Amy Snow

Date of Award


Document Type

Doctor of Nursing Practice (DNP)

Degree Name

Doctor of Nursing Practice (DNP)



Committee Chair

Tracie Morgan


Depression (Mental)--Diagnosis, Rural health services


There is a high prevalence of depression in the rural primary care population. This project aimed to identify patients suffering from depression in a rural primary care clinic. The project’s goal was to improve the diagnosis and treatment of major depression in adults through the implementation of the Patient Health Questionnaire-2 (PHQ-2) and the Patient Health Questionnaire-9 (PHQ-9). Follow-up visits were conducted over a 12-week period to assess patients’ response to pharmacotherapy and/or psychotherapy established by the current American Psychological Association guidelines. Identification of depression through the use of screening protocols assists in appropriate diagnosis and treatment plans. The project site is a not-for-profit primary care clinic located in rural Surry County, North Carolina. The clinic provides medical services ranging from initial diagnosis to chronic disease management. Currently, there is no established depression screening protocol being routinely used within the workflow or consistent adherence to current clinical guidelines for the treatment of depression at this site. This practice change project implemented depression screening and treatment management at the rural primary care clinic. Screening for depression is recommended in a two-stage screening process using the PHQ-2 and the PHQ-9. The PHQ-2 was administered, and those scoring 3 or greater were then asked to fill out the PHQ-9. After completion of the PHQ-9, if their score was 5 or greater the questionnaire was given to the healthcare provider to use during the clinical assessment. Successful treatment for patients of this project was defined as a significant decrease between the patient’s initial and follow-up PHQ-9 scores. The mean score for the pre-test PHQ-9 was 18.47 (SD = 4.685) and the mean score for the post-test PHQ-9 was 11.68 (SD = 5.079). The lower the score on the PHQ-9, the fewer symptoms of depression were reported. The paired samples t-test was used to compare the mean difference of 6.79 (SD = 4.990) and was found to be statistically significant at t (34) = 7.940, p

Available for download on Saturday, February 08, 2025