Date of Degree


Document Type

Doctoral Project

Degree Name

Doctor of Nursing Practice (DNP)




Diana Beckmann-Mendez


Najah Al-Shalchi


Background and Review of Literature. Approximately 11 million Americans 18 years or older experienced a severe symptom of depression leading to impairment in 2017. The severity of depressive symptoms is often miscalculated in primary care as measurement-based tools for the diagnosis and ongoing reassessment varies. Purpose. The purpose of the project was to increase provider adherence in using the patient health questionnaire-9 (PHQ-9) for ongoing evaluation of the severity of depressive symptoms in patients with depression at a primary care clinic in San Antonio, Texas. Objectives. The main objective of this Doctor of Nursing Practice project is to improve provider assessment and use of a measurement-based tool to assess depressive symptoms. Another objective is to improve referral rates to behavioral health services for the treatment of depressive disorders that are not responding to their current treatment plan. Planned Intervention. Important intervention includes staff education on the importance of using reliable tools to measure depression severity, such as with the PHQ-9, in patients of the clinic. Additionally, assuring provider adherence to using the PHQ-9 to assess the severity of depressive disorders to guide treatment plans, follow-up care, establish medication regimen, determine psychotherapy needs, and refer to behavior health services. Results. Post-intervention there was a 50% (N=25) increase in PHQ-9 use for depression severity scoring and of those patients screened, 40% were referred to mental health providers post-intervention. Implication. The use of a measurement-based tool to assess depression severity allows for individualized and accurate disease management, making it an essential aspect primary care.