Center of the Hudson Valley
Good Health includes Good Mental Health: Administer the GAD7 and PHQ9 Annually
Suzette Gjonaj MD, Jenny Sung MD, Timothy Collins MD, Alyssa D'Amico RD, Georgette Curcio, Elaine Suderio-Tirone DNP, Addison Forgit LCSW/MHC, Caitlin Lennon LMSW, Boston Children’s Health Physicians, Valhalla,NY, Vassar Brothers Med Ctr, Poughkeepsie,NY, MidHudson Regional Hosp, Poughkeepsie,NY
Background:
Living with Cystic Fibrosis (CF), presents a myriad of challenges that extend beyond physical health. People with CF (PwCF) often must navigate a complex landscape where the management of their health intertwines with the preservation of their mental wellbeing. The burden of coping with a chronic illness can give rise to mental health difficulties, including anxiety and depression, which, if left unaddressed, can negatively exacerbate the already demanding nature of the condition. The toll of these psychological challenges can manifest in various aspects of life, from adherence to prescribed treatments to overall physical health and quality of life. Screening for and recognizing the early signs of depression and anxiety becomes paramount. Timely intervention and access to appropriate mental health services can mitigate their impact by offering individuals the chance to better cope and thrive despite the challenges they face.
In 2015, the Cystic Fibrosis Foundation and the European Cystic Fibrosis Society published consensus statements for annual screening and treating depression and anxiety.
A review of our internal center data showed that we needed to improve the depression and anxiety screening with our eligible patients at our affiliate center. This propelled us to launch a quality improvement initiative to align with the CFF guidelines.
Method:
Our global aim is to improve assessing patients and meeting their psychosocial needs. The process began with evaluating depression and anxiety screenings completed in 2022 and ended with all eligible patients being screened with the PHQ9 questionnaire for depression and GAD7 questionnaire for anxiety. By doing this, we would identify patients with anxiety and depression, and connect them with our mental health coordinator and other needed services. Our specific aim was to increase the percentage of patients screened for anxiety and depression from 50% to 100%. After assessing the barriers and identifying eligible patients, we started the multiple plan-do-study-act (PDSA) cycles. Initially physicians administered questionnaires at the time of an encounter. A tick-and-tally of all completed screens were reviewed quarterly. Lastly, social workers contacted any outstanding eligible patients who have yet to complete an annual mental health screening in the last quarter. Patients who declined a mental health screen for the year were evaluated to identify further barriers.
Results:
Completed anxiety and depression screening using the GAD7 and PHQ9 questionnaires increased from 50% in 2022 to 78% in 2023.
Conclusion:
The prevalence of depression and anxiety among PwCF is high with studies revealing significant percentages across different age groups. It has been reported that in CF, 26% of adolescents (12-18years) and 28.4% adults have anxiety, and 18.7% of adolescents and 27.2% of adults have depression. These statistics underscore the need for regular screening to identify and address mental health. Mental wellbeing plays a pivotal role in treatment adherence, quality of life, and disease progression. To address this issue we are committed to the ongoing of this QI initiative, implementing additional PDSA cycles until we achieve our target of screening 100% of eligible patients annually. Through diligent monitoring and updates using the QI process, we are confident in our ability to attain our objective in the near future.