Title : Findings from a quality improvement project: Implementation of the patient health questionnaire 9 modified for teens
Abstract:
Background: Adolescent depression is a prevalent and significant public health concern, strongly linked to increased suicidality, poor health outcomes, impaired psychosocial functioning, and substantial societal costs. Although measurement based care using validated screening instruments is recommended by clinical practice guidelines, the routine use of standardized depression screening tools remains limited in mental health settings.
Objective: The purpose of this quality improvement project was to assess the impact of implementing the Patient Health Questionnaire-9 modified for teens (PHQ-9M) in depression screening rates among adolescents aged 11–17 years at an outpatient mental health clinic in Southern Colorado.
Methods: A quantitative, quasi experimental pre- and post-intervention design was used to evaluate changes in depression screening rates following an 8 week implementation period. The intervention included integrating the PHQ-9M into the clinic's electronic health records and providing clinician training. Pre- and post-intervention screening rates of three participating clinicians were compared using a chi square test of independence.
Results: Prior to implementation, no adolescent patients received standardized depression screening (0%). Following implementation, the screening rates increased to 15.8% (22 of 139 de-identified patient chart data). The increase was statistically significant (χ²(1) = 17.265, p < .001), indicating a strong association between PHQ 9M implementation and improved screening practices.
Conclusion: Integrating the PHQ 9M into routine clinical workflows significantly increased adolescent depression screening rates in a mental health clinic setting. These findings support the feasibility and effectiveness of implementing validated measurement based care tools to enhance early identification of depression. Addressing implementation barriers, such as electronic health records usability and clinician engagement, may further improve adoption and sustainability. Routine use of standardized screening tools can improve early detection, timely intervention, and mental health outcomes for adolescents.
