Regarding your presentation assignment, what did you learn about the research project? Would you have approached the assignment differently? Why or why n

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Improving Depression Screening in Adults with Type 2 Diabetes: A Nursing Literature

Tiffany Amaya 

St. Thomas University 

NUR-611-AP2.25/SU2

Dr. Janet M. Huxley DNP, ARNP, FNP-C ( Do not put my credentials)

July 20, 2025

Improving Depression Screening in Adults with Type 2 Diabetes: A Nursing Literature Review

The common comorbidity in type 2 diabetes is depression, which is very serious yet largely unrecognized. The probability of being depressed is nearly two times that of the normal population when an individual has diabetes (De Groot, 2023). Depression, in turn, leads to poor glycemic control and a lack of compliance, high healthcare expenses, and overall as well as worse outcomes when not diagnosed and managed accordingly. Primary care nurse practitioners (NPs) can easily identify and treat this comorbidity since they are well-positioned to provide routine screening , as they are well-positioned to provide routine screening that aligns with evidence-based guidelines. Nevertheless, such screening protocols have been inconsistently followed( What literature do you have to support this statement? , failing to make the diagnosis and provide care that is less than ideal. This literature review examines existing studies on the screening of depression among diabetic patients in primary care facilities and the role of nurse practitioners in this process. It outlines a methodology for improving the screening.

Literature Review

Andrews et al. (2025)

The study by Andrews, Convoy, Anderson, and WaldropS (2025) is a quantitative randomized clinical trial aimed at determining whether a standardized depression screening tool among diabetic patients in a primary care facility was an effective practice. Nurse practitioners assessed one hundred and twenty 120 patients with Type 2 diabetes type 2 diabetes patients using the PHQ-9 screening tool. It was observed that practitioners who followed a more dramatic screening guideline were 40 percent more likely to spot depression symptoms than those who followed the regular ones. The authors inferred, based on this argument, that screening depression with evidence-based tools and their regular use results in greater detection and thus justification of incorporating depression screening in the process of diabetes care. The methodological rigorquality of this study was high, and this study scored high quality (A). Comment by Janet Huxley [2]: Andrews et al., (2025) Comment by Janet Huxley [3]: Why dramatic? That is not a concise term. Strict screening guidelines.

De Groot (2023)

In an interventional study, De Groot (2023) examined the tactics of managing depression and diabetes comorbidity in primary health services. A total of 15 randomized controlled trials were reviewed to test the effects of routine screening interventions, the collaborative care models, and the NP training programs. The data supported the fact that systematic depression screening, along with follow-up care, led to improved mental health as well as the self-management of diabetes. The point of critical observation made was that the installation of screening tools in the workflow and electronic health records (EHRs) enhanced their compliance (Groot, 2023). Although the review was thorough, the study's inhomogeneity in terms of setting and interventions justifies assigning it a moderate quality rating (B). Still, the results also highlight the significance of operational aid and training as a factor in screening uniformity enhancement.

Hermanns et al. (2013)You should not be using this reference.

The study, performed presented inby Hermanns et al. (2013), was is a quantitative one, which focused on the assessment of the extentdegree to which NPs were using the recommendations of depression screening of diabetic patients. The researchers analyzed more than 300 participants and established that cases of underdiagnosing depression were prevalent, with the research noting that they were present in approximately 60 percent of the patients. The identified barriers to adherence were: lack of time, guidance, and mental health resources. Even though the study is more than five years old, it can still be applied to modern practice in terms of revealing the operations and systemic issues that have remained unchanged over these years. Because of its contribution to this knowledge base of investigation on foundation barriers, it has been ranked as of moderate quality (B).

Richardson et al. (2014) You can not use this.

A mixed-methods research design was applied in an evaluation of NP management of type 2 diabetes with depression screening behaviors conducted by Richardson, Derouin, Vorderstrasse, Hipkens, and Thompson (2014). Literature findings demonstrated inconsistent application of evidence-based screening practices across different NP-led clinic practices, as revealed by the conduct of surveys and a review of medical records. A few of the barriers were insufficient training on mental health care and the absence of EHR prompts. Even though the study only covered a subsection of screening for depression, real-life lessons can be useful in implementing the study. This study is regarded as having poor quality (C), following the fact that it has a narrower focus and a small sample size. However, it helps in gaining insight into various contextual factors that can influence NP behavior.

Findings Synthesis

The four articles to read portray a number of similar trends. To start with, depression is rarely diagnosed in people with diabetes with type 2, yet it is clear that early diagnosis is the key to recovery in terms of both psychiatric and diabetic health. Second, standardized instruments, such as PHQ-9, have a vast improvement in the detection process when used by nurse practitioners (Andrews et al., 2025). Third, the lack of adherence to the guidelines is caused by some systemic factors, including the shortage of time, training, and integration of tools into EHR systems (Hermanns et al., 2013; Richardson et al., 2014). Fourth, integrated screening processes in workflow systems and collaborative care models remarkably increase screening rates and quality of follow-ups (De Groot, 2023).

One important gap found in the U.S. based literature is the paucity of research examining the effects of structural interventions, U.N.P. focused, that directly assess specific processes on adherence to depression screening-related guidelines. A majority of the literature is aimed at general healthcare systems or general primary care providers, other than the actions of nurse practitioners. The reduction of this gap is essential since NPs are taking a more active role in giving front-line care to diabetic populations.

Proposed Methodology

To address this gap, a quantitative approach is proposed for a randomized controlled trial. The trial will estimate the impact of a bundle of interventions, that is, the NP training and implementation of PHQ-9 prompting into EHRs, on adherence to depression checks and the rate of detection in patients with diabetes. ( This seems like your population should be the nurses being trained on the PHQ-9 and watching their consistency with doing the screening, not the patients. You might want to start there.) Comment by Janet Huxley:

Design and Setting

· Research design: Randomized controlled trial (RCT)

· Setting: Three primary care clinics in the U.S. with an NP as the leader ( Start small and then expand. Look at the one you would be working at or have precepted at.)

· Sample size: 150 adult patients with type 2 diabetes (consisting of 50 patients in each of the clinics)

· Producers: 10 NPs will be selected randomly for an intervention or control group

Intervention

Members of the intervention group will take part in a 2-hour training session on PHQ-9 as a depression screening tool, and automated EHR reminders will be enabled. In the control group, the usual care will be provided, and no further training or change of EHRs will be provided.

Measures

· Primary outcomes: Percentage of depression screenings performed, percentage of depression diagnoses, and the number of follow-up referrals

· Data Collection: Excavation of EHR data and review of charts in three months

· Test: Chi-square for categorical variables and t-test for continuous results

In this research, the researcher seeks to give compelling evidence on how the changes in the system can enhance the rate of NP compliance with the guidelines on depression screening and treat diabetic patients effectively. ( This statement proves my earlier assertion that your sample size does not come from the patients. This is directed towards the NPs. They are your population.

Conclusion

Depression is a health condition that is poorly dealt with in diabetic patients, and nurse practitioners have a big role in overcoming this situation by carrying out regular screening on hypertensive patients. It emerges in the literature that when there is systematic application of evidence-based tools, diagnostics will be improved; however, there are still major obstacles. The study being proposed will pursue these objections by evaluating the impact of the training and integrating the EHR on NP adherence. The results may be used to guide the future NP training curriculum and policies that influence the betterment of the diabetic population's mental health care.

You utilized outdated resources- which is a major issue. Also you did not preparing a document that compared and contrasts the information in the articles you found. That was part of the instructions. You were also missing the gaps in knowledge

References

Andrews, W. R., Convoy, S., Anderson, B., & Waldrop, J. B. (2025). Detection of depression in patients with type 2 diabetes. The Journal for Nurse Practitioners, 21(2), 105299. https://doi.org/10.1016/j.nurpra.2024.105299

De Groot, M. (2023). Diabetes and depression: Strategies to address a common comorbidity within the primary care context. American Journal of Medicine Open, 9, 100039. https://doi.org/10.1016/j.ajmo.2023.100039

Hermanns, N., Caputo, S., Dzida, G., Khunti, K., Meneghini, L. F., & Snoek, F. (2013). Screening, evaluation, and management of depression in people with diabetes in primary care. Primary Care Diabetes, 7(1), 1–10. https://doi.org/10.1016/j.pcd.2012.11.002

Richardson, G. C., Derouin, A. L., Vorderstrasse, A. A., Hipkens, J., & Thompson, J. A. (2014). Nurse practitioner management of type 2 diabetes. The Permanente Journal, 18(2), e134–e140. https://doi.org/10.7812/TPP/13-108