Problem The National Institute of Mental Health (NIMH) (2016)

Problem Inquiry Discussion Board


Problem Definition and Widespread Significance

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            The National Institute of Mental Health (NIMH) (2016) defines depression as a serious mood disorder associated with persistent negative feelings such as anxiety, guilt, irritability, sadness, and worthlessness as well as with physical ailments that go unresolved despite treatment. Depression is a common mental disorder affecting more than 300 million individuals of all ages internationally, is the leading cause of disability worldwide, and contributes substantially to the overall global burden of disease (World Health Organization, 2017). In the United States, 2016 statistics indicate that 16.2 million adults had at least one episode of major depression in the past year which equates to nearly 7 percent of all adults (NIMH, 2017). The economic burden of depression is significant as well as widespread with costs to individuals, loved ones, employers, and expenses at the health system and society levels. According to researchers Egede, Bishu, Walker,  and Dismuke (2016), the estimated national annual expenditure for depression is 288 billion dollars.  


Prevalence and Impacts Specific to Older Adults in Primary Care Setting


     Depression is one of the most prevalent health concerns for older adults and 66 percent of the population under care receives treatment in primary care settings (O’Conner, Whitlock, Gaynes, & Beil, 2009). Recent statistics reveal that while lifetime occurrence of  the major depressive disorder is approximately 14 percent, evidence suggests prevalence among nursing home residents is over 50 percent (Pellegrino, Peters, Lyketsos, & Marano, 2013). This devastating disease process has severe consequences for aging patients to include declines in functional abilities, diminished quality of life, and increased use of supportive services with strong associations to poor outcomes and high rates of mortality (O’Conner et al., 2009). Impacts of the disorder are far-reaching as evidenced by research showing not only individual suffering, but also caregivers at an increased risk for developing mental disorders related to high levels of burden and stress, employers contributing significantly to treatment, and society incurring high costs in the areas of healthcare, reduced productivity, and lives lost (O’Conner et al., 2009).


Intervention in Primary Care Setting


The primary care setting is the entry point for most patients and manages 80 percent of those with psychological disorders (Sadock, Auerbach, Rybarczyk, & Aggarwal, 2014). Identifying depression in the elderly is complex as symptoms mimic physical illness, patients frequently deny low mood, and providers are often too busy and lack the necessary experience and skill to assess patients’ mental health (Sadock et al., 2014). Research shows that as many as 40 percent of depression cases are not detected in this setting and although providers are increasingly moving towards an integrative approach in regards to psychological services, a limited amount of evidence exists to support this (Sadock et al., 2014). The purpose of this project is to expand upon and update the evidence regarding the benefits of implementing systematic depression screening practices for older adults in the primary care setting.





In older adults between the ages of 55 to 75, does integrating a standardized depression screening tool into the patient check-in process increase the overall rates of depression screenings and new mental health diagnoses within a six month time period in the primary care clinic setting?




Egede, L. E., Bishu, K. G., Walker, R. J., & Dismuke, C. E. (2016). Impact of diagnosed

     depression on healthcare costs in adults with and without diabetes: Unites States, 2004-2011.

     Journal of Affective Disorders, 195, 119-126.


National Institute of Mental Health. (2016). Depression. Retrieved from


National Institute of Mental Health. (2017). Major depression among adults. Retrieved from


O’Conner, E. A., Whitlock, E. P., Gaynes, B., & Beil, T. M. (2009). Screening for depression in

     adults and older adults in primary care: An updated systematic review. Rockville, Maryland:

     Agency for Healthcare Research and Quality.


Pellegrino, L. D., Peters, M. E., Lyketsos, C. G., & Marano, C. M. (2013). Depression in

      cognitive impairment. Current Psychiatry Reports, 384(15). doi: 10.1007/s11920-013-0384-1


Sadock, E., Auerbach, S. M., Rybarczyk, B., & Aggarwal, A. (2014). Evaluation of integrated  

     psychological services in a university-based primary care clinic. Journal of Clinical

     Psychology in Medical Settings, 21(1) 19-32. doi: 10.1007/s10880-013-9378-8


World Health Organization. (2017). Depression. Retrieved from