National Healthcare Quality and Disparities Report
Latest available findings on quality of and access to health care
Data
- Data Infographics
- Data Visualizations
- Data Tools
- Data Innovations
- All-Payer Claims Database
- Healthcare Cost and Utilization Project (HCUP)
- Medical Expenditure Panel Survey (MEPS)
- AHRQ Quality Indicator Tools for Data Analytics
- State Snapshots
- United States Health Information Knowledgebase (USHIK)
- Data Sources Available from AHRQ
Search All Research Studies
Topics
- Ambulatory Care and Surgery (1)
- Anxiety (3)
- Behavioral Health (19)
- Cancer (1)
- Care Management (1)
- Case Study (1)
- Children/Adolescents (7)
- Chronic Conditions (2)
- Clinical Decision Support (CDS) (1)
- (-) Depression (24)
- Diagnostic Safety and Quality (10)
- Disparities (2)
- Elderly (1)
- Evidence-Based Practice (2)
- Guidelines (2)
- Health Information Technology (HIT) (4)
- Health Services Research (HSR) (1)
- Implementation (2)
- Low-Income (1)
- Maternal Care (1)
- Medical Expenditure Panel Survey (MEPS) (1)
- Medicare (1)
- Neurological Disorders (1)
- Patient-Centered Healthcare (1)
- Patient Safety (1)
- Pregnancy (1)
- Prevention (3)
- Primary Care (10)
- Primary Care: Models of Care (2)
- Quality Improvement (1)
- Quality of Care (1)
- Racial and Ethnic Minorities (2)
- Research Methodologies (1)
- Respiratory Conditions (1)
- Risk (1)
- (-) Screening (24)
- Shared Decision Making (2)
- Social Determinants of Health (2)
- Surgery (1)
- U.S. Preventive Services Task Force (USPSTF) (4)
- Women (2)
AHRQ Research Studies
Sign up: AHRQ Research Studies Email updates
Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 24 of 24 Research Studies DisplayedO'Connor EA, Perdue LA, Coppola EL
Depression and suicide risk screening: updated evidence report and systematic review for the US Preventive Services Task Force.
The objectives of this article were to review the benefits and harms of depression and suicide risk screening and treatment and the accuracy of instruments to detect these conditions in primary care patients. Evidence gathered from the literature search supported screening for depression in primary care settings, including during pregnancy and postpartum. The authors noted, however, that there were numerous important gaps in the evidence for suicide risk screening.
AHRQ-funded; 290201500011I; 75Q80120D00004.
Citation: O'Connor EA, Perdue LA, Coppola EL .
Depression and suicide risk screening: updated evidence report and systematic review for the US Preventive Services Task Force.
JAMA 2023 Jun 20; 329(23):2068-85. doi: 10.1001/jama.2023.7787..
Keywords: U.S. Preventive Services Task Force (USPSTF), Screening, Depression, Behavioral Health, Evidence-Based Practice, Guidelines, Risk
Franco MI, Staab EM, Zhu M
Pragmatic clinical trial of population health, portal-based depression screening: the PORTAL-Depression study.
Utilizing patient portals in a population health framework for depression screening presents a potentially effective method for proactively engaging and identifying individuals with depression. The purpose of this study was to evaluate the efficacy of a population health-based depression screening compared to in-clinic screening alone in detecting patients with depression. A practical clinical trial conducted at an urban, academic, tertiary care center's adult internal medicine outpatient clinic included a total of 2713 eligible adult patients due for depression screening with active portal accounts. Patients with known depression or bipolar disorder, and those who had been screened within the previous year were excluded. Participants were randomly allocated to receive either usual care (n = 1372) or population health care (n = 1341). In the usual care group, medical assistants screened patients during clinic visits. In the population health care group, patients were sent portal-based letters inviting them to complete an online screener, irrespective of appointment status. The Computerized Adaptive Test for Mental Health (CAT-MH™) was used for both in-clinic and portal-based screenings. The study found that the population health care group displayed a higher depression screening rate compared to the usual care group (43% (n = 578) vs. 33% (n = 459), p < 0.0001). Additionally, the rate of positive screens was greater in the population health care group than in the usual care group (10% (n = 58) vs. 4% (n = 17), p < 0.001).
AHRQ-funded; HS26151
Citation: Franco MI, Staab EM, Zhu M .
Pragmatic clinical trial of population health, portal-based depression screening: the PORTAL-Depression study.
J Gen Intern Med 2023 Mar;38(4):857-64. doi: 10.1007/s11606-022-07779-9.
Keywords: Depression, Behavioral Health, Screening, Health Information Technology (HIT)
Viswanathan M, Wallace IF, Cook Middleton J
Screening for depression and suicide risk in children and adolescents: updated evidence report and systematic review for the US Preventive Services Task Force.
The authors sought to review the evidence on screening for depression or suicide risk in children and adolescents to inform the US Preventive Services Task Force. They found indirect evidence that suggested some screening instruments were reasonably accurate for detecting depression. Further, psychotherapy and pharmacotherapy were associated with some benefits and no statistically significant harms for depression, but the evidence was limited for suicide risk screening instruments and interventions.
AHRQ-funded; 290201500011I.
Citation: Viswanathan M, Wallace IF, Cook Middleton J .
Screening for depression and suicide risk in children and adolescents: updated evidence report and systematic review for the US Preventive Services Task Force.
JAMA 2022 Oct 18;328(15):1543-56. doi: 10.1001/jama.2022.16310..
Keywords: U.S. Preventive Services Task Force (USPSTF), Children/Adolescents, Depression, Behavioral Health, Screening, Primary Care, Guidelines, Evidence-Based Practice, Prevention
Tobin JN, Cassells A, Weiss E
Integrating cancer screening and mental health services in primary care: protocol and baseline results of a patient-centered outcomes intervention study.
AHRQ-funded; HS021667.
Citation: Tobin JN, Cassells A, Weiss E .
Integrating cancer screening and mental health services in primary care: protocol and baseline results of a patient-centered outcomes intervention study.
J Health Care Poor Underserved 2021;32(4):1907-34. doi: 10.1353/hpu.2021.0173..
Keywords: Patient-Centered Healthcare, Cancer, Behavioral Health, Primary Care, Depression, Women, Screening
Gorman DC, Ham SA, Staab EM
Medical assistant protocol improves disparities in depression screening rates.
This study examined the impacts of a medical assistant screening protocol on the rates of depression screening, overall and by sociodemographic groups, in a primary care setting. Findings showed that implementation of a medical assistant protocol in a primary care setting may significantly increase depression screening rates while mitigating or removing sociodemographic disparities.
AHRQ-funded; HS026151.
Citation: Gorman DC, Ham SA, Staab EM .
Medical assistant protocol improves disparities in depression screening rates.
Am J Prev Med 2021 Nov;61(5):692-700. doi: 10.1016/j.amepre.2021.05.010..
Keywords: Disparities, Depression, Behavioral Health, Screening, Racial and Ethnic Minorities
Liu FF, Lew A, Andes E
Implementation strategies for depression and anxiety screening in a pediatric cystic fibrosis center: a quality improvement project.
The objective of this study was to share key strategies that led to successful mental health screening (MHS) implementation in one pediatric cystic fibrosis center and to report implementation and screening outcomes. Results showed that leveraging coproduction to address stakeholder needs led to successful implementation of a sustainable MHS process.
AHRQ-funded; HS026393.
Citation: Liu FF, Lew A, Andes E .
Implementation strategies for depression and anxiety screening in a pediatric cystic fibrosis center: a quality improvement project.
Pediatr Pulmonol 2020 Dec;55(12):3328-36. doi: 10.1002/ppul.24951..
Keywords: Children/Adolescents, Respiratory Conditions, Chronic Conditions, Depression, Anxiety, Behavioral Health, Screening, Implementation, Quality Improvement, Quality of Care, Diagnostic Safety and Quality
Wu Y, Levis B, Riehm KE
Equivalency of the diagnostic accuracy of the PHQ-8 and PHQ-9: a systematic review and individual participant data meta-analysis.
Item 9 of the Patient Health Questionnaire-9 (PHQ-9) queries about thoughts of death and self-harm, but not suicidality. Although it is sometimes used to assess suicide risk, most positive responses are not associated with suicidality. The PHQ-8, which omits Item 9, is thus increasingly used in research. In this study the investigators assessed equivalency of total score correlations and the diagnostic accuracy to detect major depression of the PHQ-8 and PHQ-9.
AHRQ-funded; HS018246.
Citation: Wu Y, Levis B, Riehm KE .
Equivalency of the diagnostic accuracy of the PHQ-8 and PHQ-9: a systematic review and individual participant data meta-analysis.
Psychol Med 2020 Jun;50(8):1368-80. doi: 10.1017/s0033291719001314..
Keywords: Diagnostic Safety and Quality, Depression, Behavioral Health, Screening
Munger Clary HM, Croxton RD, Allan J
Who is willing to participate in research? A screening model for an anxiety and depression trial in the epilepsy clinic.
This study assessed the willingness of epilepsy patients positively screened for anxiety and/or depression to participate in a research study. A total of 199 patients screened positively during a routine epilepsy screening visit and 154 (77.4%) opted-in for further research assessment. Nearly half of those 199 individuals were already being treated for anxiety and/or depression, with 46.7% receiving neither antidepressants or therapy. Higher depression scores and current treatment were independently associated with opting in. One-quarter reported a past psychiatric hospitalization, but only half of those individuals were currently receiving mental health specialty care.
AHRQ-funded; HS025723.
Citation: Munger Clary HM, Croxton RD, Allan J .
Who is willing to participate in research? A screening model for an anxiety and depression trial in the epilepsy clinic.
Epilepsy Behav 2020 Mar;104(Pt A):106907. doi: 10.1016/j.yebeh.2020.106907..
Keywords: Anxiety, Depression, Behavioral Health, Neurological Disorders, Chronic Conditions, Screening, Diagnostic Safety and Quality, Health Services Research (HSR), Research Methodologies
Klawetter S, McNitt C, Hoffman JA
Perinatal depression in low-income women: a literature review and innovative screening approach.
This paper is a literature review of perinatal depression prevalence, consequences, and screening among low-income women and women of color. The Warm Connections program has an innovative perinatal depression screening protocol and was used with WIC participants. The literature showed mixed findings of perinatal prevalence among low-income women and women of color. There were lower perinatal depression rates in the Warm Connections program in studies using less specific perinatal depression screening instruments with similar samples.
AHRQ-funded; HS026370.
Citation: Klawetter S, McNitt C, Hoffman JA .
Perinatal depression in low-income women: a literature review and innovative screening approach.
Curr Psychiatry Rep 2020 Jan 7;22(1):1. doi: 10.1007/s11920-019-1126-9.
.
.
Keywords: Depression, Pregnancy, Women, Low-Income, Social Determinants of Health, Screening, Behavioral Health, Maternal Care, Disparities, Diagnostic Safety and Quality
Samples H, Stuart EA, Saloner B
The role of screening in depression diagnosis and treatment in a representative sample of US primary care visits.
This study aimed to examine depression screening patterns and the role of screening in depression diagnosis and treatment in the outpatient primary care setting. The investigators found that physicians appeared to use depression screening selectively based on patients' presenting symptoms. Higher screening rates were associated with higher odds of depression diagnosis and treatment. The investigators suggest that even modest increases in screening rates could meaningfully increase population-level rates of depression identification and treatment in primary care.
AHRQ-funded; HS000029.
Citation: Samples H, Stuart EA, Saloner B .
The role of screening in depression diagnosis and treatment in a representative sample of US primary care visits.
J Gen Intern Med 2020 Jan;35(1):12-20. doi: 10.1007/s11606-019-05192-3..
Keywords: Depression, Behavioral Health, Diagnostic Safety and Quality, Primary Care, Screening, Ambulatory Care and Surgery
Sorkin DH, Rizzo S, Biegler K
AHRQ Author: Ngo-Metzger Q
Novel health information technology to aid provider recognition and treatment of major depressive disorder and posttraumatic stress disorder in primary care.
This article describes a multicomponent health information technology screening tool designed to aid provider recognition and treatment of major depressive disorder and posttraumatic stress disorder (PTSD) in the primary care setting, with an eye toward meeting the mental health needs of traumatized refugees in the US Cambodian community. In a randomized controlled trial, 18 primary care providers were randomized to receive access to the mental health screening intervention, or to a minimal intervention control group. Cambodian American patients empaneled to participating providers were assigned to the providers' randomized group. From the results, the authors conclude that this approach offers the potential for training providers to diagnose and treat traumatized patients seeking mental health care in primary care.
AHRQ-authored.
Citation: Sorkin DH, Rizzo S, Biegler K .
Novel health information technology to aid provider recognition and treatment of major depressive disorder and posttraumatic stress disorder in primary care.
Med Care 2019 Jun;57 Suppl 6 Suppl 2:S190-s96. doi: 10.1097/mlr.0000000000001036..
Keywords: Depression, Diagnostic Safety and Quality, Health Information Technology (HIT), Behavioral Health, Primary Care, Primary Care: Models of Care, Racial and Ethnic Minorities, Screening
Levis B, Benedetti A, Thombs BD
Accuracy of Patient Health Questionnaire-9 (PHQ-9) for screening to detect major depression: individual participant data meta-analysis.
This study’s goal was to determine the accuracy of the Patient Health Questionnaire-9 (PHQ-9) in diagnosing major depression. A bivariate random effects meta-analysis was done to estimate sensitivity and specificity for cut-off scores 5-15. It was determined that the PHQ-9 is similarly sensitive for use as the Mini International Neuropychiatric (MINI) diagnosis tool, but may be less specific for younger patients. However, a cut-off score of 10 or above can be used regardless of age.
AHRQ-funded; HS018246.
Citation: Levis B, Benedetti A, Thombs BD .
Accuracy of Patient Health Questionnaire-9 (PHQ-9) for screening to detect major depression: individual participant data meta-analysis.
BMJ 2019 Apr 9;365:l1476. doi: 10.1136/bmj.l1476..
Keywords: Depression, Diagnostic Safety and Quality, Behavioral Health, Screening
Rinke ML, German M, Azera B
Effect of mental health screening and integrated mental health on adolescent depression-coded visits.
This article describes a retrospective primary care network natural cohort study to analyze how mental health screening and integrated mental health practitioners affect adolescent depression identification. The percentage of depression-coded adolescent visits were compared between practices with and without mental health screening and with and without integrated mental health practitioners, using difference-in-differences analyses. The authors conclude that adolescent mental health screening and integrated mental health practitioners increase depression-coded visits in primary care.
AHRQ-funded; HS0203608.
Citation: Rinke ML, German M, Azera B .
Effect of mental health screening and integrated mental health on adolescent depression-coded visits.
Clin Pediatr 2019 Apr;58(4):437-45. doi: 10.1177/0009922818821889..
Keywords: Children/Adolescents, Depression, Diagnostic Safety and Quality, Primary Care, Screening
Graham AK, Minc A, Staab E
Validation of the computerized adaptive test for mental health in primary care.
This study compared the use of a computerized assessment tool with paper questionnaires to diagnose major depressive disorder (MDD) and general anxiety disorder (GAD). It was found that the majority of patients in the study preferred the computerized adaptive testing tool. Diagnostic accuracy of the tool was similar or higher than many of the traditional screening methods.
AHRQ-funded; HS000078.
Citation: Graham AK, Minc A, Staab E .
Validation of the computerized adaptive test for mental health in primary care.
Ann Fam Med 2019 Jan;17(1):23-30. doi: 10.1370/afm.2316..
Keywords: Anxiety, Depression, Diagnostic Safety and Quality, Behavioral Health, Primary Care, Screening
Srivatsan S, Guduguntla V, Young KZ
Clinical versus patient-reported measures of depression in bariatric surgery.
This study examined the relationship between traditional clinical screening tools and a novel patient-reported depression screening survey, Patient Health Questionnaire 8 (PHQ-8), in the setting of the bariatric surgery preoperative assessment. The researchers found a higher rate of clinically diagnosed depression in their cohort compared to the general population. However, when using the validated PHQ-8 survey, the rate of depression more closely approximated the national incidence.
AHRQ-funded; HS023621; HS024403.
Citation: Srivatsan S, Guduguntla V, Young KZ .
Clinical versus patient-reported measures of depression in bariatric surgery.
Surg Endosc 2018 Aug;32(8):3683-90. doi: 10.1007/s00464-018-6101-8..
Keywords: Depression, Patient Safety, Screening, Surgery
Kato E, Borsky AE, Zuvekas SH
AHRQ Author: Kato E, Borsky AE, Zuvekas SH, Soni A, Ngo-Metzger Q
Missed opportunities for depression screening and treatment in the United States.
This study estimates the prevalence of depression assessment in adults age 35 and older and how prevalence varies by sociodemographic characteristics and depressive symptoms. It found that approximately 50 percent of US adults aged 35+ were being assessed for depression in 2014-2015. Certain populations were more likely to be missed, including men, people over 75 years old, minorities, and the uninsured.
AHRQ-authored.
Citation: Kato E, Borsky AE, Zuvekas SH .
Missed opportunities for depression screening and treatment in the United States.
J Am Board Fam Med 2018 May-Jun;31(3):389-97. doi: 10.3122/jabfm.2018.03.170406.
.
.
Keywords: Depression, Medical Expenditure Panel Survey (MEPS), Prevention, Screening, Social Determinants of Health
Aalsma MC, Zerr AM, Etter DJ
Physician intervention to positive depression screens among adolescents in primary care.
The objective of this study was to determine the effectiveness of computer-based screening and physician feedback to guide adolescent depression management within primary care. The investigators found that when a computer-based decision support system algorithm focused on adolescent depression and was implemented in two primary care clinics, a majority of physicians utilized screening results to guide clinical care.
AHRQ-funded; HS022681.
Citation: Aalsma MC, Zerr AM, Etter DJ .
Physician intervention to positive depression screens among adolescents in primary care.
J Adolesc Health 2018 Feb;62(2):212-18. doi: 10.1016/j.jadohealth.2017.08.023..
Keywords: Care Management, Children/Adolescents, Shared Decision Making, Depression, Health Information Technology (HIT), Behavioral Health, Primary Care, Primary Care: Models of Care, Screening
Etter DJ, McCord A, Ouyang F
Suicide screening in primary care: use of an electronic screener to assess suicidality and improve provider follow-up for adolescents.
The purpose of this study was to assess the feasibility of using an existing computer decision support system to screen adolescent patients for suicidality and provide follow-up guidance to clinicians in a primary care setting. The authors concluded that incorporating adolescent suicide screening and provider follow-up guidance into an existing computer decision support system in primary care was feasible and well utilized by providers.
AHRQ-funded; HS022681.
Citation: Etter DJ, McCord A, Ouyang F .
Suicide screening in primary care: use of an electronic screener to assess suicidality and improve provider follow-up for adolescents.
J Adolesc Health 2018 Feb;62(2):191-97. doi: 10.1016/j.jadohealth.2017.08.026..
Keywords: Children/Adolescents, Clinical Decision Support (CDS), Shared Decision Making, Depression, Behavioral Health, Primary Care, Screening
Biegler K, Mollica R, Sim SE
AHRQ Author: Ngo-Metzger Q
Rationale and study protocol for a multi-component health information technology (HIT) screening tool for depression and post-traumatic stress disorder in the primary care setting.
The authors described the rationale and protocol of a clustered randomized controlled trial to test the effectiveness of a health information technology (HIT) intervention that provides a multi-component approach to delivering culturally competent mental health care in the primary care setting. They expect the outcomes to include assessing the potential of the HIT intervention to improve screening rates, clinical detection, provider initiation of treatment, and patient outcomes for depression and post-traumatic stress disorder. They suggest that this technology has the potential to be adapted in order to facilitate mental health screening and treatment in the primary care setting.
AHRQ-authored.
Citation: Biegler K, Mollica R, Sim SE .
Rationale and study protocol for a multi-component health information technology (HIT) screening tool for depression and post-traumatic stress disorder in the primary care setting.
Contemp Clin Trials 2016 Sep;50:66-76. doi: 10.1016/j.cct.2016.07.001.
.
.
Keywords: Health Information Technology (HIT), Behavioral Health, Depression, Screening, Primary Care
Kato E, Beswick-Escanlar V
AHRQ Author: Kato E
Screening for depression in adults.
This case study involves a 29-year-old man, who presents to your office for a routine visit. He has a history of being overweight and has hypertension that is controlled by diet and exercise. It poses three multiple choice questions about screening for depression together with the U.S. Preventive Services Task Force recommendations and related background information.
AHRQ-authored.
Citation: Kato E, Beswick-Escanlar V .
Screening for depression in adults.
Am Fam Physician 2016 Aug 15;94(4):305-6.
.
.
Keywords: U.S. Preventive Services Task Force (USPSTF), Screening, Depression, Behavioral Health, Case Study
Lewandowski RE, O'Connor B, Bertagnolli A
Screening for and diagnosis of depression among adolescents in a large health maintenance organization.
The researchers determined changes in patterns of depression screening and diagnosis over three years in primary and specialty mental health care in a large HMO. They found that the rate of depression screening in primary care increased over the study period, corresponding to an increase in the number of depression diagnoses made in primary care and a shift in the location in which depression diagnoses were made, from the mental health department to primary care.
AHRQ-funded; HS020503.
Citation: Lewandowski RE, O'Connor B, Bertagnolli A .
Screening for and diagnosis of depression among adolescents in a large health maintenance organization.
Psychiatr Serv 2016 Jun;67(6):636-41. doi: 10.1176/appi.ps.201400465.
.
.
Keywords: Children/Adolescents, Depression, Diagnostic Safety and Quality, Behavioral Health, Screening
Forman-Hoffman V, McClure E, McKeeman J
Screening for major depressive disorder in children and adolescents: a systematic review for the U.S. Preventive Services Task Force.
This report updates the 2009 U.S. Preventive Services Task Force (USPSTF) systematic review on screening for and treatment of Major depressive disorder (MDD) in children and adolescents in primary care settings. No evidence was found of a direct link between screening children and adolescents for MDD in primary care or similar settings and depression or other health-related outcomes. Evidence showed that some screening tools are accurate.
AHRQ-funded; 290201200015.
Citation: Forman-Hoffman V, McClure E, McKeeman J .
Screening for major depressive disorder in children and adolescents: a systematic review for the U.S. Preventive Services Task Force.
Ann Intern Med 2016 Mar 1;164(5):342-9. doi: 10.7326/m15-2259.
.
.
Keywords: U.S. Preventive Services Task Force (USPSTF), Screening, Depression, Behavioral Health, Children/Adolescents
Pfoh E, Mojtabai R, Bailey J
Impact of Medicare annual wellness visits on uptake of depression screening.
This study assessed whether patients with an initial annual wellness visit (AWV) were more likely to be screened for depression than those with a primary care visit. Fifteen percent of patients with non-AWVs and 10 percent of patients with AWVs received depression screening. After accounting for clustering, there was no statistically significant difference in depression screening by visit type.
AHRQ-funded; HS000029.
Citation: Pfoh E, Mojtabai R, Bailey J .
Impact of Medicare annual wellness visits on uptake of depression screening.
Psychiatr Serv 2015 Nov;66(11):1207-12. doi: 10.1176/appi.ps.201400524.
.
.
Keywords: Depression, Screening, Medicare, Elderly, Primary Care
Yawn BP, Bertram S, Kurland M
Repeated depression screening during the first postpartum year.
The researchers report a substudy of a large pragmatic trial of early post-partum depression screening and practice management, the Translating Research into Practice for Postpartum Depression (TRIPPD) study. They concluded that repeated PPD screening at 6 and 12 months’ postpartum increases the percentage of women identified as being at high risk of PPD.
AHRQ-funded; HS014744.
Citation: Yawn BP, Bertram S, Kurland M .
Repeated depression screening during the first postpartum year.
Ann Fam Med 2015 May-Jun;13(3):228-34. doi: 10.1370/afm.1777..
Keywords: Depression, Implementation, Screening, Prevention