Date of Award

Spring 5-31-2026

Document Type

Doctor of Nursing Practice Final Manuscript

Degree Name

Doctor of Nursing Practice

Department

Nursing

First Advisor

Autumn Roque, DNP, APRN, PMHNP-BC, DNP Faculty Advisor

Abstract

Objective: The purpose of this evidence-based practice (EBP) project is to implement the routine use of the Patient Health Questionnaire-9 (PHQ-9) screening instrument in the primary care setting to improve early diagnosis, treatment, and referrals to mental health.

Background: Depression is frequently underdiagnosed in primary care despite its significant impact on health outcomes. Inconsistent screening practices and a lack of standardized workflows contribute to missed opportunities for early identification and intervention. Routine PHQ-9 screening has been shown to improve detection and facilitate timely referral to behavioral health services.

Methods: A standardized PHQ-9 screening was implemented for adult patients aged 18 years and older during routine visits at a community-based primary care clinic serving an underserved population over a 4-week period. Patients completed a paper-based PHQ-9 prior to provider evaluation, and providers scored and followed a standardized protocol, with scores of 10 or higher prompting referral to behavioral health services. Baseline and post-implementation outcomes were compared to assess changes in depression screening and referral rates.

Results: A total of 8,005 eligible adult patients were seen during the evaluation period. Compared to baseline, depression screening rates demonstrated a modest upward trend following implementation of routine PHQ-9 screening, increasing from 18.49% (436/2,374) in January to 21.49% (616/2,866) in March. Behavioral health referral rates improved substantially, rising from 23.39% (102/436) in January to 59.57% (367/616) in March, representing a 36.18 percentage-point increase.

Conclusions: Implementation of routine PHQ-9 screening increased screening and referral rates for depression and behavioral health. These findings support routine screening as an effective strategy to enhance early detection and access to mental health care in primary care settings.

Download

Included in

Nursing Commons

Share

COinS