The Problem Of Underdiagnosed Major Depressive Disorder Assignment

Final Problem Worksheet

1. Please state and describe your selected specific clinical problem for your DNP Project

The selected clinical problem for my DNP Project is the rising incidence of underdiagnosed major depressive disorder (MDD) and suicidality among adolescents and young African American adults. This problem is characterized by a lack of timely recognition and intervention within this demographic, leading to potentially severe consequences such as suicide attempts and exacerbation of mental health issues. The problem is compounded by systemic barriers, including stigma surrounding mental health in underserved communities and limited access to culturally responsive care (Handy et al., 2022)The Problem Of Underdiagnosed Major Depressive Disorder Assignment. Addressing this issue requires a comprehensive approach that entails culturally sensitive screening tools, community outreach programs to destigmatize mental health discussions, and the development of tailored interventions that consider the unique sociocultural factors impacting young African American adults.

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2. Is this a problem globally? If yes, cite data/description. If no, describe why it is not.

Yes, the underdiagnosis of major depressive disorder (MDD) and the increasing rates of suicidality among adolescents and young adults in the United States represent a global concern mirrored in various cultural contexts. According to the World Health Organization (WHO) (2023), depression is a leading cause of disability worldwide, affecting over 5% of all adults, with suicide being a major cause of death among individuals aged 15-29. While the prevalence rates might vary across different regions, studies have consistently shown disparities in mental health outcomes among minority populations and adolescents, including African Americans, due to systemic barriers such as stigma, inadequate access to mental health services, and cultural insensitivity in care delivery (Jimenez et al., 2022)The Problem Of Underdiagnosed Major Depressive Disorder Assignment. These findings emphasize the urgency of addressing mental health disparities on a global scale and implementing culturally competent strategies to improve early detection and intervention for MDD and suicidality among diverse populations.

3. Is this a problem nationally? If yes, cite data/description. If not, describe why it is not.

Yes, the underdiagnosis of major depressive disorder (MDD) and suicidality in adolescents and young African American adults is a problem nationally in the United States. According to White (2019), African Americans are 20% more likely to experience serious mental health problems than their white counterparts, yet they are less likely to seek treatment. This underdiagnosis and undertreatment can be attributed to various factors, including cultural stigma surrounding mental health, lack of culturally competent mental health services, and systemic barriers to accessing care. Studies have shown that African American youth are more likely to experience environmental stressors such as discrimination and socioeconomic disadvantages, which can contribute to the development of MDD and suicidality (Argabright et al., 2021)The Problem Of Underdiagnosed Major Depressive Disorder Assignment. Addressing these issues requires a comprehensive approach that includes increasing access to culturally competent care, reducing stigma, and addressing the social determinants of mental health within African American communities.

4. Is this a problem in your state, region, or city? If yes, cite data/description. If not, then explain why it is still a problem at your clinical site, even if it is not present anywhere else locally.

Yes, this problem is present in Maryland, particularly in urban areas such as Baltimore. At my clinical site in Laurel Regional Hospital, we often receive referrals from hospitals and primary care providers of patients who were underdiagnosed or did not receive appropriate treatment for MDD and suicidality. While the issue may not be as widely recognized in other parts of the state, it is still a significant concern within our community, highlighting the need for targeted interventions and improved access to culturally competent care.

5. Provide data/support through internal evidence and stakeholder testimony regarding why this is a problem at your clinical site. Please provide a rationale for selecting this problem at your site.

At Laurel Regional Hospital, this problem is evident through internal evidence gathered from patient records and provider observations. We have noticed a pattern of patients presenting with symptoms suggestive of depression or suicidality, but their conditions were not accurately diagnosed or treated during initial encounters. Stakeholder testimony from our healthcare team corroborates this, with providers expressing concerns about the lack of culturally responsive screening tools and resources tailored to the unique needs of our patient population. The rationale for selecting this problem at our site stems from the organization’s commitment to providing equitable and comprehensive care to all patients, recognizing the disparities that exist in mental health diagnosis and treatment among adolescents and young African American adults. The Problem Of Underdiagnosed Major Depressive Disorder Assignment

6. What are the current related mortality and morbidity rates of this problem in the United States?

In the United States, the current related mortality and morbidity rates associated with underdiagnosed MDD and suicidality are concerning. Data from the Centers for Disease Control and Prevention (CDC) (2023) reveal an alarmingly increasing rate of suicide over the past two decades at 37%, with young adults and minority populations experiencing disproportionately high rates. Youth suicide rates rose by 62% between 2007 and 2021, with African American youth, in particular, facing a higher risk of suicide compared to their white peers.

7. What are the financial implications of this problem at a global and or national level? What are the financial implications of this problem at your selected clinical site?

The financial implications of underdiagnosed MDD and suicidality are significant both nationally and at our clinical site. Globally, common mental health disorders (anxiety and depression) were estimated to cost the global economy 2.5 trillion dollars in 2010 in healthcare expenditures and lost productivity and are projected to increase to US$ 6.1 trillion in 2030 (de Oliveira et al., 2022)The Problem Of Underdiagnosed Major Depressive Disorder Assignment. In the United States, inadequate diagnosis and treatment of mental health conditions contribute to substantial economic burdens, including healthcare costs, lost workdays, and decreased productivity. At our clinical site, the financial implications of this problem include increased healthcare utilization due to untreated or undertreated mental health conditions, potential legal liabilities associated with missed diagnoses, and the need for additional resources to address the mental health needs of our patient population.

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8. What are some risk factors for why this problem is occurring, including who is at risk in your practice setting?

Several risk factors contribute to the occurrence of underdiagnosed MDD and suicidality, including socioeconomic disparities, access barriers to mental health services, cultural stigma surrounding mental illness, and environmental stressors such as discrimination and trauma. In our practice setting, patients from underserved communities, particularly young African American adults, are at increased risk due to these factors. Additionally, lack of provider awareness or training in culturally competent care may contribute to underdiagnosis and inadequate treatment.

9. What are some barriers that currently exist for addressing this problem?

Barriers to addressing underdiagnosed MDD and suicidality include systemic challenges such as limited access to mental health services, especially for marginalized populations, the stigma surrounding mental illness within communities, and a shortage of culturally competent providers (Jimenez et al., 2022). Within our clinical setting, specific barriers include time constraints during patient visits, lack of standardized screening protocols, and insufficient resources for mental health education and outreach.

10. How will addressing this problem improve patient outcomes and quality of health for the practice site’s patients? The community at large? The nation? The Problem Of Underdiagnosed Major Depressive Disorder Assignment

Addressing this problem will improve patient outcomes and quality of health at our practice site, in the community, and nationally by implementing culturally responsive screening tools and interventions, ensuring timely diagnosis and appropriate treatment for patients, thereby reducing the risk of suicide attempts and improving mental health outcomes. This will benefit individual patients by alleviating suffering and improving quality of life and will also have broader societal implications, including reduced healthcare costs, increased productivity, and enhanced community well-being.

11. What is your PICO question using the P-I-C-O format?

“For primary care providers referring adolescents and young African American adults for mental health care (P), does an educational presentation on the use of a validated depression screening tool (I) compared to current practice (C) affect provider knowledge and the number of correctly completed screening assessments? (O)?”

12. What is a potential project idea (include the who, where, how, and when)?

A potential project idea could be implementing an educational intervention for primary care providers (PCPs) at our clinical site, focusing on using a validated depression screening tool, such as the PHQ-9. The intervention could involve training sessions or workshops conducted by mental health professionals, where PCPs learn about the importance of early detection of depression among adolescents, receive guidance on administering the screening tool effectively, and gain insights into interpreting results and initiating appropriate referrals or interventions. The project could commence with a needs assessment to identify current practices and knowledge gaps among PCPs, followed by developing and implementing the educational intervention. Data collection could occur over a specified period to evaluate the impact of the intervention on provider knowledge and the number of correctly completed screening assessments, potentially leading to improved mental health outcomes for adolescents in the community. The Problem Of Underdiagnosed Major Depressive Disorder Assignment

References

Argabright, S. T., Visoki, E., Moore, T. M., Ryan, D. T., DiDomenico, G. E., Njoroge, W., Taylor, J., Sinan Gülöksüz, Gur, R. C., Gur, R. E., Benton, T. D., & Barzilay, R. (2021). Association between discrimination stress and suicidality in preadolescent children. MedRxiv (Cold Spring Harbor Laboratory). https://doi.org/10.1101/2021.05.30.21258084

Centers for Disease Control and Prevention. (2023, May 9). Disparities in Suicide | CDC. Www.cdc.gov. https://www.cdc.gov/suicide/facts/disparities-in-suicide.html#:~:text=Between%202018%2D2021%2C%20suicide%20rates

de Oliveira, C., Saka, M., Bone, L., & Jacobs, R. (2022). The role of mental health on workplace productivity: A critical review of the literature. Applied Health Economics and Health Policy, 21(2). https://doi.org/10.1007/s40258-022-00761-w

Handy, A., Mangal, R., Stead, T. S., Coffee, R. L., & Ganti, L. (2022). Prevalence and impact of diagnosed and undiagnosed depression in the United States. Cureus, 14(8). https://doi.org/10.7759/cureus.28011

Jimenez, D. E., Park, M., Rosen, D., Joo, J. hui, Garza, D. M., Weinstein, E. R., Conner, K., Silva, C., & Okereke, O. (2022). Centering culture in mental health: Differences in diagnosis, treatment, and access to care among older people of color. The American Journal of Geriatric Psychiatry, 30(11). https://doi.org/10.1016/j.jagp.2022.07.001

White, R. (2019, February 12). Why mental health care is stigmatized in Black communities. USC Suzanne Dworak-Peck School of Social Work. https://dworakpeck.usc.edu/news/why-mental-health-care-stigmatized-black-communities

World Health Organization (WHO). (2023, March 31). Depressive disorder (depression). Www.who.int. https://www.who.int/news-room/fact-sheets/detail/depression#:~:text=Globally%2C%20an%20estimated%205%25%20of

Assignment Instructions

Hello,

I submitted a draft of the PICO question; from the feedback I have received from the instructor I had to reword my clinical problem and my PICO question. Please see the attached updated assignment I have submitted last time.

Please use a different paper for the assignment with question at the heading

 NUR 702 Problem Identification Worksheet | 20% of Grade | 130 points

Please include citations for all facts and data shared in your responses for each question. Proper spelling and grammar is expected and up to 5 points may be deducted from a response if it is not written at a scholarly, doctoral level. Please write in complete sentences and do not use bullets. Use of APA 7^th edition for citations and references is required with no exceptions. There is no correct length to your response if the prompt is answered in a clear and complete manner. Each response is worth ten points. A cover sheet is not required. Please save your worksheet with your last name first. You may type on this document or create a new one.

1. Please state and describe your selected specific clinical problem for your DNP Project:

Based on what I have submitted the clinical problem is: The increasing cases of underdiagnosed major depressive disorder (MDD) and suicidality among young adults.

2. Is this a problem globally? If yes cite data/description. If no, describe why it is not.

3. Is this a problem nationally? If yes, cite data/description. If not, describe why it is not.

4. Is this a problem in your state, region or city? If yes, cite data/description. If not, then explain why it is still a problem at your clinical site even if it isn’t present anywhere else locally.

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State is Maryland, hopefully you find cite data for Maryland. if you find any cite data for any city of Maryland you can use it. If no cite data, to explain why it is still a problem, mention what I had on the previous assignment: Referrals from the hospital and Primary care providers of patients who were underdiagnosed.

5. Provide data/support in the form of internal evidence and stakeholder testimony as to why this is a problem at your clinical site. Please provide rational for selecting this problem at your site.

It is more of what was already said in the previous assignment but please add more to it

6. What are the current related mortality and morbidity rates of this problem in the United States?

7. What are the financial implications of this problem at a global and or national level? What are the financial implications of this problem at your selected clinical site?

8. What are some risk factors for why this problem is occurring including who is at risk at your practice setting?

9. What are some barriers that currently exist for addressing this problem?

10. How will addressing this problem improve patient outcomes and quality of health for the practice site’s patients? The community at large? The nation?

11. What is your PICO question using the P-I-C-O format?

The PICO question developed for my DNP project is as follows: ” For primary care providers referring adolescents for mental health care (P), does an educational presentation on the use of a validated depression screening tool (I) compared to current practice (C), affect provider knowledge and the number of correctly completed screening assessments? (O)?”

12. What is a potential project idea (include the who, where, how and when)?

I am not sure yet what this is about, I am guessing clinical problem for DNP project is different from project idea. Probably project idea would be: Increasing Depression screening at primary care level. I may be wrong. Please help.

13. Please list references in alphabetical order for all citations used throughout this worksheet below in proper APA 7^th edition format. If citing a website or a journal article, please include a doi hyperlink so that faculty has access to the article. The Problem Of Underdiagnosed Major Depressive Disorder Assignment