Depression Screening in Obesity: A Quality Improvement Project

Conclusion

A total of 24.7% of patients screened positive for depression with a score of 3 or more using the PHQ-2 and were further screened with the PHQ-9. Of the patients who screened positive for depression, 88.9% scored 10 or more, indicating moderate to severe depression symptoms. Approximately 27.8% of patients accepted a referral for psychiatric evaluation. Only 4.1% of all patients screened were newly diagnosed with depression. The number of patients with obesity who were screened for depression and returned to the clinic for weight loss management totaled 12.3%. Nearly 48% of participating patients reported a history of depression.

Statistically significant results were found illustrating the need for regular depression screening in patients with obesity being treated for or with a history of depression. Results showed that patients with obesity and depression were more likely to accept a referral for psychiatric evaluation; screening helps identify the need for further evaluation. Successful weight loss may be tied to a reduced risk for depression symptoms, making screening for both obesity and depression imperative. While not statistically significant, trends in the data show that patients with a higher BMI were more likely to have depression, and those with depression were more likely to accept a nutritionist referral and return for weight loss management.

Changes in the process, such as initiating screening in the waiting room or during triage, could increase the efficiency of the process. Although a low number of cases of newly diagnosed depression were identified in patients with obesity, continued screening to improve mental health of any patient in need is valuable. Research has proven that obesity and depression have a negative impact on one another. It is important to screen for both conditions and address them together when possible. Additional studies on this topic can assess the generalizability of the results in other facilities, during different times of the year, and in areas of varying income and diversity.

Michelle Triche, DNP, ARPN, FNP-C, PCCN is a Primary Care Provider at Sherman Wellness in Texas. Shannon Harris, DNP, APRN, FNP-BC, CCRN, is an Assistant Clinical Professor, University of South Alabama and a provider at Diagnostic Medical Clinic in Alabama. John Gomez, MD, board certified in Emergency Medicine, is the owner and Rebecca Gomez, MD, board certified in Family Medicine, is the co-owner of Rapid Med Urgent Care Center in Texas.

References

1. Pratt LA, Brody DJ. Depression and obesity in the US adult household population, 2005-2010. NCHS data brief, no 167. October 2014. Accessed November 12, 2019.

2. Preiss K, Brennan L, Clarke D. A systematic review of variables associated with the relationship between obesity and depression. Obes Rev. 2013;14(11):906-918.

3. Brumpton B, Langhammer A, Romundstad P, Chen Y, Mai XM. The associations of anxiety and depression symptoms with weight change and incident obesity: the HUNT Study. Int J Obes (Lond). 2013;37(9):1268-1274.

4. Carey M, Small H, Yoong SL, Boyes A, Bisquera A, Sanson-Fisher R. Prevalence of comorbid depression and obesity in general practice: a cross-sectional survey. Br J Gen Pract. 2014;64(620):e122-e127.

5. Opel N, Redlich R, Grotegerd D, et al. Obesity and major depression: body-mass index (BMI) is associated with a severe course of disease and specific neurostructural alterations. Psychoneuroendocrinology. 2015;51:219-226.

6. Sharma S, Fulton S. Diet-induced obesity promotes depressive-like behaviour that is associated with neural adaptations in brain reward circuitry. Int J Obes (Lond). 2013;37(3):382-389.

7. Xiang X, An R. Obesity and onset of depression among U.S. middle-aged and older adults. J Psychosom Res. 2015;78(3):242-248.

8. Pagoto S, Schneider KL, Whited MC, et al. Randomized controlled trial of behavioral treatment for comorbid obesity and depression in women: the Be Active Trial. Int J Obes (Lond). 2013;37(11):1427-1434.

9 Busch AM, Whited MC, Appelhans BM, et al. Reliable change in depression during behavioral weight loss treatment among women with major depression. Obesity (Silver Spring). 2013;21(3):E211-E218.

10. World Health Organization. Depression.  https://www.who.int/en/news-room/fact-sheets/detail/depression. March 22, 2018. Accessed July 16, 2019.

11. Toups MS, Myers AK, Wisniewski SR, et al. Relationship between obesity and depression: characteristics and treatment outcomes with antidepressant medication. Psychosom Med. 2013;75(9):863-872.

12. Agency for Healthcare Research and Quality. Practice Facilitation Handbook. Module 16. Introduction to the Care Model.  https://www.ahrq.gov/professionals/prevention-chronic-care/improve/system/pfhandbook/mod16.html. May 2013. Accessed July 16, 2019.

13. American Psychological Association. Patient Health Questionnaire (PHQ-9 & PHQ-2).  https://www.apa.org/pi/about/publications/caregivers/practice-settings/assessment/tools/patient-health. Accessed November 14, 2019.

14. City-data.com. Double Oak, Texas.  http://www.city-data.com/city/Double-Oak-Texas.html. Updated 2019. Accessed July 16, 2019.

15. Pender N, Murdaugh C, Parsons MA. Health Promotion in Nursing Practice. 7th ed. Upper Saddle River, NJ: Pearson Education; 2015.

16. National institute of Diabetes and Digestive and Kidney Diseases. Overweight and Obesity Statistics.  https://www.niddk.nih.gov/health-information/health-statistics/overweight-obesity. August 2017. Accessed July 16, 2019.

This article originally appeared on Clinical Advisor