Routine PHQ-9 depression screening in home health care: depression prevalence, clinical and treatment characteristics, and screening implementation
Open accessAbstract
This study aimed to examine: the prevalence and correlates of depression among adults age 65 and over on admission to diverse home health care programs; nurse compliance with routine screening using the PHQ-9; and concordance between the number of depressed individuals identified by the PHQ-9 and Medicare-mandated nursing assessment following targeted nurse training in identifying depression among the elderly using a standard diagnostic screen. Data are drawn from routine screening of 9,178 patients (a 77% screening compliance rate). Of all patients screened, 782 (8.5%) met criteria for probable major depression and 148 (1.6%) for mild depression. Concordance between nurse identified depression via PHQ-9 and OASIS depression assessment improved over that reported in previous studies. Findings suggest that the use of a routine screening tool for depression can be implemented with minimal in-house training and improves detection of depression among older adults with significant physical and functional impairment.
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The pre-pandemic prevalence of depressive symptoms was estimated to range from 6.2% to 11.5%.
“Based on effect sizes from these large studies (Ell et al., 2006; Ko et al., 2012, Slade et al., 2011), we determined pre-pandemic rate of depressive symptoms to range from 6.2% to 11.5%.”
From Prevalence rates of anxiety, depressive, and eating pathology symptoms between the pre- and peri-COVID-19 eras: A meta-analysis (2022) · cites this paper as Ell et al., 2006
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“Because of its brevity and its relatively high positive predictive value (6), the PHQ-9 has gained increased recognition as the preferred instrument for researching depression screenings in primary care settings (8-11).”
BackgroundReliability and validity of the PHQ‐9 for screening late‐life depression in Chinese primary care
Chen, S., Chiu, H. F. K., Xu, B., Ma, Y., Jin, T., Wu, M., & Conwell, Y. (2009) · International Journal of Geriatric Psychiatry · doi:10.1002/gps.2442 · Cited by 242 · see citing works
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BackgroundMethodMaking the Investment Count: Revision of the Minimum Data Set for Nursing Homes, MDS 3.0
Saliba, D., & Buchanan, J. L. (2012) · Journal of the American Medical Directors Association · doi:10.1016/j.jamda.2012.06.002 · Cited by 187 · see citing works
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“[1, 2] Other studies also found the rates of clinically significant depression (PHQ-9 ≥ 10[3, 4]) to be 11–12% among homebound older adults.”
BackgroundOverview of Significant Changes in the Minimum Data Set for Nursing Homes Version 3.0
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“A study of 9178 adult community members (Ell et al., 2006) found that 8.”
Testing the PHQ-9 Interview and Observational Versions (PHQ-9 OV) for MDS 3.0
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“These preliminary results are consistent with a previous randomized controlled trial of general medically disabled home care elderly that compared PST-HC with usual care.(26) Similar to our results, the previous study reported that PST-HC participants improved significantly more on selfreported measures of depression…”
MethodResultBarth, J., Kern, A., Lüthi, S., & Witt, C. (2019) · BMJ Open · doi:10.1136/bmjopen-2018-026712 · Cited by 73 · see citing works
“Patients indicated their answers on a scale ranging from 0 (not at all) to 3 (almost every day).(28) A higher score indicates a higher severity of depressive symptoms (ranging between 0 and 27).”
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Major Depression and Subthreshold Depression among Older Adults Receiving Home Care
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“For example, the Patient Health Questionnaire (PHQ-9) is widely used internationally in medical contexts to identify depressed patients and monitor their progress (e.g., Clark et al. 2009; Ell et al. 2006).”
MethodChowdhury, S., Kabir, H., Mazumder, S., Akter, N., Chowdhury, M. R., & Hossain, A. (2022) · PLoS ONE · doi:10.1371/journal.pone.0274965 · Cited by 52 · see citing works
Fletcher, T. L., Cummings, J. P., Armento, M. E. A., Cully, J. A., Amspoker, A. B., WILSON, N. L., Mallen, M. J., Shrestha, S., Kunik, M. E., & Stanley, M. A. (2016) · Clinical Gerontologist · doi:10.1080/07317115.2016.1254133 · Cited by 57 · see citing works
Managing Depression in Home Health Care: A Randomized Clinical Trial
Ell, K., Unützer, J., Aranda, M., Gibbs, N. E., Lee, P.-J., & Xie, B. (2007) · Home Health Care Services Quarterly · doi:10.1300/j027v26n03_05 · Cited by 56 · see citing works
“%) of compliance with depression screening across participating study sites (Ell et al., 2005).”
BackgroundInfluentialSelf-citationMarkle‐Reid, M., McAiney, C. A., Forbes, D. A., Thabane, L., Gibson, M., BROWNE, G. B., Hoch, J. S., Peirce, T. H., & Busing, B. (2014) · BMC Geriatrics · doi:10.1186/1471-2318-14-62 · Cited by 54 · see citing works
Sami, R., Soltaninejad, F., Amra, B., Naderi, Z., Javanmard, S. H., Iraj, B., Hajiahmadi, S., Shayganfar, A., Dehghan, M., Khademi, N., et al. (2020) · PLoS ONE · doi:10.1371/journal.pone.0241537 · Cited by 53 · see citing works
“In the 12th week and the first year, each patient attends the hospital to complete the Patient Health Questionnaire-9 (PHQ-9) and the Depression Anxiety Stress Scales (DASS-21) [19].”
Choi, N. G., Marti, C. N., & Conwell, Y. (2015) · Suicide and Life-Threatening Behavior · doi:10.1111/sltb.12195 · Cited by 53 · see citing works
Choi, N. G., Teeters, M., Perez, L. M., Farar, B., & Thompson, D. (2009) · Aging & Mental Health · doi:10.1080/13607860903421078 · Cited by 50 · see citing works
“, 2003); in the IMPACT trial and elsewhere, it has been used with low-income racial/ ethnic minorities, with homecare patients, and with home-delivered meal recipients (Dwight-Johnson, Ell, & Lee, 2005; Ell et al., 2005; Miranda, Azocar, Organista, Dwyer, & Arean, 2003; Sirey et al., 2008).”
MethodResultInfluentialBevilacqua, L. A., Dulak, D., Schofield, E., Starr, T. D., Nelson, C. J., Roth, A. J. L., Holland, J. C., & Alici, Y. (2017) · Psycho-Oncology · doi:10.1002/pon.4605 · Cited by 46 · see citing works
“Its psychometrics have been established in diverse general and medical populations.(6,26) Each item is rated 0 (not at all) to 3 (nearly every day) to indicate howmuch a person has been bothered by each symptom over a 2‐week period and summed to produce total scores ranging from 0 to 27.”
BackgroundDepression in Homebound Older Adults: Recent Advances in Screening and Psychosocial Interventions
Choi, N. G., Sirey, J. A., & BRUCE, M. L. (2012) · Current Translational Geriatrics and Experimental Gerontology Reports · doi:10.1007/s13670-012-0032-3 · Cited by 42 · see citing works
“The PHQ-9 was also successfully used as an assessment tool to identify depression in homebound older adults served by homecare agencies or homedelivered meals programs [7, 9, 10].”
MethodHow do the phq‐2, the phq‐9 perform in aging services clients with cognitive impairment?
Boyle, L. L., Richardson, T. M., He, H., Xia, Y., Tu, X. M., Boustani, M. A., & Conwell, Y. (2010) · International Journal of Geriatric Psychiatry · doi:10.1002/gps.2632 · Cited by 40 · see citing works
“, 2006), both older adult home health care clients (Ell et al., 2005) and community-based social services agency clients receiving care management (Richardson et al.”
BackgroundMethodCorrelates of Depressive Symptoms among Homebound and Semi-Homebound Older Adults
Xiang, X., & Brooks, J. (2017) · Journal of Gerontological Social Work · doi:10.1080/01634372.2017.1286625 · Cited by 41 · see citing works
“To a lesser degree, risks of depression differed by sociodemographic characteristics in the homebound population (Choi et al., 2010; Ell et al., 2005; Li & Conwell, 2007).”
BackgroundInfluentialScreening Depression Aging Services Clients
Richardson, T. M., He, H., Podgorski, C. A., Tu, X. M., & Conwell, Y. (2010) · American Journal of Geriatric Psychiatry · doi:10.1097/jgp.0b013e3181dd1c26 · Cited by 39 · see citing works
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Training Nursing Staff to Recognize Depression in Home Healthcare
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“This training was particularly important given previous findings that nurses are reluctant to talk about depression with culturally diverse patients.(20) At the end of the first session, nurses were encouraged to practice the depression assessment interviewing skills (field trial assignment) before the second session.”
BackgroundResultInfluentialMcGuire, L. C., Strine, T. W., Allen, R. S., Anderson, L. A., & Mokdad, A. H. (2009) · American Journal of Geriatric Psychiatry · doi:10.1097/jgp.0b013e3181953bae · Cited by 35 · see citing works
Sheeran, T. F., Reilly, C. F., Weinberger, M. I., BRUCE, M. L., & Pomerantz, J. C. (2010) · Home Healthcare Now · doi:10.1097/nhh.0b013e3181cb560f · Cited by 34 · see citing works
“Work by Ell et al. found that depression could be identified in home care using the Patient Health Questionnaire-9 (PHQ-9), a nine-item screening instrument based on the diagnostic criteria for depression (Ell et al., 2005).”
Epidemiological study of depression among population above 60 years in Visakhapatnam, India
Sundru, M., & Goru, K. B. (2013) · International Journal of Medical Science and Public Health · doi:10.5455/ijmsph.2013.030520133 · Cited by 34 · see citing works
“2% also confirms geriatric depression as an emerging public health problem.[2-10]When the role of socio-demographic factors leading to depression was assessed, it was observed that”
BackgroundMarkle‐Reid, M., McAiney, C. A., Fisher, K., Ganann, R., Gauthier, A. P., Heald-Taylor, G., McElhaney, J. E., McMillan, F., Petrie, P., Ploeg, J., et al. (2021) · PLoS ONE · doi:10.1371/journal.pone.0254573 · Cited by 37 · see citing works
Sirey, J. A., Berman, J., Salamone, A., DePasquale, A., Halkett, A. E., Raeifar, E., Banerjee, S., BRUCE, M. L., & Raue, P. J. (2015) · Journal of Elder Abuse & Neglect · doi:10.1080/08946566.2015.1008086 · Cited by 33 · see citing works
Death wishes among older people assessed for home support and long‐term aged residential care
Cheung, G., Edwards, S., & Sundram, F. (2016) · International Journal of Geriatric Psychiatry · doi:10.1002/gps.4624 · Cited by 32 · see citing works
“Our finding is very similar to previous studies of home care patients or home-delivered meal recipients where 8.5–13.5% of their sample had a diagnosis of major depressive disorder or clinically significant depressive symptoms (Bruce et al., 2002; Ell et al., 2006; Sirey et al., 2008).”
BackgroundResultInfluentialSinn, C. J., Betini, R., Wright, J., Eckler, L., Chang, B. W., Hogeveen, S. E., Turcotte, L., & Hirdes, J. P. (2018) · Canadian Journal on Aging / La Revue canadienne du vieillissement · doi:10.1017/s0714980817000538 · Cited by 32 · see citing works
“In the general home care population, the prevalence of depressive symptoms and major depression is estimated to be 11–16 per cent and 6–14 per cent (Bruce et al., 2002, 2004; Ell, Unützer, Aranda, Sanchez, & Lee, 2005; Phillips et al., 1997; Pickett, Raue, & Bruce, 2012).”
Mental Health Status of Home Care Elders in Michigan
Li, L., & Conwell, Y. (2007) · The Gerontologist · doi:10.1093/geront/47.4.528 · Cited by 32 · see citing works
“Our findings about sociodemographic and clinical correlates of frail elders’ mental health, for the most part, corroborate previous research (Bruce et al., 2002; Ell et al., 2005; Hybels & Blazer, 2003; Lyness et al., 2006).”
ResultShao, H., Peng, T. R., BRUCE, M. L., & Bao, Y. (2011) · Psychiatric Services · doi:10.1176/appi.ps.62.5.538 · Cited by 32 · see citing works
Choi, N. G., Marti, C. N., BRUCE, M. L., & Kunik, M. E. (2012) · BMC Psychiatry · doi:10.1186/1471-244x-12-233 · Cited by 31 · see citing works
“Discussion Depression is a serious problem among older adults who are homebound due to disability [24-27].”
BackgroundLate-Life Depression in Home Healthcare
Pickett, Y. R., Raue, P. J., & BRUCE, M. L. (2012) · Aging Health · doi:10.2217/ahe.12.28 · Cited by 29 · see citing works
Depression Care for Patients at Home (Depression CAREPATH)
BRUCE, M. L., Raue, P. J., Sheeran, T. F., Reilly, C. F., Pomerantz, J. C., Meyers, B. S., Weinberger, M. I., & Zukowski, D. M. (2011) · Home Healthcare Now · doi:10.1097/nhh.0b013e318229d75b · Cited by 27 · see citing works
“…MD, Mark I. Weinberger, PhD, MPH, and Diane Zukowski, RN, BSN HOME CARE DEPRESSION CARE MANAGEMENT PROTOCOL, for Part 2 Most clinicians have observed depressive symptoms in many of their older medical/surgical patients (Brown et al., 2003; Bruce et al., 2002; Ell et al., 2005; Suter et al., 2008).”
BackgroundMethodPotentially inappropriate management of depressive symptoms among Ontario home care clients
Dalby, D. M., Hirdes, J. P., Hogan, D. B., Patten, S. B., Beck, C. A., Rabinowitz, T., & Maxwell, C. J. (2008) · International Journal of Geriatric Psychiatry · doi:10.1002/gps.1987 · Cited by 27 · see citing works
Suter, P. M., Hennessey, B., Harrison, G., Fagan, M., Norman, B., & Suter, W. N. (2008) · Home Healthcare Now · doi:10.1097/01.nhh.0000316700.76891.95 · Cited by 26 · see citing works
Musculoskeletal Pain Management and Patient Mental Health and Well-being
Wally, M. K., Hsu, J. R., & Seymour, R. B. (2022) · Journal of Orthopaedic Trauma · doi:10.1097/bot.0000000000002457 · Cited by 26 · see citing works
Weinberger (2009) · Patient Preference and Adherence · doi:10.2147/ppa.s5722 · Cited by 25 · see citing works
“The PHQ-9 has been to be found easy to administer and has been reliability used by nonpsychiatric interviewers in home health care settings 17 and in community samples.”
Zhang, J., Yu, Z., Zhang, N., Zhao, W., Wei, B., He, R., Xue, H., Zhu, B., & Mao, Y. (2023) · Aging & Mental Health · doi:10.1080/13607863.2023.2214091 · Cited by 24 · see citing works
Depression prevalence and treatment among older home health services users in the United States
Xiang, X., Danilovich, M., Tomasino, K. N., & Jordan, N. (2017) · Archives of Gerontology and Geriatrics · doi:10.1016/j.archger.2017.12.005 · Cited by 23 · see citing works
Kim, S., & Lee, K. (2021) · Neuropsychiatric Disease and Treatment · doi:10.2147/ndt.s339412 · Cited by 25 · see citing works
Choi, N. G., Hegel, M. T., Sirrianni, L., Marinucci, M. L., & BRUCE, M. L. (2012) · Behaviour Research and Therapy · doi:10.1016/j.brat.2012.07.003 · Cited by 23 · see citing works
Markle‐Reid, M., McAiney, C. A., Ganann, R., Fisher, K., Gafni, A., Gauthier, A. P., Heald-Taylor, G., McElhaney, J. E., Ploeg, J., Urajnik, D. J., et al. (2020) · BMC Geriatrics · doi:10.1186/s12877-020-01638-0 · Cited by 22 · see citing works
Choi, N. G., Lee, A. S. Y., & Goldstein, M. (2011) · Home Health Care Services Quarterly · doi:10.1080/01621424.2011.622251 · Cited by 22 · see citing works
“5% ( Ell, Unutzer, Aranda, Sanchez, & Lee, 2005 ) to 13.”
Depression Care for Patients at Home (Depression CAREPATH)
BRUCE, M. L., Sheeran, T. F., Raue, P. J., Reilly, C. F., Greenberg, R. L., Pomerantz, J. C., Meyers, B. S., Weinberger, M. I., & Johnston, C. L. (2011) · Home Healthcare Now · doi:10.1097/nhh.0b013e31821fe9f7 · Cited by 19 · see citing works
“The research group and others have demonstrated that nurses can be taught to successfully screen and refer patients with depressive symptoms for further evaluation (Brown et al., 2010; Bruce et al., 2007; Ell et al., 2005).”
BackgroundMental health disorders in home care elders: An integrative review
Wang, J., Shang, J., & Kearney, J. A. (2015) · Geriatric Nursing · doi:10.1016/j.gerinurse.2015.10.013 · Cited by 18 · see citing works
Mental Health Service Use Among Depressed, Low-Income Homebound Middle-Aged and Older Adults
Choi, N. G., Kunik, M. E., & WILSON, N. L. (2013) · Journal of Aging and Health · doi:10.1177/0898264313484059 · Cited by 18 · see citing works
Ayalon, L., Fialová, D., Areán, P. A., & Onder, G. (2010) · International Psychogeriatrics · doi:10.1017/s1041610209991797 · Cited by 17 · see citing works
“Finally, it is important to note that epidemiological studies found that depressed home care recipients hardly ever receive psychotherapeutic interventions (Bruce et al., 2002; Ell et al., 2005).”
BackgroundInfluentialRansing, R. S., Deshpande, S. N., Shete, S. R., Patil, I., Kukreti, P., Raghuveer, P., Mahadevaiah, M., Bhosale, N., Vallamkonda, O. R., Puri, M., et al. (2020) · Asian Journal of Psychiatry · doi:10.1016/j.ajp.2020.102109 · Cited by 17 · see citing works
Markle‐Reid, M., McAiney, C. A., Forbes, D. A., Thabane, L., Gibson, M., Hoch, J. S., BROWNE, G. B., Peirce, T. H., & Busing, B. (2011) · BMC Geriatrics · doi:10.1186/1471-2318-11-50 · Cited by 17 · see citing works
“The existing research involving home care clients is limited to descriptive, case control and quasi-experimental studies evaluating the effectiveness of nurse-led screening and referral for depression; not direct and ongoing follow-up care [3,64,66-69].”
BackgroundMedical Assistant Protocol Improves Disparities in Depression Screening Rates
Gorman, D. C., Ham, S. A., Staab, E. M., Vinci, L. M., & Laiteerapong, N. (2021) · American Journal of Preventive Medicine · doi:10.1016/j.amepre.2021.05.010 · Cited by 16 · see citing works
“Internal medicine 25,013 4,132 (17) 17,190 9,579 (56)”
InfluentialChoi, N. G., Hegel, M. T., Marinucci, M. L., Sirrianni, L., & BRUCE, M. L. (2011) · International Journal of Geriatric Psychiatry · doi:10.1002/gps.2741 · Cited by 16 · see citing works
“In other studies, 10% to 12% of homebound older adults reported clinically significant depressive symptoms—a score of ≥10 on the Patient Health Questionnaire 9 (PHQ‐9; Ell et al., 2005; Sirey et al., 2008).”
BackgroundExcessive Daytime Sleepiness in Tension-Type Headache: A Population Study
Kim, K. M., Kim, J., Cho, S., Kim, W., Yang, K. I., Yun, C., & Chu, M. K. (2019) · Frontiers in Neurology · doi:10.3389/fneur.2019.01282 · Cited by 15 · see citing works
Davitt, J. K., & Gellis, Z. D. (2011) · Journal of Gerontological Social Work · doi:10.1080/01634372.2010.540075 · Cited by 14 · see citing works
“Lack of training in the use of valid screening tools, as well as the variability of symptoms and onset of mental illnesses make them difficult to detect and diagnose ( Ell, Unutzer, Aranda, Sanchez, & Lee, 2005 ; Gellis, 2009 ).”
BackgroundThe Prevalence of Depression in Older U.S. Women: 2006 Behavioral Risk Factor Surveillance System
McGuire, L. C., Strine, T. W., Vachirasudlekha, S., Mokdad, A. H., & Anderson, L. A. (2008) · Journal of Women s Health · doi:10.1089/jwh.2008.0815 · Cited by 14 · see citing works
Bao, Y., Eggman, A. A., Richardson, J. E., & BRUCE, M. L. (2014) · Psychiatric Services · doi:10.1176/appi.ps.201300158 · Cited by 13 · see citing works
“A complementary policy would be to require vendor-developed home health EHRs to incorporate a PHQ-9 assessment tool and clinical decision support for evidence-based depression care as a certification criterion for these systems.”
InfluentialSmith, M., Haedtke, C., & Shibley, D. (2015) · Journal of Gerontological Nursing · doi:10.3928/00989134-20150115-99 · Cited by 13 · see citing works
The Patient Health Questionnaire (PHQ-9) Scores and the Lifestyles of Nursing Students
Urasaki, M., Oshima, N., Okabayashi, A., Sadatsune, M., Shibuya, A., Nishiura, A., & Takao, T. (2009) · Southern Medical Journal · doi:10.1097/smj.0b013e3181ad6009 · Cited by 13 · see citing works
“The distribution of PHQ-9 scores in our sample is similar to the distribution in the other reports.(8,14,15) In addition, approximately 8.”
ResultEvidence-Based Practice Guideline: Late-Life Depression Detection
Smith, M., Haedtke, C., & Shibley, D. (2015) · Journal of Gerontological Nursing · doi:10.3928/00989134-20150115-01 · Cited by 12 · see citing works
Choi, N. G., BRUCE, M. L., Sirrianni, L., Marinucci, M. L., & Kunik, M. E. (2012) · Brain and Behavior · doi:10.1002/brb3.48 · Cited by 11 · see citing works
“Other studies found 10–12% rates of clinically significant depressive symptoms— a score of 10 or higher on the Patient Health Questionnaire-9 (PHQ-9)—among homebound older adults (Ell et al. 2005; Sirey et al. 2008).”
BackgroundSuter, P. M., Suter, W. N., & Johnston, D. (2008) · Home Healthcare Now · doi:10.1097/01.nhh.0000338514.85323.35 · Cited by 11 · see citing works
“The addition of a simple depression instrument to the practice routines of both the office physician and the home health nurse has been shown to improve depression detection with minimal staff training (Ell et al., 2005; Spitzer, Kroenke, & Williams, 1999).”
MethodBorglin, G., Räthel, K., Paulsson, H., & Forss, K. S. (2019) · BMC Nursing · doi:10.1186/s12912-019-0368-5 · Cited by 10 · see citing works
Lifting the Home Care Veil From Depression: OASIS-C and Evidence-Based Practice
Cabin, W. D. (2009) · Home Health Care Management & Practice · doi:10.1177/1084822309348693 · Cited by 10 · see citing works
Schnall, R., Currie, L. M., Jia, H., John, R. M., Lee, N., Vélez, O., & Henry, S. B. (2010) · Journal of Urban Health · doi:10.1007/s11524-010-9464-2 · Cited by 9 · see citing works
Lee, I. (2012) · Health and Social Welfare Review · doi:10.15709/hswr.2012.32.4.31 · Cited by 9 · see citing works
Sami, R., Arabi, S., Ghasemi, K., Savari, M. A., Ebrahimi, S. H., Toghyani, A., Mahvari, R., Moayednia, R., Dadkhahi, S. A., Sadeghi, S., et al. (2023) · Quality of Life Research · doi:10.1007/s11136-023-03415-z · Cited by 8 · see citing works
“Each domain was given a score of 0–100, with greater scores revealing a more satisfactory functional status [12].”
BackgroundWeissman, J. D., Meyers, B. S., Ghosh, S., & BRUCE, M. L. (2011) · General Hospital Psychiatry · doi:10.1016/j.genhosppsych.2011.07.006 · Cited by 8 · see citing works
Price, S. N., Hamann, H. A., Halaby, L., Trejo, J. I., Corella, F., & Weihs, K. L. (2022) · Behavioral Sleep Medicine · doi:10.1080/15402002.2022.2033243 · Cited by 8 · see citing works
“The PHQ-9 can be used as a routine screening tool and is effective in assessing depression among diverse populations (Ell et al., 2006).”
MethodShier, V., Edelen, M. O., McMullen, T., Dunbar, M. S., Bruckenthal, P., Ahluwalia, S. C., Chen, E. K., Dalton, S. E., Paddock, S. M., Rodriguez, A., et al. (2022) · Journal of the American Geriatrics Society · doi:10.1111/jgs.17647 · Cited by 8 · see citing works
Standardized assessment of depression symptoms in post‐acute care: A screening threshold approach
Siconolfi, D. E., Edelen, M., McMullen, T., Martino, S. C., Ahluwalia, S., Chen, E. K., Dalton, S. E., Paddock, S., Rodriguez, A., Saliba, D., et al. (2022) · Journal of The American Geriatrics Society · doi:10.1111/jgs.17646 · Cited by 5 · see citing works
“Prior research in PAC settings has also found that younger patients evidence more prevalent or more severe depression symptoms.(1,2) Several indicators of greater illness/condition severity were associated with PHQ-2 positive screening at admission, including specific ADLs, discharge setting, and severe septicemia/sep…”
ResultSuicide risk factors among older adults: Implications for counselors as Medicare providers
Mize, M. C., Shannonhouse, L., Minton, C. A. B., Fullen, M. C., Shaikh, A. N., & Westcott, J. B. (2024) · Journal of Counseling & Development · doi:10.1002/jcad.12512 · Cited by 7 · see citing works
Implementation and Evaluation of a Depression Care Model for Homebound Elderly
Madden-Baer, R., McConnell, E. S., Rosati, R. J., Rosenfeld, P., & Edison, I. (2012) · Journal of Nursing Care Quality · doi:10.1097/ncq.0b013e318265702a · Cited by 5 · see citing works
Price, S., Hamann, H., Halaby, L., Trejo, J., Rogers, F. C., & Weihs, K. (2023) · Journal of psychosocial oncology · doi:10.1080/07347332.2023.2224314 · Cited by 4 · see citing works
“13,41 Each of the 9 questions assess the frequency of major depressive disorder symptoms during the past 2 weeks, with responses ranging from 0 (not at all) to 3 (nearly every day); summary scores range from 0 – 27.”
BackgroundBest Practices for Heart Failure
Suter, P. M., Gorski, L. A., Hennessey, B., & Suter, W. N. (2012) · Home Healthcare Now · doi:10.1097/nhh.0b013e31825b11ab · Cited by 3 · see citing works
“Depression is an independent predictor of poor adherence to the medical plan of care, and is often underdiagnosed and undertreated (Ell et al., 2005).”
BackgroundCommunity Treatment of Older Adults
Carlson, W. L., & Snowden, M. B. (2014) · Clinics in Geriatric Medicine · doi:10.1016/j.cger.2014.04.010 · Cited by 3 · see citing works
Kim, I., Kim, C., & Jeong, M.-H. (2023) · Journal of Preventive Medicine and Public Health · doi:10.3961/jpmph.23.022 · Cited by 2 · see citing works
“In the past few decades, scientific research has confirmed that older community care users are vulnerable to depression worldwide [5-7].”
BackgroundResultInfluentialEdelen, M. O., Rodriguez, A., Ahluwalia, S. C., Chen, E., Cohen, C. C., Dalton, S. E., Etchegaray, J. M., Huang, W., Karkos, B., Klein, D. J., et al. (2019) · RAND Corporation eBooks · doi:10.7249/rr3004.7 · Cited by 2 · see citing works
“Patients/residents who are unable to complete the 21 Ell et al., 2006; Hyer, 2005; Blazer, 2002; Jones, Marcantonio, and Rabinowitz, 2003; Payne et al., 2002; Teresi et al., 2001.”
BackgroundUtilization of social workers in home care: An analysis of service use
Hovey, A., Edick, C., & Brownlee, K. (2020) · Home Health Care Services Quarterly · doi:10.1080/01621424.2020.1749920 · Cited by 2 · see citing works
Marsala-Cervasio, K., & Acee, A. M. (2021) · International Journal of Nursing Education · doi:10.37506/ijone.v13i3.16311 · Cited by 1 · see citing works
Karabegovic, A., Indermaur, E., Santi, S., & Fierz, K. (2025) · Journal of Community Health Nursing · doi:10.1080/07370016.2025.2564069 · Cited by 1 · see citing works
“In studies using screening tools, the reported prevalence of depressive symptoms ranged from 10% (Ell et al., 2005) to 61.7% (Lewin et al., 2006).”
InfluentialAntidepressant Medication Management Among Older Patients Receiving Home Health Care
Bao, Y., Shao, H., BRUCE, M. L., & Press, M. J. (2014) · American Journal of Geriatric Psychiatry · doi:10.1016/j.jagp.2014.07.001 · Cited by 1 · see citing works
“Typically, patients are discharged from HHC upon resolution of medical issues, often before sufficient nurseepatient rapport is established to dissipate discomfort and reluctance on both sides to engage in depression care management.(13,14) This may explain the finding that the pathway of PCP visits to active antidepr…”
Improving Depression Care for Older Home Health Patients
Schirmer, S. R. (2015) · UKnowledge (University of Kentucky) · Cited by 1 · see citing works
Diabetes, Depression, and OASIS-C
Acee, A. M. (2014) · Home Healthcare Now · doi:10.1097/nhh.0000000000000091 · Cited by 1 · see citing works
Epidemiology of Late-Life Mood Disorders
Marino, P., & Sirey, J. A. (2013) · Oxford University Press eBooks · doi:10.1093/med/9780199796816.003.0003 · Cited by 1 · see citing works
MacKay, D., Mollard, R. C., Granger, M. J., Bruce, S. G., Blewett, H., Carlberg, J. G., Duhamel, T. A., Eck, P., Faucher, P., Hamm, N. C., et al. (2019) · BMJ Open · doi:10.1136/bmjopen-2018-023318 · Cited by 1 · see citing works
Edelen, M. O., Rodriguez, A., Ahluwalia, S. C., Chen, E., Cohen, C. C., Dalton, S. E., Etchegaray, J. M., Huang, W., Karkos, B., Klein, D., et al. (2019) · RAND Corporation eBooks · doi:10.7249/rr3004.4 · Cited by 1 · see citing works
“…is also associated with worse outcomes with chronic illness;22 slower recovery rates following acute medical events, such as hip fracture,23 stroke,24 myocardial infarction,25 and delirium;26 and increased risk of institutionalization.27 Depression 14 Ell et al., 2006; Bruce et al., 2002.”
BackgroundImplementation of a Depression Screening Program in Long-Term Care
Tanner, B. (2015) · UA Campus Repository (The University of Arizona)
Depression and suicidal ideation in community-dwelling older adults in Korea
Kwon, S., & Sohn, M. (2014) · Journal of the Korean Data and Information Science Society · doi:10.7465/jkdi.2014.25.3.655
Skimun fyrir þunglyndi aldraðra. Fræðileg samantekt
Haraldsdóttir, S. E. (2011)
Thielke, S. M., & Unützer, J. (2010) · Cambridge University Press eBooks · doi:10.1017/cbo9780511861147.013
Self-citation
- Authors
- Ell, K., Unützer, J., Aranda, M., Sanchez, K., & Lee, P.-J.
- Affiliations
- University of Southern California (US)
- Venue
- Home Health Care Services Quarterly
- Publisher
- Informa UK Limited
- Published
- 2006-01-24
- Volume
- 24
- Issue
- 4
- Pages
- 1-19
- ISSN
- 0162-1424 (ISSN-L)
- 1545-0856
- PMC
- PMC1421520
- OpenAlex
- W2061868822
- Cited by
- 109
- References
- 49
- Citations by year
- 2026: 1 · 2025: 2 · 2024: 2 · 2023: 4 · 2022: 5 · 2021: 5 · 2020: 5 · 2019: 7 · 2018: 2 · 2017: 3 · 2016: 3 · 2015: 8 · 2014: 9 · 2013: 5 · 2012: 12
- FWCI
- 8.63
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Home Health Care Services Quarterly (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Mental Health (5 R24 MH61700-02, R24MH061700)
- Topics
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Aging, Health, and Disability
- Social Sciences › Psychology › Clinical Psychology › Health and Well-being Studies
- Keywords
- depression screening, PHQ-9, home health care, older adults, depression prevalence, nurse compliance, screening program implementation, functional disability
- MeSH terms
- Aged, Aged, 80 and over, Community Health Nursing, Depression, Diagnostic Tests, Routine, Female, Home Care Services, Humans, Male, United States, Geriatric Assessment
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