for clinical depression.
C: Using GDS screening tool VS PHQ-2 SCREEN
O: to improve the identification of clinical depression in the elderly by 100%.
T: in the initial office visit and over a six month period?

References

Levis, B., Yan, X. W., He, C., Sun, Y., Benedetti, A., & Thombs, B. D. (2019). Comparison of depression prevalence estimates in meta-analyses based on screening tools and rating scales versus diagnostic interviews: a meta-research review. BMC medicine, 17(1), 1-10.

Manea, L., Gilbody, S., Hewitt, C., North, A., Plummer, F., Richardson, R., … & McMillan, D. (2016). Identifying depression with the PHQ-2: A diagnostic meta-analysis. Journal of Affective Disorders, 203, 382-395.

Maurer, D. M., Raymond, T. J., & Davis, B. N. (2018). Depression: screening and diagnosis. American family physician, 98(8), 508-515.

Tsoi, K. K., Chan, J. Y., Hirai, H. W., & Wong, S. Y. (2017). Comparison of diagnostic performance of Two-Question Screen and 15 depression screening instruments for older adults: systematic review and meta-analysis. The British Journal of Psychiatry, 210(4), 255-260.