Date of Award

Spring 5-20-2026

Document Type

Doctor of Nursing Practice Final Manuscript

Degree Name

Doctor of Nursing Practice

Department

Nursing

First Advisor

ELIGIO DAVID SOLIMAN JR., DNP, APRN, FNP-BC, CDCES

Abstract

Depression and anxiety are prevalent yet underdiagnosed in limited-English-proficient (LEP) populations due to language barriers, cultural stigma, and provider bias. Vietnamese-speaking patients are particularly vulnerable to under-recognition in primary care. This quality improvement project evaluated whether implementing Vietnamese-translated Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) tools would improve mental health diagnosis and referral rates. Guided by the Johns Hopkins Evidence-Based Practice Model, a pre–post design was conducted at a San Diego clinic from March 26 to June 26, 2025. Vietnamese-speaking adults (≥18 years) completed translated PHQ-9 and GAD-7 forms during intake. Providers used scores in conjunction with clinical assessment to guide diagnosis and referral. Outcomes included symptom detection (≥5), referral eligibility (≥10), documented diagnoses, psychiatry referrals, and medication initiation compared to a 0% baseline rate. Fifty-six patients were screened. Eighteen (32.1%) scored ≥5, and six (10.7%) met moderate or greater severity thresholds (≥10). Documented diagnosis and psychiatry referral rates increased from 0% to 10.7%. Four patients (7.1%) were offered medication, and three (5.4%) initiated treatment. Implementation of translated screening tools improved the identification and management of depression and anxiety in a previously undocumented population. When paired with clinician judgment, culturally responsive screening offers a scalable, low-cost strategy to reduce mental health disparities in LEP primary care settings. 

Keywords: Depression screening; Anxiety screening; PHQ-9; GAD-7; Limited-English proficiency; Primary care; Health equity

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