Date of Award

Fall 2021

Project Type

Clinical Doctorate

College or School




Program or Major

Doctor of Nursing Practice

Degree Name


First Advisor

Lauryn LeGacy Frost

Second Advisor

Cathleen Colleran

Third Advisor

Tasneem Rashid



Background: Major depression is a serious health problem that affects both children and adults. It is a leading cause of disability worldwide. Most cases of major depression are treated in primary care settings. Many cases of major depression presenting in primary care are missed. Many PCPs do not routinely use screening tools. The aim of this project is to improve the diagnosis of major depression in adults in a primary care practice through routine use of the Patient Health Questionnaire-9 (PHQ-9) during initial encounter with patients and during follow-up visit for patients who are receiving treatment for depression to assess their response to treatment.

Method: Chart review of patients 30 days prior to intervention was conducted to get a baseline on the utilization rate of PHQ-9 by the providers. Literature review conducted to obtain the best available evidence in support of screening for depression in primary care. The Plan-do-Study-Act model was used for this quality improvement project. Post-intervention chart review was conducted following 30 days of implementation to evaluate the outcome measures.

Intervention: Pretest survey was done to assess knowledge of providers on depression tool. Both providers indicated being familiar with the PHQ-9. Education focused on screening and diagnosing major education was conducted. Post-test survey was done after 30 days of implementation.

Results: Pre-test survey showed that the providers reported using PHQ-9 during initial encounter only for patients reporting of symptoms of depression. Previous patient encounters did not include the use of the PHQ-9. Following intervention, 100% utilization rate was achieved for both new patients and follow-up cases for patients already receiving treatment for depression.

Conclusion: The diagnosis of major depression can be improved in primary care settings through routine use of a validated depression tool like PHQ-9 by primary care providers.

Keywords: major depression, diagnosing major depression, PHQ-9, primary care practice, patient Health Questionnaire-9