Implementing Universal Adult Depression Screening In A Rural Maine Free Medical Clinic, Karen Hussion

Doctor of Nursing Practice Scholarly Projects

Abstract

BACKGROUND: Depression in adults is a leading cause of disability, morbidity and mortality worldwide with an estimated prevalence of 20% in the US population. Despite estimates that one out of every five Americans suffers from depression, less than 50% of adult primary care patients with depression are identified, and less than 5% of all adult primary care patients are screened. To increase early detection and management of depression, the United States Protective Service Task Force (USPSTF) recommends routine depression screening for adults older than 18 years in primary care settings.

LOCAL PROBLEM: This project site was a rural, free, …

Finding Solutions To Institutional Corruption: Lessons From Cognitive Dissonance Theory, Lisa Cosgrove, Robert Whitaker

Counseling and School Psychology Faculty Publication Series

The American Psychiatric Association and academic psychiatry in the United States have two conflicts of interest that may affect their assessment of psychiatric drugs and their development of diagnostic and clinical care guidelines: payments from pharmaceutical companies and guild interests. Until recently, the proposed solution to industry-academic relationships has been transparency. However, cognitive dissonance research reveals that disclosure is not a solution because cognitive biases are commonplace and difficult to eradicate. Indeed, bias is most often manifest in subtle ways unbeknownst to the researcher or clinician, and thus is usually implicit and unintentional. Also, recent studies suggest that disclosure of …

Conflicts Of Interest In Clinical Practice Guidelines, Lisa Cosgrove, Allen F. Shaughnessy

Counseling and School Psychology Faculty Publication Series

Clinical practice guidelines are used increasingly across medical specialties and settings, making evaluation of their utility and validity a critical public health issue. In this paper, we describe some of the challenges that specialty organizations face as they try to ensure that their guidelines are trustworthy and useful. We examine the practice guidelines for Major Depressive Disorder recently published by the American Psychiatric Association (APA), identify five sources of potential bias that may affect the guideline development process and offer suggestions based on our review. For example, even for mild depression, this guideline privileges pharmacotherapy over other interventions, despite questions …

Psychiatric Taxonomy, Psychopharmacology And Big Pharma, Lisa Cosgrove

Counseling and School Psychology Faculty Publication Series

Clinicians practicing today need to be aware of the ways in which the current industry-dominated climate may undermine the integrity of the scientific process and, thus, may compromise patient care. In the mental health field, corporate sponsorship bias can affect psychiatric taxonomy and clinical Practice Guidelines (CPG). Financial conflicts of interest (FCOI) can occur when there are financial associations between researchers, authors, or panel members developing psychiatric diagnostic and treatment guidelines, and the pharmaceutical industry, or when randomized clinical trials (RCTs) are industry funded. Therefore, clinicians need to be especially vigilant about the informed consent process when patients are prescribed …