Date of Award

Spring 5-27-2023

Document Type

Doctor of Nursing Practice Final Manuscript

Degree Name

Doctor of Nursing Practice

Department

Nursing

First Advisor

Susan Magorno, DNP, APRN, PMHNP-BC

Abstract

Purpose: This evidence-based practice project integrates a structured periodic depression evaluation follow-up protocol for patients diagnosed with Major Depressive Disorder who have been prescribed antidepressant(s) at an outpatient mental health clinic. The purpose of this DNP project is to standardize the method of treatment progression monitoring to improve the timeliness of change detection and subsequent treatment adjustments using the Beck Depression Inventory (BDI) Scale.

Background: According to the World Health Organization (WHO), MDD is one of the most common mental health conditions affecting approximately 280 million people globally and 17.5 million adults in the United States. (WHO, 2021). The economic costs of MDD in the U.S. have been estimated at $326.2 billion annually. Although antidepressant medications are an effective method to treat patients' conditions, early discontinuation of antidepressants is a common phenomenon, with 30.6% being without any antidepressants and 30% discontinuing antidepressants within one month of their treatment initiation (Lou et al., 2020). There are several mood assessment tools that may assist with monitoring treatment progression; however, consistency and standardization are often lacking.

Methods: This clinic utilized the Beck Depression Inventory scale, established baseline scores for the existing patients diagnosed with MDD, and reestablished evaluations at standardized intervals to determine any indicated treatment changes. Comparison of pre-BDI use and post-BDI use was determined primarily by medical record reviews. The patient population for both stages was selected from one provider within the clinic to maintain consistency and limit variability in practice.

Results: Based on comparison data, patients who were seen and evaluated using the BDI scale for each initial and follow-up visit were provided medication changes within the first 90 days of treatment and often within the first 30 days, with a subsequent decrease in reported mood symptoms. The earlier treatment change is indicative of better patient outcomes. The results show that consistent use of assessment tools may have contributed to helping providers change, adjust, or switch antidepressants to treat MDD. Utilizing the BDI scale consistently at this clinic provided periodic treatment efficacy measurements.

Evaluation: Results of systemized follow-up care management using the BDI scale for patients prescribed medications in a mental health clinic showed overall benefits toward treatment progression though the sample size was small. Preliminary results indicate the benefits of using an assessment tool consistently rather than specifically the BDI scale itself.

Keywords: Major Depressive Disorder, MDD, BDI Scale, Antidepressant treatment, treatment progression

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