Teenage years are loaded with strong emotions and low moods that often manifest as major depressive episodes (MDEs). Teen depression is rising, affecting about 10.4% of American adolescents and 29.7% of students in high school (Avenevoli, Swend-sen, He, Burstein, & Merikangas, 2015). Despite the high prevalence, it remains an under-recognized mental health issue because adolescents usually exhibit low readiness for treatment. Therefore, depression awareness could help increase utilization of psychiatric services by this population. This paper describes a depression awareness program (DAP) developed using the PDSA model and evidence-based strategies to achieve specific promotion objectives aligned with AHRQ indicators.
The Health Promotion Program
Adolescent depression is a chronic public health issue. Avenevoli et al. (2015) established that about 11% of teenagers report experiencing MDEs by the age of 18. The emotional instability arising from hormonal changes during adolescence increases the teens’ vulnerability to depression. MDE impacts the individual’s functioning, which leads to family burden, and it is a risk factor for suicide (Avenevoli et al., 2015).
Parental and adolescent understanding of depression and its effects may enhance the readiness for treatment. The objectives of the DAP program are to promote the emotional development of teens, facilitate public awareness on stress management, train teachers on handling depressed adolescents, and encourage depression screening.
The DAP program seeks to improve awareness and knowledge of depressive symptoms among the adolescent population. It will involve public education through booklets and short films about depression circulated in schools and colleges. Working with schools and other institutions would require participatory policy analysis to develop guidelines and modalities anchored in democratic principles for the program to succeed (Teitelbaum & Wilensky, 2018).
Other than mass media, the program will use social networking sites to create awareness and encourage health-seeking behaviors among teens. Additionally, it will also include community presentations and events to enhance individual mood recognition capacity and stir self-awareness. Participants will develop paintings illustrating their feelings or emotions. The aim is to encourage the expression of low moods and treatment-seeking behavior.
The role of advanced practice registered nurses (APRNs) as facilitators (educators) aligns with the DAP program. Community education is an evidence-based intervention for overcoming barriers to the utilization and frequency of use of health services (Brent et al., 2015).
There are obvious benefits to early identification and treatment of depression. Working with the teens and their families, APRNs can refer a depressed individual to specialist care for treatment. According to Avenevoli et al. (2015), adolescents with depressive symptoms who had not used mental health services at age 17 were at a higher risk of relapsing than those who had received treatment. Thus, early referral to specialist care is essential.
In addition to community sensitization and promoting the expression of melancholic emotions by adolescents, the DAP program will include depression screening days in schools. Students diagnosed with moderate to severe depressive symptoms will be referred to psychiatric care for early intervention. The awareness created through the DAP program will help decrease stigmatization of depression to promote treatment-seeking behavior among the youth.
The program will also teach the participants positive coping strategies through booklets, short films, and leaflets. Other methods for reaching the target population will include game says and road shows. Adaptive coping will help alleviate negative emotions associated with depression (Brent et al., 2015). DAP will also involve efforts to sensitize healthcare professionals and increasing their capacity to recognize mood disorders and refer the adolescent to psychiatric care for early intervention.
The Health Promotion Program Based on the PDSA Model
Several models exist for implementing change projects in healthcare organizations. Effective adoption of the DAP project’s activities – community/adolescent education, community presentations to raise awareness on depression, and teaching positive coping – will be executed using the PDSA model’s four steps – plan, do, study, and act.
In the “plan” step, an implementation team, comprising of school nurses, parents, teachers, and adolescents will be assembled to lead the DAP program. Its roles will include developing an aims statement for the project, analyzing the current prevalence of depression and use of psychiatric care by adolescents in the community, and creating the educational content and resources. A survey of the teens’ level of awareness of depression and its symptoms will be conducted to inform the process.
Those with a high need will be targeted first by the DAP program. Additionally, the school nurses will be trained in a “train the trainer” workshop to enhance their capacity to identify and refer youth with depressive symptoms to early psychiatric treatment. The content for the training material and resources, including short films, will be prepared at this stage in collaboration with adolescent mental health experts. The “Depression Awareness” kit will aim at raising community responsiveness to depression, as an impetus for seeking treatment.
The next step, “Do” stage, is where the actual implementation of a program occurs. For the DAP program, it will include rolling out of the activities – public education, encouraging the adolescent expression of emotions through painting, and teaching of coping strategies. Data on the problems experienced during implementation will be obtained to guide the “study” step of the model. Depressed youth will receive private psychiatric care. Access to these services will be ensured through collaboration with providers and volunteers. The DAP program will be offered to parents and peers to reduce the stigma associated with the use of mental health services.
The “Study” step encompasses the evaluation or review of the program. Some of the parameters assessed include the return on investment, modifications required, and any side effects noted. For the DAP program, the “study” stage will include monitoring self-reported MDEs, mental healthcare utilization rates, staff feedback, and participation levels of adolescents in awareness events. The last step of the PDSA model is “Act”. It entails a critical reflection of the project and its outcomes. The success of this program will be indicated by its preventive efforts, adolescent satisfaction with the care and privacy, and a rise in help-seeking behavior in this population.
Achieving Health Promotion Objectives Using AHRQ Indicators
Primary healthcare access and utilization show a significant variation among age groups. A large proportion of adolescents are uninsured or underinsured. As such, they are unable to access preventive care, health promotion, or counseling services. The Agency for Healthcare Research and Quality (AHRQ) (2019) has developed a set of quality indicators to address these disparities. A relevant module of the AHRQ measures covers the Prevention Quality Indicators (PQIs) that advocates for preventive care to avoid complications that could lead to hospitalization.
The DAP program’s awareness activities will encourage early depression screening and interventions to preclude severe disease or outcomes such as suicide. As Avenevoli et al. (2015) point out, adolescents who receive mental health services are at a lower risk of depression at age 17. Thus, DAP will address the PQIs through early intervention – community education, adolescent expression of emotions, and referrals. PQIs reflect the quality of care delivered by a hospital.
High-quality psychiatric services offered by the mental healthcare providers will indicate the success of the project. Patient education on coping strategies and access to resources will increase self-management among adolescents. The timeliness and privacy of care will lead to client satisfaction, which is a core indicator of quality. The rates of depression will decrease by giving adolescents adequate mental healthcare services.
Another set of AHRQ measures that will be used to achieve promotion objectives includes the pediatric quality indicators (PQIs) (AHRQ, 2019). It is meant to create a safety climate when delivering care to children and adolescents aged 17 years and below. For adolescents, access to community education and awareness activities included in the DAP program will alleviate stigma associated with the use of psychiatric services. Another aspect of safety is that achieving a lower adolescent depression prevalence will reduce cases of suicide or homicide in the community.
Conclusion
Adolescent depression is a severe health problem that requires early intervention. The DAP program encompasses public education through booklets and short films on depression, community presentations, and awareness events to promote the utilization of mental health services by teenagers. The implementation of the project is modeled along the four steps of the PDSA framework. Relevant AHRQ indicators for measuring the quality aspect of the program include measures on prevention and pediatric care. The goal is to promote self-management and positive coping among adolescents.
References
Agency for Healthcare Research and Quality. (2019). Innovation concepts and strategies. Web.
Avenevoli, S., Swendsen, J., He, J. P., Burstein, M., & Merikangas, K. R. (2015). Major depression in the national comorbidity survey–Adolescent supplement: Prevalence, correlates, and treatment. Journal of the American Academy of Child and Adolescent Psychiatry, 54(1), 37–44. Web.
Brent, D. A., Brunwasser, S. M., Hollon, S. D., Weersing, R. V., Clarke, G. N., Dickerson, J. F., … Garber, J. (2015). Effect of cognitive-behavioural prevention program on depression six years after implementation among at-risk adolescents: A randomized clinical trial. JAMA Psychiatry, 72(11), 1110-18. Web.
Teitelbaum, J. B., & Wilensky, S. E. (2018). Essentials of health policy and law (3rd ed.). Burlington, MA: Jones & Bartlett Learning.