A go to to a sexual well being neighborhood clinic could also be the very best place to display screen LGBTQ+ sufferers for melancholy. In a top quality enchancment challenge, the speed of melancholy screening for LGBTQ+ sufferers elevated 3-fold after the implementation of this program in Austin and Dallas, Texas. There was a 4-fold enhance in sufferers who scored higher than 9 on the PHQ-9 screening device and a 5-fold enhance in referrals to behavioral well being groups, in accordance with the outcomes of a examine introduced on the DNPs of Colour assembly, held September 19-22, in Washington DC.
In accordance with Michael Williams, DNP, FNP-BC, and Jennifer Jones, DNP, FNP-C, coauthors of the examine, “LGBTQ+ people typically encounter boundaries to well being care, together with cultural incompetence, institutional bias, and social stigma, all of which contribute to melancholy.”
Despair can pose a big impediment to treatment adherence for HIV pre-exposure prophylaxis (PrEP). In 2021, males who’ve intercourse with males accounted for 67% of newly identified HIV sufferers, with Black and Hispanic males disproportionately making up 40% and 29% of recent instances, respectively. PrEP use in Texas falls beneath the goal objectives (28%), underscoring the necessity for improved adherence methods, as reported by the authors. By addressing the elements that stop treatment adherence, together with undiagnosed melancholy, the authors hope to enhance each circumstances.
The target of the High quality Enchancment (QI) challenge was to make sure that all LGBTQ+ sufferers over the age of 17 underwent melancholy screening. The screening was carried out by the entrance desk workers and nurse practitioners (NPs) throughout PrEP care visits and accomplished electronically and on paper. It was hoped that any affected person who scored increased than 9 on the screening device can be referred for psychological well being care.
The variety of melancholy screenings elevated considerably with the implementation of the challenge, famous the authors. Earlier than the challenge, 44 sufferers had been screened for melancholy, after the 3-month challenge, 130 members had been screened. The vast majority of members recognized as Hispanic (58.5%), adopted by non-Hispanic White (16.9%), non-Hispanic Black (16.2%), Asian (6.2%), and different (2.1%).
Earlier than the challenge, 4 sufferers scored increased than 9 on the PHQ-9 for melancholy; of these, 3 sufferers (75%) had been referred for remedy. After the challenge, 16 sufferers scored increased than 9 on the PHQ-9 and 15 sufferers (93.8%) had been referred for remedy. “It was hoped that fifty% of sufferers screened would rating increased than 9, however outcomes confirmed solely 12% did. It was additionally hoped that no less than 80% of people that scored increased than 9 can be referred, 93.8% had been,” Dr. Williams mentioned.
Sociopolitical occasions over the previous 12 months, together with elevated laws in opposition to LGBTQ+ communities, have contributed to an increase in melancholy amongst these sufferers, in accordance with the authors. “The purpose of the challenge was to see if melancholy screenings ought to be part of our care as a sexual well being clinic. That has been determined and the screening is now a part of care in Austin and Dallas,” mentioned Dr. Williams. Because of the challenge, melancholy screenings are carried out no less than yearly, however could also be repeated sooner for these partaking in remedy. Suppliers are reviewing treatment adherence and up to date medical visits throughout every PrEP go to, that are in 3-month intervals.
Nurse practitioners ought to contemplate melancholy screening in nontraditional settings, akin to sexual well being clinics and HIV PrEP applications.
Williams M, Jones J. PrEP the Method: Standardizing PHQ-9 Despair Screening in LGBTQ+ Sufferers at Sexual Well being Neighborhood Clinics. Introduced at: DNPs of Colour 2023; September 19-22; Washington, DC.