Depression Screening in Pediatric Patients With Type 1 Diabetes

Researchers implemented an electronic medical record-based depressive symptom screen in type 1 diabetes mellitus adolescents seen in an outpatient clinic.

The following article is part of coverage from the National Association of Pediatric Nurse Practitioners Annual Meeting (NAPNAP 2020). Due to the global COVID-19 pandemic, the Association made the necessary decision to cancel the meeting originally scheduled for March 25 to 28, 2020, in Long Beach, CA. While live events will not proceed as planned, readers can click here to catch up on the latest research intended to be presented at the meeting.

The addition of an electronic medical record (EMR)-based screening system for depression in adolescents with type 1 diabetes mellitus (T1DM) increased screening from 0% to 77% and helped identify adolescents with depression and other mental health disorders, according to a poster presented virtually at the National Association of Pediatric Nurse Practitioners Annual Meeting (NAPNAP 2020).

Adolescents with diabetes experience a higher risk of depression than their peers (30% vs 10%-20%), according to Sally S. Humphrey, DNP, APRN, CPNP-PC, lead author of the study from Vanderbilt University School of Nursing and the University of Tennessee College of Nursing. “There is an association between poor glycemic control and depression this population. The American Diabetes Association recommends annual depression screening for all diabetic patients, yet providers often find implementation and follow-up logistically difficult,” she added.

To improve screening rates, the quality improvement project used the Plan-Do-Study-Act format as a guide in which patients in a pediatric endocrinology office who had a confirmed diagnosis of T1DM and were aged 14 to 18 years completed the Patient Health Questionnaire-9 (PHQ-9). The 9-item questionnaire was distributed with parental consent. Patients were asked to complete the screening in the examination room; project team members incorporated the scored results into the clinic note. The provider overseeing the EMR then determined if referral was necessary based on current evidence, guidelines, and clinic flow.

The screening rate at the clinic improved from 0% at the start to 77% at project end. Of all patients screened, 10% were found to be positive for depression 20% were referred for mental health evaluation. Of screened patients, 10% indicated thoughts of suicidal ideation but on further inquiry did not endorse active plans. A significant portion of (38%-48%) patients indicated somatic symptoms including fatigue and difficulty sleeping.

“The results of this project also offer insights that will enable the team to continue [quality improvement] measures into the future and improve the quality of care for our patient population,” concluded the authors.

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Humphrey SS, Karp SM, Zsambosky M. EMR-based depression screening for adolescent type 1 diabetes patients: a quality improvement project. Presented virtually at: NAPNAP 2020; June 4-5, 2020. Abstract F16.

This article originally appeared on Clinical Advisor