Introduction
The healthcare challenges associated with adolescents seeking care for depression, anxiety, and suicidal throughs remain unaddressed despite their increasing severity. It is problematic for adolescents to deal with negative emotions on their own because, during that period of their life, they struggle with developing and preserving emotional and social habits, which are essential to their well-being. When left unaddressed, young individuals’ mental health issues exacerbate and contribute to the increased level of stress through adolescence and adulthood, as well as severe implications such as depression and suicide (Malakouti et al., 2015). Therefore, the psychological challenges that individuals face when they are younger are essential to address in order to reduce the occurrence of adverse consequences such as suicide. The aim of the current assessment is to evaluate the available evidence-based practice targeted at addressing suicide rates and improving the strategies intended to prevent the occurrence of adolescent depression and suicide. In the course of the assessment, a position statement will be developed in the evidence-based PICO format concerning the recommended intervention to address symptoms of depression and suicidal thoughts among adolescents.
POI Significance
The significance of establishing evidence-based practice procedures is associated with the possibility of addressing the mental health needs of the target population. Some changes in practice would be put in places, such as maintaining regular contact with patients and their parents. The promotion of relevant health information for ongoing patient education, as well as the referral to mental health specialists and suicide prevention programs if needed (Malakouti et al., 2015). The implementation of the change process is expected to bring improved outcome measures, which would illustrate the influence of a healthcare intervention on patients’ health status (Agency for Healthcare Research and Quality, 2015). Specifically, it is expected to see a reduced percentage of adolescents ending their lives by suicide, a dropping rate of individuals of the age group having thoughts about suicide, as well as a lowering occurrence of depression and anxiety in the adolescent population group.
PICO
The PICO or clinical question formulated in regards to the identified healthcare issue is the following: in the population (P) of adolescents aged between 10 and 19 presenting to emergency departments or their NPs, what is the impact of an intervention (I) implying routine depression and suicidal evaluations, in comparison (C) to not implementing intervention and preserving the standard procedures, on improving the mental health of adolescents (O) with depression and suicidal throughs and ideations.
Thus, the target population involved in the PICO question is the group of adolescents aged 10 to 19 years old who present to emergency departments or seek care through their PCPs and NPs with symptoms of behavioral depression and suicidal attempts or having thoughts about killing themselves. The intervention suggested for implementation is concerned with conducting regular evaluations of the target population’s depression and suicidal thoughts during their visits to primary care professionals as opposed to evaluating patients’ mental health upon their visits to the emergency department. The effectiveness of the intervention will be compared by not implementing any changes in the care process and preserving the previously established procedures that are not concerned with regular evaluations and assessments of individuals’ mental states. The outcome expected from the intervention is the improvement of the target’s population mental health and well-being by reducing their symptoms of depression or suicidal ideation before they present to an acute care setting.
Tool Completion (Separate document)
Critique of Position Statement
Within the formulated position statement, the purpose is formulated clearly and in accordance with the needs of the identified population. Based on the latest research conducted by Chowdhury and Champion (2020), primary care-based interventions that are supported by the expertise of pediatric nurse practitioners have been shown to be imperative for addressing mental health needs. Therefore, the findings support the need to incorporate protocols aimed at helping patients overcome their mental health challenges that contribute to their considerations of suicide and the overall experience of poor mental health.
The recommendations of the statement imply the implementation of consistent mental health evaluations and the provision of the necessary level of support and intervention in cases when individuals struggle with their psychological well-being. Therefore, there is a need to incorporate evidence-based procedures for the follow-up and assessment of depression. The latest recommendations for depression assessment among adolescents have been developed by the American Academy of Pediatrics, which received funding from governmental agencies, foundations, as well as corporations. Because of the increased need to reduce the occurrence of depressive symptoms and suicide ideation among adolescents, the guidelines developed by the American Academy of Pediatrics include a valued interest for its authors, who are directly involved with caring for adolescents and children (Shain, 2016).
The information in the position statement is credible because it relies on data provided by the American Academy of Pediatrics regarding the rates of adolescent suicide and depressive symptoms as well as the currently implemented prevention programs within the primary health care network (Malakouti et al., 2015). However, it should be mentioned that data on adolescents’ suicide may sometimes be diminished considering the fact that some of the suicides are classified as accidents and are not included in genuine suicide statistics. The majority of interventions recommended considering both individual and environmental factors, which is what the position statement considers a preventive method.
The evidence used for supporting the position statement is predominantly level I, level V, and level VII due to the need to incorporate both experimental research from evidence-based clinical practice and expert and qualitative opinions provided by the researchers from expert committees. For the issue at hand, the evidence hierarchy in terms of the weakness or strength of evidence cannot be used as the main factor of qualification due to the significant social impact of the issue overall. The weaker-level evidence does not have an adverse impact on the overall recommendation because it adds to the considerations of adolescents’ individual factors that may not have been studied extensively yet. Thus, even in the case if the level of evidence is lower than expected, the decision to implement the proposed intervention is even more vital because of the need to reveal whether the solution would work to reduce suicidal ideation and depressive symptoms in adolescents. It is necessary to incorporate the practical procedures for assessing depression in the target population to prevent adverse outcomes for health (Chowdury & Champion, 2020).
Quality Improvement
The position statement developed with the aim of reducing symptoms of depression and suicidal thoughts among the target population aims to improve care quality. The bioethical principles of justice and beneficence are particularly important in regard to the position statement of the American Academy of Pediatrics concerning the prevention of depression and suicide in adolescents (Munyaradzi, 2012). The bioethical principle of justice is characterized as a moral obligation to act on the basis of fair adjudication between competing claims. In the ethics of healthcare, the principle is divided into several categories, such as the equal distribution of scarce resources, which is distributive justice, respect for people’s rights, and respect for morally acceptable laws. Because of the high rates of deaths by suicide among adolescents, it is essential to facilitate justice through advocating for the support of adolescents from various socioeconomic groups, as suggested by Shain (2016) for the American Academy of Pediatrics. This is necessary because adolescents from minority backgrounds, such as American Indian/Alaska Native males have the highest suicide rate (Shain, 2016).
In addition, sexual minority youth have more than twice the rate of suicidal thoughts and ideation, which is a relevant point for consideration when it comes to quality improvement recommendations. Therefore, primary care providers should pay close attention to the bioethical principle of justice when addressing adolescents’ mental health and improving the environments in which they find themselves. The principle of beneficence is understood as the necessity of healthcare professionals to provide, to the best level of their ability, positive benefits such as good health and the removal of harmful conditions from the patients that they serve. In the present context, adolescents must be removed from the circumstances that may negatively contribute to their emotional well-being and reduce the impact of risk factors that would enable depressive thoughts among the target population.
Conclusion
In conclusion, it is highly recommended to consider the primary care setting as a critical point for healthcare professionals to detect early signs of depression and anxiety and prevent suicide attempts. Routine depression screenings have a positive impact on suicide prevention rates, and their implementation will improve the quality of care and overall well-being of adolescents. Based on the existing evidence, the necessary changes must be made to increase the detection rates, such as additional personnel training, promotion of suicide prevention programs, and spreading of relevant information among the public. The reduction of depression and anxiety causes among the target population is one of the essential objectives for the healthcare system, and close cooperation between professionals will help facilitate this task. Moreover, suicide rates among the target population show significant racial and class-based disparity, further increasing the need to address the issue within the underresourced communities.
References
Agency for Healthcare Research and Quality. (2015). Types of health care quality measures.
Chowdhury, T., & Champion, J. (2020). Outcomes of depression screening for adolescents accessing pediatric primary care-based services.Journal of Pediatric Nursing, 52, 25-29.
Malakouti, S. K., Nojomi, M., Poshtmashadi, M., Hakim Shooshtari, M., Mansouri Moghadam, F., Rahimi-Movaghar, A., Afghah, S., Bolhari, J., & Bazargan-Hejazi, S. (2015). Integrating a suicide prevention program into the primary health care network: A field trial study in Iran.BioMed Research International, 2015, 193729.
Munyaradzi, M. (2012). Critical reflections on the principle of beneficence in biomedicine. The Pan African Medical Journal, 11, 29.
Shain, B. (2016). Suicide and suicide attempts in adolescents. Pediatrics, 138(1). Web.