Improved Screening for Depression in Patients Initiating Fertility Treatment

Objective: To improve screening for depression in patients who are initiating fertility treatment at a reproductive endocrinology and infertility (REI) center by screening all patients at their initial visit using the Patient Health Questionnaire-9 (PHQ-9). Design: This quality improvement project was conducted using a plan-do-study-act cycle implemented with a postintervention study design. Setting/Local Problem: A medium-size REI center in a mid- Atlantic U.S. metropolitan area where screening for mental health status in patients initiating fertility treatments was not occurring. Participants: Patients who were scheduled in person with REI providers for a new patient consult regarding fertility were declared eligible. Intervention/Measurements: The PHQ-9 was administered by providers at initial consults for patients seeking fertility treatments from October 2022 to February 2023. Three cycles of the plan-do-study-act model were used to execute change. For all patients who scored 5 to 9 (mild depression), conversations regarding counseling referrals occurred. For all patients who scored >= 10 (moderate to severe depression), a referral for counseling and medication management was generated. Data were analyzed via descriptive statistics. Results: A total of 115 participants were included. A screening rate of 84.3% (n n 1 / 4 97) was achieved for patients initiating treatment. Of the 97 screened, 21 patients had a score of >= 5; 19 were given a referral for counseling. However, none of the patients attended a counseling session or started medication prescribed by their primary care provider during the 2-month follow-up period. Barriers identified fi ed included costs, personal preferences, and access to services. Conclusion: The PHQ-9 screening tool was implemented at an REI clinic to improve the frequency of mental health screenings and provide necessary referrals. However, additional follow-up is needed to ensure patients are receiving appropriate mental health care.