Introduction
The negative feeling is a common thing in people as they grow. This is because they experience various challenging events because of various factors such as illness, relationship breakup, and loss of loved ones. Painful feelings are associated with these events and are present to provide one with an opportunity to grow. Conversely, the feelings may become dangerous when they are symptoms of depression. The current study investigates the early diagnosis of depression among young adults in primary care practice.
Literature Review
PHQ-2 and PHQ-9
Shannon Hughes, Mary Rondeau, Scott Shannon, Julia Sharp, Grace Ivins, JeongJin Lee, Ian Taylor, and Brianna Bendixsen examined the topic “A holistic self‑learning approach for young adult depression and anxiety compared to medication‑based treatment‑as‑usual.” The type of research is quantitative and qualitative, where data is collected from various research groups for qualitative purposes. The qualitative data was retrieved from a focus group where lifestyle, social connection, and relationships with other people were collected. Biopsychosocial services are methods that evaluate biological, psychological, and social factors. Hughes et al. (2020) assessed the biopsychosocial of young adults experiencing depression, comparing it with the usual outpatient psychiatric care. The research used a quantitative methodology, collecting data using an online pre-screening tool. The participants were subjected to interventions involving peer support groups, multi-vitamin supplements, coaching, and weekly education. The findings show that participants portrayed an improvement at the end of the research implying that the self-learning approach is an effective alternative to outpatient psychiatric care programs. The research recommended that future studies incorporate cost effectiveness and other treatment modalities in the short-term and long-term.
Larson Sharon, Nemoianu Andrei, Lawrence Debra F, Troup Melissa A, Gionfriddo Michael R, Pousti Bobak, Sun Haiyan, Riaz Faisal, Wagner Eric S, Chrones Lambros, and Touya Maelys analyzed the topic “Characterizing primary care for patients with major depressive disorder using electronic health records of a US-based healthcare provider.” The research type is quantitative, where patients with major depressive disorder (MDD) were selected and data collected regarding their condition. Variables such as persistence, treatment costs, and the first-time diagnosis were utilized. Primary care is crucial in managing major depressive disorder (MDD). Conversely, primary healthcare providers face challenges in delivering the treatment algorithms (Larson et al., 2022). The research used a quantitative methodology where Patient Health Questionnaire (PHQ)-9 was used to collect data. Larson et al. (2022) findings show that the high cost of healthcare resource utilization (HRU) in primary care affects treatment persistence.
The Patient Health Questionnaire depression module (PHQ-9) is an instrument used to determine depression and its severity. Levis Brooke, Sun Ying, He Chen, Wu Yin, Krishnan Ankur, Bhandari Parash Mani, Neupane Dipika, Imran Mahrukh, Brehaut Eliana, Negeri Zelalem, Fischer Felix H, Benedetti Andrea, Thombs Brett D, Che Liying, Levis Alexander, Riehm Kira, Saadat Nazanin, Azar Marleine, and Rice Danielle et al. explored the topic “Accuracy of the PHQ-2 alone and in combination with the PHQ-9 for screening to detect major depression: systematic review and meta-analysis.” The research type is quantitative, where data from various researches that employed the two types of instruments were included. Levis et al. (2020) investigated the accuracy of the PHQ-2 in conjunction with the PHQ-9 tool in detecting depression. The study utilized a quantitative research methodology where a literature review was used. The results show that PHQ-2 is significant in detecting depression compared to PHQ-9. The study recommends further research to determine the combined value of the PHQ-2 and PHQ-9. Furthermore, the authors suggest that further research should be conducted to determine the research and clinical significance of the integrated approach of PHQ-2 and PHQ-9.
Wang Margaret Z, Jha Manish K, Minhajuddin Abu, Pipes Ronny, Levinson Sara, Mayes Taryn L, Greer Tracy L, and Trivedi Madhukar H researched the topic “A primary care first (PCP-first) model for screening and treating depression: A VitalSign6 report from the second cohort of 32,106 patients.” The research type employed is quantitative and longitudinal, where comparison is made on the treatment selection based on quantitative data collected. The longitudinal data is from November 2016 to July 2019. Wang et al. (2022) employed the PCP-First model to investigate depression severity. The research utilizes a quantitative methodology, using the Patient Health Questionnaire 2-item (PHQ-2). The PCP implemented showed more positive results than the usual primary care. Continuous use of PCP-First significantly improves patients’ healthcare with depression symptoms. Despite depressive disorders being prevalent among young and older adults, a significant barrier affects accessibility to treatment.
Renn Brenna N, Johnson Morgan, Powers Diane M, Vredevoogd Mindy, and Unutzer Jurgen researched the topic “Collaborative care for depression yields similar improvement among older and younger rural adults.” The research type is quantitative, where data was collected from five states Idaho, Wyoming, Montana, Washington, and Alaska. Renn et al. (2021) explore the relationship between depression affecting young adults aged 18 to 64 and older adults aged 65 and above. The study implements a quantitative research methodology, where Patient Health Questionnaire-9 (PHQ-9) is used. The finding suggests a significant difference in depressive symptoms between young and older adults, where young adults portray high levels of depression (Renn et al., 2021). Furthermore, older adults are vulnerable compared to young adults as they experience various challenges in obtaining treatment. Despite CoCM portraying significant results among older adults, it has proven helpful in attaining similar results for young adults in primary care patients (Renn et al., 2021). The authors recommend additional of marginalized populations into the research to enhance the CoCM evidence base.
Bianca Lauria-Horner, Tara Beaulieu, Stephanie Knaak, Rivian Weinerman, Helen Campbell, and Scott Patten examined the topic “Controlled trial of the impact of a BC adult mental health practice support program (AMHPSP) on primary health care professionals’ management of depression.” The type of research is quantitative, where 77 practices were enrolled. Lauria-Horner et al. (2018) examine the effect of family physician training in reducing depressive symptoms. The study employs a quantitative research methodology where Patient Health Questionnaire (PHQ-9) was used for assessment. The findings suggest that the novel-skill program is essential in improving clinical outcomes of depressed patients through increased family physician comfort. The program is effective as it provides critical insights into the impact of the Adult Mental Health Practice Support Program (AMHPSP) on clinical results and its application in primary care. Furthermore, the study shows that there are challenges when administering community-based interventions. The researchers recommend future studies consider that randomization in the intervention should utilize practice-level outcome measures that will provide the total benefit of randomization. Furthermore, it is crucial to use large sample sizes and effective strategies to prevent attrition.
Kimberly A. Siniscalchi, Marion E. Broome, Jason Fish, Joseph Ventimiglia, Julie Thompson, Pratibha Roy, Ronny Pipes, and Madhukar Trivedi explored the topic “depression screening and measurement-based care in primary care.” The research type is quantitative, where primary care data was utilized. The research investigated the significance of the vitalsign6 in enhancing the identification and depression management among adult patients aged 18 and above. There is a wide gap in the treatment of depression which is a common disease in the USA. Most primary care use screening and evidence-based protocols. Siniscalchi et al. (2020) used quantitative methodology using Patient Health Questionnaire-2 (PHQ-2) and Patient Health Questionnaire-9 (PHQ-9). The project used VitalSign6, effectively producing positive results in managing depression in primary care. VitalSign6 is effective in enhancing clinical screening of depression and promoting mental health awareness (Siniscalchi et al., 2020). The research supports the approach of depression care as an issue that is triage rather than as a mental health access problem. The research recommends that efforts be based on technology to equip primary caregivers with equipment that will integrate screening with measurement-based care (MBC). Furthermore, there is a need to identify factors that contribute to and improve retention, such as patient engagement, care coordination, and teletherapy.
Relationship with Other Factors
Davis Molly, Jones Jason D, So Amy, Benton Tami D, Boyd Rhonda C, Melhem Nadine, Ryan Neal D, Brent David A, and Young Jami F explored the topic “Adolescent depression screening in primary care: Who is screened and who is at risk?” The research type is quantitative, where various groups were involved in the study. There is a significant variation in people who require depression screening and those at high risk of suicide. Females have a higher chance of getting screened compared to males. Davis et al. (2022) used a quantitative methodology and Patient Health Questionnaire similar to Wang et al. (2022). The finding shows that the risk of suicide is high among females (Davis et al., 2022). The study recommends using data from various hospitals. Furthermore, the study identifies misalignment during screening and risk factors that require critical consideration to ensure quality health outcomes.
Marcia M. Zorrilla, Naomi Modeste, Peter C. Gleason, Diadrey-Anne Sealy, Jim E. Banta, and Sang Leng Trieu investigated the topic “Assessing depression-related mental health literacy among young adults.” The type of research is quantitative, where 600 participants, both students, and non-students, were involved in the research. Zorrilla et al. (2019a) investigated the significance of mental health literacy (MHL) in enabling one to seek help on depression issues that lead to suicide ideation among young adults from San Francisco Bay aged 18 to 24. According to Zorrilla et al. (2019a), mental health literacy is significant in determining individuals with suicide ideation. The research employs a quantitative research methodology using a mental health literacy questionnaire. The finding of this research shows that males are at a higher risk hence recommending assessment of the usefulness of legalization of Cannabis in future studies. Furthermore, the study recommends future research involve alcohol education when replicating the same study.
Alma Sorberg Wallin, Ilona Koupil1, Jan‑Eric Gustafsson, Stanley Zammit, Peter Allebeck, and Daniel Falkstedt researched the topic “Academic performance, externalizing disorders and depression: 26,000 adolescents followed into adulthood.” Wallin et al. (2019) study is quantitative and longitudinal research where quantitative data is collected from 1967 to 1982 involving Swedish men and women aged 16 to 48. The prevalence of high depression among adults seems to be differentiated, and there are various reasons that try to explain this effect. Wallin et al. (2019) used a quantitative methodology to investigate the relationship between academic performance and depression in adulthood. The methodology used variables such as GPA and first-time diagnosis of depression using the Cox proportional hazards model. Wallin et al. (2019) identified a significant relationship between young adults and poor academic performance. The results show the need for early diagnosis among children and youths.
Marcia Monica Zorrilla, Naomi Modeste, Peter C. Gleason, Diadrey-Anne Sealy, Jim E. Banta, and Sang Leng Trieu examined the topic “depression and help-seeking intention among young adults: The theory of planned behavior.” The type of research is quantitative, where students and non-students were recruited to participate. Zorrilla et al. (2019b) investigated the presence of a correlation between the intention of seeking help and factors such as marijuana use, relationship status, age, knowing a family member with depression, long-term mental health services, alcohol use, gender, previous use of mental health, ethnicity, and race. Furthermore, the study explores how such factors predict an individual’s help-seeking intention (Zorrilla et al., 2019b). The findings show that attitude is significant in predicting help-seeking intention among young adults. Zorrilla et al. (2019b) also argue that depression is prevalent among young adults. The researchers used a quantitative methodology where a cross-sectional online survey was used. The research shows that encouraging help-seeking behavior is helpful in suicide. The researchers recommend future studies use mental health literacy instruments with a different scale in the theory of behavior studies.
Swenda Moreh and Henry O’Lawrence explored the topic “common risk factors associated with adolescent and young adult depression.” The research type is quantitative, where various studies are evaluated. The purpose of the study was to investigate the relationship between gender and depression among adolescents and young adults. Moreh and Lawrence (2016) argue that depression is a psychological disorder that affects people of all ages. The research uses a quantitative methodology where various literature materials are investigated. The findings suggest that depression has multiple causes involving environmental risks, biological and genetics. Furthermore, the findings of this research are similar to Davis et al. (2022), which show that females have a higher chance of getting depression symptoms. Depression is a mental condition not majorly associated with adults as it affects a large proportion of adolescents and young adults (Davis et al., 2022). The current study provides critical information regarding the high rate of depression among adolescent girls, making it a crucial health issue. The researchers recommend further studies to determine factors contributing to increased depression among females. Furthermore, future studies need to identify interventions suitable that will help primary clinicians initiate depression management programs.
Hou Xang-Ling, Bian Xiao-Hua, Zuo Zhi-Hong, Xi Ju-Zhe, Ma Wei-Jun, and Owens Laurence D explored the topic “Childhood maltreatment on young adult depression: A moderated mediation model of negative automatic thoughts and mediating role of self-compassion.” The type of research is quantitative, where depression symptoms were reported. Hou et al. (2020) investigated the relationship between young adult depression and childhood maltreatment based on the mediating role of automatic negative thoughts. The research used a quantitative research methodology where the self-reported questionnaire was used. The findings suggest that maltreatment in childhood correlates with young adult depression, which is linked indirectly with negative thoughts. This shows the significance of self-compassion in curbing negative outcomes from childhood maltreatment (Hou et al., 2020). Childhood maltreatment significantly predicted negative automatic thoughts, which predicted upcoming depression symptoms among young adults. The current study recommends future studies to investigate the effect of self-compassion intervention for individuals who had experienced childhood maltreatment.
Beth Han, Mark Olfson, and Ramin Mojtabai researched the topic “Depression care among depressed adults with and without comorbid substance use disorders in the United States.” The type of research is quantitative, where individuals aged 18 and above participated in a national survey. Han et al. (2017) compared adults in the USA undergoing depression care with years of major depressive disorder and substance use disorder to those without substance use disorder. The researchers used a quantitative research methodology where a questionnaire was used (Han et al., 2017). The finding suggests that individuals with comorbid substance abuse disorder had a low chance of receiving depression care in the past. This also affected less educated individuals, depressed young adults, and minority groups.
Sandipan Bhattacharjee, Lisa Goldstone, Nina Vadiei, Jeannie K. Lee, and William J. Burke examined the topic “Depression screening patterns, predictors, and trends among adults without a depression diagnosis in ambulatory settings in the United States.” The research type is quantitative, where data is retrieved from the 2005 to 2015 National Ambulatory Medical Care Survey. Bhattacharjee et al. (2018) investigated the patterns, trends, and predictors among adults that lack a diagnosis of depression but have undergone depression screening. The study used a quantitative research methodology with a cross-sectional design. The finding shows a significant increase in screening rates after 2009. However, it remains low in adults that lack a depression diagnosis. Furthermore, Bhattacharjee et al. (2018) argue that increasing screening time helps increase screening rates. The research shows significant regional disparities where most people who participated in the study were from rural areas.
Yena Lee, Elisa Brietzke, Bing Cao, Yan Chen, Outi Linnaranta, Rodrigo B Mansur, Paulina Cortes, Markus Kösters, Amna Majeed, Jocelyn K Tamura, Leanna M W Lui, Maj Vinberg, Jaakko Keinanen, Steve Kisely, Sadiq Naveed, Corrado Barbui, Gary Parker, Mayowa Owolabi, Daisuke Nishi, JungGoo Lee et al. examined the topic “Development and implementation of guidelines for the management of depression: a systematic review.” The type of research is quantitative, where data from various research articles were collected. Lee et al. (2020) investigated the development and implementation of depression management guidelines. The researchers employed a quantitative methodology where a literature review was used. The research findings suggest an inadequate plan for handling the implementation guidelines in low and middle-income countries (Lee et al., 2020). This affects the health outcomes as they are critical in managing depression in primary care. The research recommends future studies to primarily evaluate guideline implementation.
Technological Changes
Edin Lakasing and Zul Mirza investigated the topic “Anxiety and depression in young adults and adolescents.” The research type is exploratory, highlighting anxiety and depression based on clinical management, including the role of social media. The authors employed a literature review methodology where various research materials were used to explain how depression changes with the current technological environment. Lakasing and Mirza (2020) argue that clinical management of depression needs to adapt following the current technological changes where social media plays a critical role in generating negative feelings that may result in depression. Increasing the responsiveness of mental health services is necessary to cater to the shifting depression epidemiology. Lakasing and Mirza (2020) also claim that mental health trust is significantly altered by over-reliance on bank nurses, high absenteeism, low morale, and staff turnover. Despite social media being an avenue of depression, it has promising outcomes in identifying youth with depression symptoms.
Minas Michikyan explored the topic “Depression symptoms and negative online disclosure among young adults in college: a mixed-methods approach.” The type of research is quantitative, where young adults in college completed a survey. Michikyan (2019) investigates the relationship between negative emotions portrayed in social media and depression symptoms. Additionally, the research needed to document the experience of young adults in an online world and the association between the disclosures of negative experiences online and depression symptoms. The research uses a mixed-method research methodology where questionnaires were used. The findings show that disclosure of negative experiences portrays depression symptoms which provides an area to identify mental health concerns. Young adults experience transition in life; those with depression and stress tend to use social media to report their experiences to alleviate mental health concerns. Michikyan (2019) shows that individuals who expose their negative feelings and experiences online reported lower depression levels than their peers. The researcher recommends the use of various tools to enable the attainment of in-depth responses.
Roystonn Kumarasan, Teh Wen Lin, Samari Ellaisha, Cetty Laxman, Devi Fiona, Shahwan Shazana, Chandwani Nisha, and Subramaniam Mythily researched the topic “Analysis and interpretation of metaphors: Exploring young adults’ subjective experiences with depression.” The type of research used is qualitative, where data was collected for almost a year in a tertiary psychiatric hospital. Roystonn et al. (2021) investigate how young adults use metaphors in describing depression. Insights from the metaphors play a critical role in enriching the understanding of depression among the participants. The researchers used semi-structured interviews to collect data from thirty-three participants. Deductive and inductive research approaches were used in data analysis. The analysis resulted in five major themes that show how the metaphors are significant in portraying depression among young adults. Metaphors are useful in enhancing depression risk assessment for timely treatment and care. The study recommends that multicultural treatment settings be incorporated to provide more insight into depression among young adults.
Alissa Knight and Niranjan Bidargaddi researched the topic “Commonly available activity tracker apps and wearables as a mental health outcome indicator: A prospective observational cohort study among young adults with psychological distress.” The type of research is quantitative, where participants were recruited for more than 18 months. It is essential to monitor the progress of individuals by tracking their mental health performance. Identifying symptoms early through warning signs is a significant way of caring for people with mental disorders. Knight and Bidargaddi (2018) used a quantitative methodology to investigate the significance of tracker apps among young adults in Australia experiencing psychological distress. The apps used proved effective in recording the levels of psychological distress (Knight & Bidargaddi, 2018). This helps clinical care to identify mental disorder that appears frequently. The study recommends that future research explore participants’ efficacy using commercial apps compared to interventions with dedicated smartphone apps.
Conclusion
The literature reviews show a need for early identification of depression symptoms in primary care practice. PHQ-2 and PHQ-9 are useful tools for portraying depression symptoms. However, depression is related to various factors such as gender and academic performance. There are multiple causes which include environmental risks, biological and genetics. Additionally, despite technological changes creating sources of depression, social media and apps provide an avenue for detecting depression. The gap in this research is a suitable method that can be used to detect early symptoms of depression following the changes in the epidemiology of depression.
References
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