IMPLEMENTING THE PHQ-(A) DEPRESSION SCREENING IN POST-CONCUSSION VISITS TO IDENTIFY EARLY SIGNS OF DEPRESSION IN ADOLESCENTS

Purpose: The purpose of this quality improvement project was to implement a depression screening, the PHQ-(A), in all post-concussion visits for adolescents aged 12 to 18. After a thorough literature review, it was determined that adolescents who have experienced one or more concussions are more likely to develop depressive symptoms. They are also at an increased risk of suicidal thoughts and suicidal acts. Current guidelines do not require providers to conduct any depression screenings on post-concussion visits. The goal of this project, through early screening, is to identify and track any depressive symptoms that may develop after a patient experiences a concussion. Methods: This quality improvement project was implemented at Clinton Medical Clinic, in rural southeastern North Carolina. The project began by providing education on the project to health care providers within the practice. An overview of the PHQ-(A) depression screening in all post-concussion visits in adolescents aged 12 to 18 was given and providers were asked to record the score within the electronic medical record. The provider then determined treatment, including follow-up, medication, referral, etc. To determine effectiveness, I looked at the following measures: percentage of screenings conducted in post-concussion visits, percentage of positive screens identified, the percentage of patients who had some sort of treatment recommendation, and provider feedback on the project. Results: 16 participants with 21 post-concussion visits were included in the project. Some participants were seen multiple times for follow-up appointments. After 12 weeks, 66.67% of these visits conducted a PHQ-(A) screen. Of these screens, there was 1 positive screen identified (7.14%). Of the 14 screens completed, the following treatment recommendations were documented within the EMR: follow-up appointment (3 patients), referral to concussion clinic (1 patient), and started on an anti-depressant medication (1 patient). Providers found the project to be beneficial to their current practice, finding the screening to be efficient and sustainable. Conclusions: Based on the overall research available about depression in post-concussion adolescents, it is important to take depression into consideration when conducting post-concussion visits. The PHQ-(A) is an easy and effective way of identifying early symptoms of depression and tracking the progression of one’s depression. Depression screening should become a requirement in all post-concussion visits to help identify worsening depression symptoms and start early interventions to help alleviate the patient’s current symptoms.