Optional Depression Screening in College Health

Many people living with depression are not receiving treatment. College students are a population particularly affected by depression, which has negative implications for future academic and personal success. U.S. organizations have recommended universal depression screening to identify those in need of treatment, to improve outcomes and minimize depression's effects. Primary care is a key access point for health services, including depression screening and management. Critics of depression screening cite concerns with the recommendation, specifically weak evidence of the overall benefits, potential for overdiagnosis, and overutilization of scarce primary care resources.The project site is a large southeastern Pennsylvania public research university within the student health clinic. Staff feedback highlighted several problems with the depression screening process. This project utilized a retrospective pre- and post-implementation quality improvement design to analyze data and determine the effect of making depression screening optional.In 2020, depression screening was embedded into the nursing triage process. By contrast, in 2024, patients were given the option to complete depression screening. A comparison was made between 2020 and 2024, looking at similar two-week periods. In 2020, of the 222 patients who were given the PHQ-2 by design, 9 (4%) completed the PHQ-9. In 2024, of the 183 patients who were offered depression screening, 78 (43%) opted to take the PHQ-2, and 14 (8%) took the PHQ-9. Results suggest that making depression screening optional in 2024 improved efficiency.