Abstract
Depression is a common pediatric problem affecting approximately 25% of U.S. adolescents and up to 35% of patients with Inflammatory Bowel Disease (IBD). Suicide is associated with mood disorders and is a leading cause of death for youth ages 10–25. Despite known risks of depression, up to 75% of depressed youth go unrecognized. Recently published guidelines recommend annual screening for youth 12 and older diagnosed with IBD (Mackner et al., 2019). We sought to implement these guidelines in a large outpatient pediatric gastroenterology practice.
We used quality improvement (QI) methodology and Plan-Do-Study-Act (PDSA) cycles to design and implement a pilot screening process for depression. We aimed to prospectively screen at least 80% of patients diagnosed with IBD who were at least 13 years old from March 3, 2019 to October 11, 2019. Screening was done using the PHQ-9, a brief and validated screening tool widely used in the medical setting. Initial steps of the PDSA cycle focused on training in tool administration, as well as scoring of the PHQ-9 simulated interviews, management of suicidal ideation, and office staff training. Next steps included eligible patient identification and distribution of screeners. As screening processes were improved, we focused on streamlining process of screener distribution and scoring during the visit, as well as disposition of patients based on screening results. The ImproveCareNow Depression Screening Toolkit was used as a resource for implementation.
During the study period, screening of all eligible patients with IBD was implemented across three pediatric gastroenterologists within the larger practice of 15 physicians. Weekly screenings improved from 0% per week to over 80% per week at the culmination of this 32-week pilot. Across the pilot, a total of 141 patients were screened, and of these, 32% had actionable scores indicating mild, moderate, or severe depressive symptoms, with 7 of these endorsing suicidal thoughts.
Development and implementation of a depression screening protocol in an IBD outpatient clinic is feasible and sustainable. A large number of patients were affected by depression and many were previously unrecognized. Next steps include expansion to a larger number of providers and automation of screening tools.
