Date Available

5-8-2025

Year of Publication

2025

Document Type

DNP Project

Degree Name

Doctor of Nursing Practice

College

Nursing

Department/School/Program

Nursing

Faculty

Dr. Holly Stith

Faculty

Dr. Julie Perry

Abstract

Background: Depression leads to significant economic and health burdens, causing 200 million lost workdays and costing employers $17 to $44 billion annually (CDC, 2022). It accounts for 4.3% of the global disease burden and is a leading cause of disability worldwide (WHO, 2021). Chronic pain, affecting 20.9% of United States adults, often exacerbates depression, creating a vicious cycle of physical and emotional suffering (Rikard et al., 2023). Despite the availability of effective treatments, depression is frequently missed in primary care settings, with 50% of cases undiagnosed (Hawkes, 2019). Addressing both depression and chronic pain through improved screening and holistic care is essential for enhancing patient outcomes and reducing healthcare costs.

Purpose: The purpose of this project is to evaluate the effectiveness of two strategies in enhancing screening rates for populations at increased risk of depression underdiagnosis.

Methods: This two-part study examines the effectiveness of improving screening rates for populations at higher risk of underdiagnosed depression. Part one consists of a quasi-experimental one-group pre-test/post-test design at Pain Treatment Institute, a multi-site, single-practice interventional pain management clinic in Texas, to evaluate the knowledge, attitudes, perceptions, skills, and self-efficacy of healthcare providers in discussing and screening depression with patients who have chronic skeletal pain, autoimmune pain, and migraine/headache pain. Data was collected through an adapted questionnaire that assessed knowledge, attitudes, perceptions, skills, and self-efficacy related to depression screening (Okoli et. al, 2017). The voluntary participation survey was dispensed in January 2025 to providers currently practicing at an interventional pain management clinic, Pain Treatment Institute, with locations in Plano, McKinney, Frisco, Allen, Rockwall, Sherman, and Mesquite, Texas. Part two consists of a cross-sectional examination to estimate the prevalence of symptoms of depression by administering a Patient Health Questionnaire – 9 (PHQ–9) to patients receiving care at Pain Treatment Institute. Data analysis was completed using IBM SPSS statistical software.

Results: This study examined the impact of an intervention on certified providers' intentions, attitudes, subjective norms, perceptions, skills, and self-efficacy regarding the assessment of depression in patients with chronic pain. Six providers participated in the study. The intervention did not have a statistically significant effect on any of these variables. A total of 18 patients with chronic pain participated in the survey. Most of these patients (61.1%) reported no depressive symptoms. However, a significant proportion (55.6%) reported that chronic pain affected their mental health.

Conclusion: Chronic pain is closely linked to depression, which necessitates routine mental health assessments and regular screenings for effective pain management. While the intervention did not change the providers' attitudes or skills, it did establish a process for incorporating depression screening into clinical practice. The results of the study show that it may be useful to use instruments such as the PHQ-9 to identify symptoms of undiagnosed depression that is not previously diagnosed in patients with chronic pain. Future efforts should be aimed at enhancing the involvement of providers, removing barriers to screening, and assessing their performance in the long term.


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