Date of Graduation


Document Type



depression, PHQ-9, economically disadvantaged, access to depression care

Degree Name

Doctor of Nursing Practice (DNP)

Degree Level



Anna Jarrett

Committee Member

Michele Kilmer


Depression is a substantial source of financial, emotional, and physical burdens to patients and their families worldwide. It also disproportionately affects economically disadvantaged populations. To combat the depression crisis, The United States Preventive Services Task Force (USPSTF) published guidelines to boost depression screenings of all patients presenting for healthcare services. A review of literature and the completed needs assessment confirmed low rates of depression screening in the rural primary care sector. This project took place in an outpatient primary care facility in rural Arkansas, where current depression screening tools were not being used. The goal was to increase the percentage of depression screenings in primary care to 50% from the national average of 5% by March 2022. The purpose of this project was to increase depression recognition thereby improving the outcomes. Data collection before and after the Patient Health Questionnaire 9 (PHQ-9) implementation phase was analyzed to evaluate outcome, process, and balancing measures. PHQ-9 scores and patient outcomes were compared using descriptive statistics and run charts. Pre- and post- implementation of depression diagnoses using an independent samples t-test were analyzed. There were 729 retrospective charts reviewed for depression diagnosis in the pre-implementation phase compared to 529 concurrent chart reviews in the post-implementation period. An independent samples t-test was conducted which demonstrated a statistically significant increase in depression diagnosis, t (528) = 13.070, p < .000 following implementation of the PHQ-9 screening. Long-term sustainability will depend on continued depression screening and follow-up care for persons screened and those diagnosed with depression.

Available for download on Wednesday, May 10, 2023