Date of Degree

Summer 2025

Document Type

DNP Scholarly Project

Academic Department

School of Nursing

Degree Type

Doctoral

Degree Name

Doctor of Nursing Practice

First Advisor

Dr. Melanie Brewer DNSc, RN, FNP-BC, NEA-BC, FAANP

Second Advisor

Dr. Brandee Temmis DNP, MSN, RN, NE-BC

Abstract

Problem: Depression among young adults aged 25 to 35 years in the United States has been among the second highest at 19.9%. Depression underdiagnosis stems from many patient-level causes, including a lack of standardized screening, inadequate provider education, and stigma of mental illness. Untreated depression results in low quality of life, comorbidities, suicidality, and socioeconomic issues.

Aim of the Project: The aim of this project was to address the gap in practice by implementing a standardized screening process for young adults to enhance diagnoses and increase screening rates.

Review of the Evidence: A comprehensive review of the evidence demonstrated that the application of standardized screening tools, such as the Patient Health Questionnaire-9 (PHQ-9), significantly enhances depression recognition by clinicians. Evidence also supports the urgent need for targeted screening among adults aged 25 to 35, a population that often presents with underdiagnosed or untreated depressive symptoms, despite being at high risk due to transitional life stressors and reduced healthcare engagement.

Project Design: This quality improvement (QI) project focused on improving depression screening rates among young adults aged 25 to 35 in an outpatient behavioral health clinic using the PHQ-9. The project used the Institute for Healthcare Improvement (IHI) Plan-Do-Study-Act (PDSA) cycles to structure iterative improvements. The OhioHealth Change Management Model provided a framework to engage stakeholders, reduce resistance, and promote long-term adoption of the screening process. During project implementation, the PHQ-9 was integrated into the electronic medical record (EMR) system, and clinical staff were educated on the administration of the tool.

Intervention: A standardized screening process was implemented using the PHQ-9 in an outpatient behavioral health center serving 75 to 100 young adult patients per month. Administration of the PHQ-9 recorded in the EMR was used to track screening rates, depression diagnoses, and treatment plans.

Significant Findings/Outcomes: The standardized screening procedures resulted in increased early detection and timely intervention. Project outcomes revealed decreased barriers to screening protocols, effective communication, and utilization of mental health professionals on primary care teams. Screening levels increased by 30% within the 10-week project timeframe. The team recommended that enhanced screening practices at the outpatient behavioral health center be sustained after the project, to include ongoing staff education and monitoring to maintain the effectiveness of the intervention.

Implications for Nursing: Early detection, timely intervention, and continuity of care for young adults experiencing depression were effective. This QI initiative aligns with the Institute of Medicine (IOM) Six Aims: Healthcare that is safe, effective, patient-centered, timely, efficient, and equitable. In addition, the project supports the IHI Triple Aim by improving the patient experience of care, advancing population health among a high-risk age group, and potentially reducing long-term healthcare costs through earlier intervention and reduced crisis-driven care utilization.

Rights

CC BY-NC-ND 4.0

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