Fall 2023

Document Type

Scholarly Project


College of Nursing

First Advisor

Dianna Inmann


Problem Statement: Patients in Family Medicine at an academic medical center in the Southeast who show signs and symptoms of depression are being referred to behavioral health to manage their depression symptoms. Long waiting lists, which delay the patient’s time to see behavioral health and a lack of patient education about the need for mental health services led to delays in patient care and poor appointment adherence.

Purpose: The purpose of this project was to determine if providing Problem Solving Therapy (PST) in a one-time setting, after referral from the primary care provider (PCP), with psychoeducation, decreases depression scores for patients on the Patient Health Questionnaire (PHQ-9) in a Family Medicine clinic. Integrated care in the primary care setting provides opportunities for patients to receive care or access specialists while visiting their PCP. Patients are referred to mental health services by their PCP after scoring greater than five on their PHQ-9, which indicates mild depressive symptoms. Many of these first appointments do not happen for several months, leading to a high no-show rate and delay in patient treatment. To address this issue, an evidenced-based intervention such as problem-solving therapy has proven to be effective in treating patients with depression (Funderburk et al., 2021).

Methods: Patients who scored higher than a five on their PHQ-9 were offered a one-time session of PST with the program director, immediately after their appointment with their PCP. A quasi-experimental design was utilized to assess the effectiveness of the pre-post intervention. Descriptive statistics was used to evaluate the feedback following the intervention. Data analysis compared pre-intervention and post-one-month follow-up PHQ-9 scores and compared them to variables such as age, gender, race, ethnicity, insurance, education, and marital status. Other outcomes included patient satisfaction and whether the patient successfully met or partially met their goal developed during PST.

Inclusion Criteria: English-speaking adult patients who scored mild or higher on the PHQ-9 scale and are already not being treated by a mental health specialist. Exclusion criteria included non-English speaking adults, adults older than 65, and people under the care of a mental health professional.

Analysis: The dependent variable is the final PHQ-9 score using a paired t-test. Because of the small sample size, a non-parameter test was used to analyze the data. The other variables used descriptive statistics. Data collected pre-intervention included: demographic information and PHQ-9. Data collected post-intervention included patient satisfaction survey, PHQ-9 score, and whether the patient’s goal from PST was met, partially met, or not met. A patient satisfaction survey was entered into a secured REDCap database at the end of the clinic day. Patient MRN, pre-PHQ-9 score, and goal were entered in an Excel spreadsheet that was kept on a file in the hospital clinic’s secured computer that could only be accessed by the program director’s EHR username and password. After successful phone follow-up, post-PHQ-9 score, and goal completion were entered into the same Excel spreadsheet.

Integration of Problem-Solving Therapy to Address Mental Health Needs of Family Medicine Patients

Mental health disorders affect over 1 in 5 Americans, with the most common illness being depression. There are delays in providing care to patients with non-emergent depression and anxiety, as well as patients not having access to psychiatric services across the country (LaRocco-Cockburn et al., 2013). Some medical centers diagnose and manage patient depressive symptoms in family medicine when the patient sees their primary care provider (PCP) with the help of other mental health providers in a model described as integrated care (Hiefner et al., 2019). Integrated care expands services to patients to address mental health care needs such as anxiety or depression in a primary care setting (Koehler et al., 2020).


© 2023, Robert M Sutter

Available for download on Tuesday, December 31, 2024

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