Health care problems involve a myriad of complications among individuals. These need a lot of contributing factors from various sources. Irrespective of age and sex, health ailments become worsen and need urgent clinical intervention. Here, information regarding the history of the disease condition and the associated symptoms, psychological or behavior pattern changes have an important role to play.
In such context, the present paper highlights a description on the topic screening depression”. Major depression is considered one of the most frequently occurring conditions in primary care that affects nearly 8% of patients (Andrews, 2001). For every five individuals, one may visit a primary healthcare facility to seek a remedy for depression. Depression could become episodic, but 12% of patients with depression are believed to have a chronic course (World Mental Health Survey Consortium, 2004). Depression episodes that reoccur are difficult to manage. Even though depression is one of the frequent disorders occurring in primary care, many health care providers do not regularly screen for treating depression. If there is the implementation of evidence-based care, a reduction in the proportion of disability for patients with depression would be expected (Sanderson et al., 2007).
Currently, in male and female individuals with an age range of 15-44 years, depression has become the second cause. It was reported that for correcting the problem of depression certain Primary care-based quality programs have an influential role in enhancing, satisfaction with care, functioning, health outcomes, economic productivity, and quality of care (Depression, 2012). Due to under treatment, morbidity and mortality are resulting from depression (Davidson and Meltzer, 1999). In the United States, nearly 9% of patients get affected with depression which rises the medical care costs to greater than $43 billion.
However, the management of depression is still a concern because of poor attention on the problem in our area. Primary care and its setup are urgently needed to resolve the issue. Health care professionals and the relevant specialists have to come forward with a standardized paradigm to screen individuals with depression.
Therefore, the main objective of the description is to provide a proposal to the funding agency or appropriate government authority seeking permission with enough funds to screen the depression patients in primary care settings.
Initially, a timeline was developed for initiating and completing the project. This involved a two-and-a-half period. This project was carried out at our prestigious Reynolds Medical Institute equipped with a primary care facility. A proposal was written describing the need for screening depression patients of nearly 375 at the institute. For implementing the project, during the first 6 month period, a survey was undertaken to identify the patients from different corners of the city. We followed the patient selection criteria similar to the earlier published reports. Here, the patients were chosen through mass household sampling and were of ages 15 or older.
Information on the questionnaire described by the U.S. Preventive Services Task Force was sought which recommended clinical practice guidelines screening adults and adolescents to facilitate precise diagnosis, reliable treatment, and follow-up strategy. Most importantly, Patient Health Questionnaire (PHQ)-2 and PHQ-9 are the most preferred screening tools for validation. It was described that PHQ-2 has 67 percent specificity and 97 percent sensitivity in adults whereas the PHQ-994 percent specificity and 61 percent sensitivity in adults. So the questionnaire we followed was in agreement with the standard PHQ-2 and PHQ-9 format.
While rating or evaluating, the PHQ-9 was applied; for older adults, if PHQ-2 is positive for depression. Similarly, for an effective follow-up test, we implemented an a15-item Geriatric Depression Scale as an important parameter. In addition, once the screening tests are found positive for depression, in the next stage we confirmed the patient’s symptoms based on agreement with the diagnostic criteria of the Diagnostic and Statistical Manual of Mental Disorders (DSM) (Maurer, 2012).
For those patients who were nonnative English speakers, especially, for Chinese patients, the questionnaire was prepared in that language version. The other questionnaire developed was the Short-Form 12-Item Health Survey (SF-12) and Happiness Scale (Yu et al., 2012). We collected information also on health service use and health. PHQ9 was on providing diagnosis by the assessment of impairments and symptoms and providing a score in the process of selection and treatment monitoring (Patient Health Questionnaire, 2012). The PHQ-2 was about the anhedonia and depressed mood developed two weeks earlier and the scoring was as 3-almost every day and 0- not at all. So, as mentioned nearly 350 patients present in 7 obstetrics-gynecology clinics, and 8 primary care clinics completed PHQ2.
Further, we used a 20 item Short-Form General Health Survey for assessing the construct validity, symptom-related difficulty, clinic visits, and self-reported sick days. Criterion validity was also assessed by conducting an independent structured mental health professional (MHP) interview in all the patient populations (Kroenke, Spitzer & Williams, 2003). The study is a cross-sectional observational study and involved a large group of people with various racial/ethnic groups, ages, and sex. The patient informed consent was obtained after the patients were told about the health benefits of participation in the study.
However, to fully implement the project certain challenges were identified. The patients were mostly from rural regions. The nearby out patient clinics of primary health care centers (PHC’c) were contacted through telephone and advised to recommend the local patients to the Research Institute.
Initially, the patients were not having proper visits to the nearby medical centers. This increased the wait time for pooling the patient sample size and presented a major obstacle for the hospital staff to identify the target patient population. The survey was undertaken through the extensive touring of rural areas. The depression evaluation team was employed in three groups. The language problem was another barrier. This made our search for a professional language translator who will be familiar with assisting the medical team in obtaining the information. Most of the rural people were reluctant to involve in the study. They have explained in detail the benefits of the study.
The other barrier was the absence of a specific group of the population who were regarded as very risky for depression. Follow-up tours and surveys were made to collect the information from all groups of the rural patient population. Some populations had secondary complications other than depression. These were excluded from the study. Apart from direct visits to households, primary health care centers and district hospitals served as assets to the overall implementation of the project. These centers served as mediators in making the rural population available to the proposed depression screening project.
They assisted the medical surveyors with all the basic information of the patient population like their exact location, living conditions, economic status, etc.
The symptoms of depression were most prevalent in the patient population as revealed from the health centers. The assistance of experts from special research centers has played a crucial role to assess the severity of the depression and consider the most suitable and under high-risk group category. Depression enables a myriad of psychological, behavioral aberrations which need to be corrected over time. To accomplish this certain goals are essential to focus and expect a good outcome. These goals may be of several kinds.
Firstly, mood patterns are short and quick to work. Most people in depression face the thought of suicide. Hence, becoming free of suicidal thoughts by contacting a crisis hotline is the option. Next, is to self-assess and describe the feeling of positivity about self and capabilities. Look for a good and comfortable sleep every night for 7-8 hours. Overcome sleep or a nap to hide from others’ attention or activities. Well grooming every day. Self expresses the feeling of a happy mood. Design at least three short and easiest performing “to do” lists and accomplish them daily. Perform the task of Journaling and self-talking positively every day and rejoice. Pass out a day/ week devoid of any disappointing spells.
While recalling the past, attempt for strategy development for thought distraction (Treatment Plan Goals, n.d.). In addition, long-term goals do play a very important role in alleviating depression. This is accomplished by the approach of formulating the objectives one needs. This could help to target exactly what is essential to achieve instead of expressing willingness to get rid of depression simply.
Since depression varies from person to a person long-term goals are vital. This enables oneself to become a target-oriented individual with a future outlook.
For example, while formulating long-term goals, one must imagine what they would become in six months’ duration.
Here, specificity works as a guide and makes it easier for reaching the expected destination. The use of positive terms makes it worth happening. Say, “I would be able to attend the big parties I have received an invitation for”. Use of negative terms is not recommended, like “I would stop attending the big parties” as it has a negative meaning.
Therefore, the use of positive terminology and avoiding negative terminology often determine the long-term goal setting. Next, prioritizing goals is important in long-term goals. The most preferred and wise method is, to begin with, the problem of most significance that depresses the person. While handling this task, very often the individual is left unsure about the type of goal that will help to alleviate depression. In such cases, he or she can look back and make a goal updating work later as they move forward into depression in depth. Managing criticism of other individuals is another strategy (Negative Thinking, 2012).
Other goals in overcoming depression are a commitment to impossible tasks. Here, many patients feel that they would not be ever cured or treated, and trying to set up goals in such context may appear an impossible task. In such cases, the first goal would be to get diagnosed accurately.
Then, build assumptions with a view that the consulting doctor is a good treatment initiator and can assure reliable treatment objectives and outcomes. The doctor may give rise to new hopes to become worth fitting for the circumstances although the patient may feel that they never manage to reach the pinnacle in overcoming the world
of darkness left by depression. Hope and Optimism are excellent feelings to fight against depression. Similarly, dairy writing, self-appraisal is also can be considered as goals to overcome depression (Murnaghan, 2010). Further, there is a need to construct an effective budget for the successful implementation of the project.
Reynolds Medical Research Institute is a prestigious organization that has good infrastructure with patient serving facilities. For this, an estimate of approximately, $25000 was required. An application cum proposal was prepared and sent to the government funding agency National Institute of Health (NIH), US. Private funding agencies, charitable trusts were also contacted to seek financial assistance. Since the problem of depression is serious in this region, rapid execution of the screening work was important. The initial plan was to recruit three special experts, three nurses, two research assistants for two years.
The hired professionals were paid a salary of $3000, $2000, and $1500, respectively. A specially equipped laboratory was set up for conducting medical examinations of Depression patients at an estimated cost of $15000. Transport facility is essential for touring remote rural locations for carrying out household and health canter surveys. To accomplish this, two vehicles, two driving assistants were hired at a $1200 estimate of $1300 $1000 per month, respectively. For digital maintenance of patient records, appropriate high configuration mac -computers were bought and data entry operators were hired. The estimate was around $ 5000.
Annual maintenance costs were expenditures to review the status and correct functioning of computer systems and avoid any information retrieval defects. To implement this, companies that provide software and networking solutions were approached and hired. They estimate for this contract was $ 10,000 annually.
The miscellaneous expenditure was another but not least budget to be proposed It included buying small to moderate furniture, some beds, emergency medical kits, medications, stationery items, etc. The estimate for this expenditure was $15000.So, keeping in view the budget approved by various funding agencies, screening for depression in the regional population is of paramount importance. Depression seems to be an important health disorder affecting nearly 16% of the US population. As such, our project has implications for diagnosing many individuals with depression. We assume that much of the population we identified was left undiagnosed for so many years.
Their depression-related complaints have worsened and they are on the verge of suicide attempts. “No-harm contracts” are not safe in avoiding suicide (Setting Priorities, 2012). As such, our timely intervention with robust planning accompanied by financial support would help many patients overcome the ill effects of depression. It will be a contribution to the government’s effort to minimize the burden of depression symptoms among adolescents and older individuals.
The government has set up many guidelines to manage depression. Some of these include recognition, information collection, cognitive behavior therapy, Antidepressant drug treatment, continuation, and relapse prevention in Inpatient care. Home treatment teams, Transcranial magnetic stimulation, etc (Agency for Healthcare, 2012). We describe that the financial sources have provided good stimulus to carry out the project in a way related to the health care guidelines, published reports, and understand the severity of the problem. We anticipate that the significant results obtained from our studies would provide additional data to the government agencies. Earlier, there were certain inconsistent investigations on depression screening probably due to lack of financial support.
Yet, there were many proposal requests from various corners of the nation. Overall, the budget sanctioned has brought forward the required work labor and provided timely feedback to the government with insights on addressing the issue of depression.
References
Andrews, G. (2001). Should depression be managed as a chronic disease? British Medical Journal, 322 (7283): 419–421.
Agency for Healthcare Research and Quality: Guideline summary -Depression. (2012). Web.
Davidson, J.R.T., & Meltzer-Brody, S.E. (1999). The underrecognition and undertreatment of depression: what is the breadth and depth of the problem? J Clin Psychiatry, 60, 4-9.
Depression: What is Depression? (2012). Web.
Kroenke, K., Spitzer, R.L., & Williams, J.B. (2003). The Patient Health Questionnaire-2: validity of a two-item depression screener. Med Care,41(11),1284-92.
Li, C., Friedman, B., Conwell, Y., & Fiscella, K. (2007). Validity of the Patient Health Questionnaire 2 (PHQ-2) in identifying major depression in older people. J Am Geriatr Soc, 55.(4)596-602.
Maurer, D.M. (2012). Screening for depression. Am Fam Physician, 85(2), 139-44.
Murnaghan Ian. (2010). Setting Realistic Goals to Overcome Depression. Web.
Negative Thinking – Cycle of Depression. (2012). Web.
Patient Health Questionnaire.(2012). Web.
Sanderson, K., Andrews, G., Corry, J., & Lapsley, H. (2003). Reducing the burden of affective disorders: Is evidence-based health care affordable? Journal of Affective Disorder, 77, 109–125.
Treatment Plan Goals & Objectives. (n.d.). Web.
World Mental Health Survey Consortium. (2004). Prevalence, severity, and unmet need for treatment of mental disorders in the World Health Organization world mental health surveys, JAMA 291(21), 2581–90.
Yu, X., Tam, W.W., Wong, P.T., Lam, T.H., Stewart, S.M. (2012).The Patient Health Questionnaire-9 for measuring depressive symptoms among the general population in Hong Kong. Compr Psychiatry,53(1),95-102.