Routine PHQ-9 Depression Screening in Home Health Care: Depression Prevalence, Clinical and Treatment Characteristics, and Screening Implementation

Abstract

This study aimed to examine: the prevalence and correlates of depression among adults age 65 and over on admission to diverse home health care programs; nurse compliance with routine screening using the PHQ-9; and concordance between the number of depressed individuals identified by the PHQ-9 and Medicare-mandated nursing assessment following targeted nurse training in identifying depression among the elderly using a standard diagnostic screen. Data are drawn from routine screening of 9,178 patients (a 77% screening compliance rate). Of all patients screened, 782 (8.5%) met criteria for probable major depression and 148 (1.6%) for mild depression. Concordance between nurse identified depression via PHQ-9 and OASIS depression assessment improved over that reported in previous studies. Findings suggest that the use of a routine screening tool for depression can be implemented with minimal in-house training and improves detection of depression among older adults with significant physical and functional impairment.

Potentially inappropriate management of depressive symptoms among Ontario home care clients

“…In this study, 12.5% of clients had significant symptoms of depression, which is similar to the prevalence rates reported in other Canadian (Victorino et al, 2003) and American (Bruce et al, 2002;Ell et al, 2005) studies. A DRS score of 3 or higher is intended to serve as an alert for the presence of depression and to aid in decisions relating to care planning and service provision.…”

Depression and suicidal ideation in community-dwelling older adults in Korea

“…(2001), and has since been used widely to screen for depressive symptoms. This scale is relatively easy to administer as well; prior research has demonstrated its reliability in primary care settings when administered by non-psychiatric interviewers (Ell et al ., 2006). Because Korean older adults tend to complain about somatic symptoms rather than cognitive and emotional ones (Lee and Farran, 2004), we determined that the PHQ-9K would be well suited to our study.…”

Testing the chronic care model for depression in homebound older adults.

“…A study using the PHQ-9 to determine probable major and minor depression in 930 newly admitted home care program participants found that older adults who were female and Latino were more likely to score in the probable minor or major depression range, and those who were married and African American were less likely to score in this range (Ell et al, 2005). Another study found no difference in rates of depression between 56 African American and 458 White older adult newly admitted home health care recipients as determined by the Structured Clinical Interview for DSM-IV disorders (SCID; Fyffe, Sirey, Heo, & Bruce, 2004).…”

“…Research shows that home health care nurses can be trained to better identify depression in their routine provision of care Brown et al, 2010;Bruce et al, 2007). Studies find that the PHQ-9 is more accurate at identifying depression than the PHQ-2 used in the OASIS (Ell et al, 2005); however, training in better use of the OASIS may also be acceptable. One intervention developed for this purpose is the TRaining In the Assessment of Depression (TRIAD) intervention, which helped home care nurses use the OASIS screening to more accurately identify depression Brown et al, 2010;Bruce et al, 2007).…”

“…Properly treating depression may help to alleviate some of these factors that are causing the need for more home care treatment in general. Furthermore, depression may be a chronic disorder in homebound older adults (Cohen-Mansfield et al, 2010;Ell, Unützer, Aranda, Sanchez, & Lee, 2005;Raue et al, 2003), which implies that it should be treated in a chronic care model. Depression is not currently being adequately treated in the homebound elderly (Qiu et al, 2010).…”