Medicine and Health Sciences Commons^™

Improving Depression Screening Protocol And Subsequent Sbirt Referrals, Mclaine S. Rich

Family Medicine Clerkship Student Projects

As a federally qualified health center, Lamoille Health Family Medicine receives annual data evaluating their performance in a number of categories. They exceeded expectations in screening eligible patients for depression, yet did not see the same success in referrals following a positive screening. After discussing with nursing and physician staff it became clear that there were discrepancies regarding office workflow/specific responsibilities. Moreover, some physicians expressed that they were unsure exactly how to handle positive screening results. This flowsheet developed will alleviate confusion in who is responsible for each step of screening, and uses evidence based guidelines for when to refer …

Is There An App For That? Introducing Self-Guided Therapy-Based Mental Health Apps In A Primary Care Setting, Althea Jem Darbin Tapales

Family Medicine Clerkship Student Projects

The prevalence of mental health disorders in Vermont continues to be an economic burden, especially in Addison County. The Addison County, VT Community Health Improvement Plan 2022-2025 identified “Access to Mental Health Services” as the top priority with a general concern regarding the affordability and demand of such services, and shortage of providers in the general community. Consequently, the shortage of mental health services along with the coronavirus pandemic resulted in a mental illness epidemic which led to an accelerated growth of self-guided therapy-based mental health apps. Most apps are affordable, accessible, and prioritize patient privacy which overcomes barriers to …

Bridging Cultural Barriers To Perinatal Mental Health Care In New Americans, Madeline Yvette Powell

Family Medicine Clerkship Student Projects

Perinatal mental health outcomes are worse in New Americans, particularly in refugee patients. Mental health stigma and cultural differences in views on mental illness impact New Americans’ willingness to discuss mental health concerns with healthcare workers. This is in addition to language barriers, time constraints, financial barriers, and general mistrust of medical professionals.

Addressing Post –Covid-19 Pandemic Depression, Aria Elahi

Family Medicine Clerkship Student Projects

This community project explores the impact of the COVID-19 pandemic on mental health, particularly focusing on depression, and introduces an intervention in the form of a pamphlet distributed at Newtown Primary Care. The pamphlet addresses individuals experiencing worsened depression due to the pandemic, regardless of COVID-19 infection status, and includes the PHQ-2 and PHQ-9 screening questionnaires for self-assessment. Insights from interviews with Newtown Primary Care were instrumental in designing the pamphlet.

Results reveal that the pandemic has substantially affected patients' mental health, increasing the need for resources. Patients diagnosed with pre-existing depression experienced worsening symptoms due increased stressors due to …

Stress Management & Resiliency Training (Smart) For Nursing Students, Lili Martin, Msn, Rn, Pccn, Dnp(C), Marcia Bosek, Dnsc, Laura Foran-Lewis, Ph.D, Rn

College of Nursing and Health Sciences Doctor of Nursing Practice (DNP) Project Publications

Background: Baccalaureate nursing students report high levels of stress and anxiety. Chronic stress in nursing students is on the rise and can increase the risk for suicide, depression, burnout, and increased academic attrition.

Objectives: The purpose of this EBP/QI project was to establish baseline stress and anxiety levels for senior baccalaureate nursing students and to evaluate the effectiveness of implementing the Benson Henry Institute (BHI) SMART program with nursing students.

Methods: Senior nursing students (n=32) self-selected into either the control or SMART group. The SMART group participated in 8 weekly 1.5 hour SMART sessions during the fall, 2020 semester. All …

Exercise As A Tool For Treating Anxiety And Depression, Lizzi Hahn

Family Medicine Clerkship Student Projects

In addition to its important role in the maintenance of physical health, exercise has been shown to have numerous benefits for mental health. Recent studies indicate that even brief engagement in physical activity can make a positive impact on the treatment of pre-existing anxiety and depression - as well as the prevention of future symptoms. Despite this relationship between exercise and emotional wellness, regular activity in the United States is still exceedingly low, and exercise remains an underused tool by healthcare providers in the treatment of their patients’ anxiety and depression. The goal of this project was to assess patient …

Opportunities For Patient Self-Reflection During Acute Phase Of Depression Treatment, Millen Abselab

Family Medicine Clerkship Student Projects

This project for UVMMC Family Medicine at Hinesburg investigates the acute phase of depression treatment for adult patients and introduces opportunities for patient empowerment during this 4-to-6-week window through de-identified automated text surveys for self-reflection about treatment and pattern tracking contributory to mood. Sample text survey built on Beck Depression Inventory (BDI-II) and deployment of text surveys is based on Mosio. Future interventions can utilize mobile phone apps based on patient response to surveys.

Community Resources Addressing Peripartum Depression, Tiffany L. Lao

Family Medicine Clerkship Student Projects

Peripartum mood disorders affect a large proportion of new mothers as well as their families, partners, and support systems. This project aims to provide patients with information about peripartum mood disorders as part of their initial prenatal packet. Also included are a list of local community resources specifically addressing peripartum mood disorders for patients seeking additional support outside of their primary care office.

Devoloping A Primary Care Screening Protocol For Post-Miscarriage Depression, Sean Muniz

Family Medicine Clerkship Student Projects

Spontaneous abortions occur in 20-33% of pregnancies, and 10-30% of these women have clinically significant depression. These women are often unscreened by either PCPs or OBs for depressive symptoms. We developed a screening protocol using the PHQ-2 to assess for depression in patients who have had a spontaneous abortion. The protocol utilizes a nursing care manager to follow up with patients who either were seen in the ED or self report spontaneous abortions to the PCP office. Follow up phone calls should be made within 2 weeks and at 6 weeks post spontaneous abortion, with offers for in-person follow-up given …

Mental Health Technology During The Era Of Covid-19, Michael Tabet

Family Medicine Clerkship Student Projects

Mental health symptoms - especially those of depression and anxiety - have become more prevalent during the COVID pandemic. As seen in previous years, direct and indirect costs of depression can be staggering. Apps exist on smart devices that are based in evidence-based practices that can be therapeutic for mental health issues such as depression, anxiety, and insomnia. A simple handout with some suggested popular mental health apps and accompanying descriptions was created to be used in the CVPH Family Medicine clinic to increase awareness of these apps among patients suffering from depression, anxiety, and insomnia.

The Use Of Technology For Mental Wellbeing In The Era Of Covid-19, Adam Fakhri

Family Medicine Clerkship Student Projects

Prevalence of mental health issues has increased during the time of COVID-19. There are many contributing factors to consider, the main one reported has been social isolation due to quarantine precautions. Members of the community have spent extended periods of time at home and away from their loved ones during this pandemic. Many patients have reported many life events occurring including deaths in the family without the ability to even mourn with their family members. This has taken a toll on the community, especially in Vergennes where this small tight knit community that has relied on its tight social bonds …

Physical Activity Levels And Depressive Disorder: A Cross-Sectional Sample Of Vermont Adults, Paige Stefanak, Obichukwu Ezennia, Marley Jurgensmeyer, Jessica Dubetsky, Elise Carlson

Master of Public Health Culminating Projects

Objective: To investigate the association between meeting physical activity (PA) recommendations and having ever been told of having a depressive disorder in a cross-sectional sample of Vermont adults.

Methods: Study participants (n = 11,429) were Vermont residents that had answered all required questions from 2015 and 2017 Behavioral Risk Factor Surveillance System (BRFSS) telephone surveys. Descriptive and binary logistic analyses were run with PA as the exposure variable and depression as the outcome variable.

Results: Study participants were 44.5% males; 93.2% white/non-Hispanic; 67.6% with some college or more; 46% age 60 or over; 45.8% employed for wages and retired. A …

High School Students Who Experienced A Concussion Are More Likely To Report Indicators Of Depression: A Cross-Sectional Examination Using The 2017 Vermont Youth Risk Behavior Survey, Zoe Adams, Elizabeth Morris, Amelia Trello, Rachel Cummings, Lexi Naylor, Thomas Delaney, Kelsey Gleason

Master of Public Health Culminating Projects

Objective: To examine the relationship between a history of concussions and depressive indicators in high school students.

Methods: 2017 Vermont Youth Behavior Risk Survey data (n = 26,962) was used to evaluate a potential association between concussions and depressive indicators in 20,653 eligible high schoolers using a multivariate logistic regression analysis, controlling for covariates.

Results: Multivariate logistic regression analysis using a dichotomous concussion variable revealed that the odds of reporting one or more depression indicators were greater for individuals reporting at least one concussion in the past year compared to individuals who did not report any concussions, controlling for all …

Phq-9, But In Spanish, Jose Calderon

Family Medicine Clerkship Student Projects

Spanish speaking patients are often missed for depression. A common issue is lack of awareness of the Spanish version of the PHQ-9

Resource To Address Pandemic-Related Anxiety And Depression For Pregnant Patients In Vermont, Mohammed Wali

Family Medicine Clerkship Student Projects

The 2019 novel coronavirus (COVID-19) has led to patient deaths, strained health care systems, and economic uncertainty. Distress during pregnancy can lead to adverse outcomes for both parent and baby. A patient-friendly handout was created for pregnant patients to offer reassurance, incorporate mind-body recommendations to address stress, and offer screening tools to empower them to address mood concerns with their obstetric providers in the COVID-era.

Coping Skills For Daily Life: Cost-Effective Strategies To Prevent And Address Mental Health Disorders, Shae Ian Rowlandson

Family Medicine Clerkship Student Projects

Mental health disorders, along with their associated cost and negative outcomes, have continued to persist in Vermont and have become one of the largest, growing challenges to public health in the United States. Unfortunately, Vermont does not appear to have enough resources or providers to optimally address it. Concurrently, coping strategies of minimal cost that have the potential to prevent or address mental health disorders may often be underutilized or misconstrued by the population. A pamphlet providing information on evidenced, cost-effective coping strategies was designed and distributed to providers and patients to enable patients with the skills to help themselves …

Addressing Adolescent And Young Adult Mental Health During The Covid-19 Pandemic, Megan Boyer

Family Medicine Clerkship Student Projects

This quality improvement project at South Burlington Family Medicine aimed to investigate the mental health of individuals ages 13-25 in our practice during the COVID-19 pandemic. Eligible patients received a PHQ-9 questionnaire with two additional questions related to COVID-19. Recommendations for future interventions to serve this population were made based on these preliminary findings, with the goal of doing a full PDSA cycle in the near future.

Improving Screening For Depression And Fall Risk In Community Dwelling Older Adults, Devan C. Lucier

College of Nursing and Health Sciences Doctor of Nursing Practice (DNP) Project Publications

Purpose. Falls and depressive symptoms are common in the older adult population and are associated with significant morbidity and mortality. The relationship between depression and falls is bidirectional. Given that community health nurses are critical health care personnel in assessing risk for depression and falls in the older adult population, the purpose of this project was to implement screening measures for depression and falls in an older adult population.

Methods:Nurses from a community health outreach team implemented depression and fall risk screening assessment with an older adult population 65 years and older in their homes. The Geriatric Depression Scale, …

Patient Education On The Association Of Hormonal Contraception With Depression, Julia E. Hannigan

Family Medicine Clerkship Student Projects

Hormonal contraceptive agents are widely used by women during their reproductive years. In recent years, research has been released linking hormonal contraception with the initiation of antidepressant medication and a first diagnosis of depression. More research is still warranted in order to further elucidate the relationship between hormonal contraception and depression, but current evidence prompts the necessity for shared decision making between clinicians and women considering treatment with hormonal contraceptive agents. The goal of this project is to give providers easily accessible patient educational materials in the form of epic smart phrases to aid in informed decision making.

Exercise Promotion For Patients With Mental Health Conditions In Milton, Vt, Pirapon Leo Chaidarun

Family Medicine Clerkship Student Projects

Depression and anxiety are two highly prevalent mental health conditions and can often occur together. Research shows that sustained low-intensity exercise releases chemicals that promote nerve cell growth in the brain, which helps regulate mood and relieve symptoms. Exercise may seem like a logical solution for mental health to those with a medical background, but may be a new idea to many patients who are unaware of the added benefits of staying active.

Meditation For Depression And Anxiety, Max Knapp

Family Medicine Clerkship Student Projects

Mental health is a major burden on residents of Vermont. Access to care is the most commonly cited cause. An evidence-based pamphlet was designed to empower providers to quickly and easily help patients start a meditation practice to help address such concerns.

Caregiver Burnout, Elizabeth Anne Lynch

Family Medicine Clerkship Student Projects

Caring for someone with advanced health care needs, dementia, or a difficult diagnosis can take a mental, physical and financial toll on the caregiver. It is important for providers to recognize, address and assist caregivers in as many ways as possible. Providing physicians with a readily available patient-education template in Epic may improve outreach and communication with increasingly isolated patients and caregivers and improve care for all without burdening physicians more.

Risk And Protective Factors Associated With Bullying Among Vermont Students, Julia Crane, Jiliian Leikauskas, Deb Cannon, Craig Morrill, Michelle Sheehan, Shayla Livingston

Master of Public Health Culminating Projects

Background: Recent research has linked depressive episodes and behavior to bullying victimization, adding to a decade of research associating bullying victimization with multiple risk and protective factors. Objective: We aimed to determine how risk and protective factors differ among Vermont high school students who are bullied electronically as compared to in-person. Methods: This study was a cross-sectional analysis and applied descriptive and logistic regression on the 2015 Vermont Youth Risk Behavior Survey (n=20,013). Results: We found that students who reported depression, suicide attempts, or physical fighting were more likely to report both in-person and electronic bullying victimization, …

Depression Screening And Prevention Among Vt Bosnian Refugees, Mushtaba Yuridullah

Family Medicine Clerkship Student Projects

Mental health and mental health disorders are stigmatized in our society today. Many people suffer from mental health disorders but are not willing to seek treatments due to various concerns. One big factor is lack of awareness about mental health disorders and brushing mental health issues as something “non-medical” or “all in your head.” This view is especially prevalent among our refugees and new immigrant communities. This project aims to bring about awareness regarding mental health in our local Vermont communities and will emphasize the availability of treatments.

Perinatal Depression: Breaking Barriers To Treatment, Florence Lambert-Fliszar

Family Medicine Clerkship Student Projects

Depression in the perinatal period is a common medical issue in Vermont, affecting about 10% of women. Multiple and severe consequences of depression during this time are seen for both mothers and babies, including lower breastfeeding rates, fewer healthcare visits for the child, and psychopathology in the child later on. The goal of this project is to identify and address some of the barriers we currently face in identifying and treating women for depression. Major barriers women encounter in seeking help involve poor recognition of symptoms facing increasing stress of motherhood, stigma, as well as neglecting to attend to mental …

The Effects Of Substance Use And Depressive Symptoms On High-Risk Sexual Behaviors In Sexually Active Vermont Adolescents, Ashley Greenfield, Kelly Clements, Lexy Doria, Jenna Cebelius, Rajan Chawla, Michelle Shepard

Master of Public Health Culminating Projects

Background: There is a high prevalence of substance use, depressive symptoms, and high-risk sexual behaviors (HRSB) among adolescents, but the relationships between these variables is less clear. Objective: To identify associations between these behaviors and outcomes, this study aims to address how depressive symptoms paired with substance use impacts HRSB in adolescents. Methods: Adolescent self-reported depressive and suicidal symptoms, substance use, and HRSB were obtained from the 2015 Vermont Youth Risk Behavior Survey (YRBS) (n= 17,041). The associations between exposures (substance use and depressive symptoms) with HRSB were studied. Variables were calculated using prevalence ratios with 95% confidence intervals (CI) …

The Association Of Hormonal Contraception With Depression, Pamela Derickson

Family Medicine Clerkship Student Projects

Hormonal contraceptives are widely used by women during their reproductive years. Currently, over 100 million women worldwide use the pill, and 82% of sexually active women in the USA will use oral contraceptive pills at some time during their reproductive years (Carrol, 2017). Oral contraceptive use, especially among adolescents, is associated with subsequent use of antidepressants and a first diagnosis of depression, suggesting depression may be a potential adverse effect of hormonal contraceptive use (Skovlund, 2016). This project focused on educating health care providers at the Community Health Center of Burlington, VT (CHCB) about the association of depression and oral …

Behavior Health Integration: Depression, Garyn Worrall

Family Medicine Clerkship Student Projects

Integration of Behavioral Health Specialists and mental health education is an important goal for the Community Health Center of Burlington (CHCB) Vermont. An educational brochure on depression was created with symptoms, definitions, self care, and ways to receive support from both CHCB, local, and national resources.

Magnesium Intake And Depression In U.S. Adults, Emily Tarleton

Graduate College Dissertations and Theses

Research has focused extensively on the negative health effects of inadequate Mg intake, but the extent of the problem of deficiency deserves further exploration. The notion that U.S. adults consume an inadequate amount of magnesium, leading to increased risk for chronic diseases such as depression, is plausible. National Health and Nutrition Examination Surveys (NHANES), which are large, cross-sectional, population-based data sets that assess the health and nutritional status of U.S. adults and children, indicate over half the adult population does not consume adequate amounts of magnesium based on the estimated average requirement (EAR) established by the Institute of Medicine. Using …

Narrative Medicine: Improving Patient Care And Shifting Office Culture, Julia Shatten, Yazen Qumsiyed

Family Medicine Clerkship Student Projects

Assessing the effects of narrative medicine on the doctor patient relationship, office culture and the management of symptoms in patients with chronic pain and depression in a primary care setting.