The Family Nurse Practitioner Role in Primary Care in Screening Patients for Depression

January 16, 2024

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A family nurse practitioner consoles a patient. According to a survey from the Centers for Disease Control and Prevention (CDC) National Center for Health Statistics, 18.5% of U.S. adults in 2019 reported they had experienced symptoms of depression. With nearly one in five adults reporting these symptoms, this underscores the importance of the family nurse practitioner (FNP) role in recognizing potential signs of depression. Left undiagnosed and untreated, depression can lead to even more serious health issues.

Particularly when working in primary care, FNPs work closely with their patients, often providing emotional support in addition to clinical services. For example, it’s pertinent that FNPs understand depression is more common in patients with chronic illnesses and symptoms of depression can vary depending on a patient’s age and gender.

Students who are exploring online master of science in nursing programs with the goal of becoming FNPs can benefit from developing an understanding of depression, because such knowledge can assist them in providing the most optimal treatment to their patients.

Understanding Depression in Patients

At some point, many patients likely will experience sadness, anxiety, or temporary depression, particularly if they’re dealing with a chronic illness. The National Institute of Mental Health explained unlike temporary feelings of sadness or unhappiness, clinical depression involves symptoms that persist over a period of time and have a negative impact on patients’ daily lives and their ability to function.

The challenge for FNPs who work in primary care is to distinguish between symptoms indicative of temporary, contextual sadness and symptoms signifying clinical depression. Dr. Maurizio Fava, in the Primary Care Companion to the Journal of Clinical Psychiatry, noted symptoms of clinical depression in patients are routinely misdiagnosed as symptoms of chronic illnesses for which the patients are being treated. Consequently, patients don't always receive the mental health care they need. It has been estimated up to 10% of patients experience a major depressive disorder.

These findings are troubling, because patients who experience depression can have poorer outcomes in terms of recovery from their chronic illness. Fava explained depressed patients may display behaviors that can negatively impact their treatment and recovery. For example, they may forget to take medications or neglect other important steps to get well. Fava cited a study to support the claim, which found patients with major depressive disorder are less likely to be successfully treated for their chronic illness and have higher rates of mortality as a consequence. FNPs who are able to accurately identify symptoms of depression and connect patients with the services they need have the potential to save lives.

Risk Factors of Depression

Family nurse practitioners’ role in recognizing depression in their patients begins with an understanding of the risk factors for the medical disorder. The American Psychiatric Association (APA) places depression risk factors into four general categories.

Personality factors: Individuals whose self-esteem is low, who are generally pessimistic, or who find stress to be overwhelming are at risk for depression.
Genetics factors: The genetic component of depression is critical because depression can run in families. For example, if an identical twin has depression, the other identical twin’s chances of developing depression are 70%.
Environmental factors: Being exposed on a continuous basis to abuse, neglect, violence, or even poverty can increase the risk of depression.
Biochemical factors: Certain brain chemicals can influence symptoms of depression.

Another important element for FNPs to consider is depression can develop when a patient has another medical illness of a serious nature, such as heart disease or cancer. In addition, major life changes, stress and trauma are risk factors for depression.

As they continue to see patients during the COVID-19 era, it’s particularly important for FNPs working in primary care to be alert to depression and become knowledgeable about individuals whose risk of depression could have been heightened during the pandemic. For example, a study published in JAMA Open Network in October 2020 concluded certain individuals were most at risk for developing moderate or severe depressive symptoms during the pandemic. These individuals included those in lower socioeconomic positions and individuals who had health-related and psychosocial risk factors (including low social support, pre-existing conditions, and trauma from psychological or physical abuse).

Signs and Symptoms of Depression

Depression can manifest itself in various ways and symptoms likely will vary. General symptoms nurse educators should train their staff to be aware of include, but are not limited to, the following:

Anger
Persistent sadness
Loss of interest in everyday activities
Low self-esteem
Irritability
Loss of energy
Lessened or increased appetite
Insomnia
Problems with concentration
Suicidal thoughts

The Role of FNPs in Screening Patients for Depression

The U.S. Preventive Services Task Force recommends the general adult population (including postpartum and pregnant women) be screened for depression. It also recommends adolescents aged 12 to 18 years be screened for major depressive disorders.

The role of the family nurse practitioner in working closely with patients, especially in primary care, naturally leads to opportunities for FNPs to screen patients for depression. While it’s important for FNPs to screen for this medical illness, it’s also critical FNPs ensure the services they provide remain within their scope of practice. A study published in the Journal for Nurse Practitioners cautioned FNPs to remain up to date on their states’ scope of practice limitations and to collaborate with and make referrals to psychiatric professionals when necessary.

One commonly used screening tool is the Patient Health Questionnaire-9 (PHQ-9), which is a free tool to screen patients for depression in the primary care environment. A study published in the Journal of the American Association of Nurse Practitioners offered insight for nurse practitioners’ use of the PHQ-9. “Nurse practitioners can and should use the PHQ-9 when screening for depression. However, they should do so with full knowledge and awareness of its strengths and limitations.”

Find a Rewarding Career Helping Others

The role of family nurse practitioners who work in primary care is well suited to identifying signs of depression in patients. Individuals who want to take their nursing career to the next level would do well to explore Bradley University’s online master of science in nursing programs. It offers an FNP track and prepares nurses to become leaders in primary care.

This dynamic, student-centered program is ideal for nurses who are passionate about guiding their peers and leading change in health care. Discover a rewarding role in health care today.

Recommended Readings

Understanding DNP vs. NP: What Do the Terms Mean?

What Is the Average DNP Salary?

Choosing Your Career Pathway: DNP vs. Ph.D.

Sources:

American Psychiatric Association, What Is Depression?

American Psychological Association, Clinical Practice Guideline for the Treatment of Depression, Depression Assessment Instruments

Centers for Disease Control and Prevention, National Center for Health Statistics, Symptoms of Depression Among Adults: United States, 2019

Depression and Bipolar Support Alliance, Depression Statistics

Healthline, Depression: Facts, Statistics, and You

JAMA Open Network, “Levels of Severity of Depressive Symptoms Among At-Risk Groups in the UK During the COVID-19 Pandemic”

Journal of the American Association of Nurse Practitioners, “Screening for Depression: Review of the Patient Health Questionnaire-9 for Nurse Practitioners”