title: Universal depression screening, diagnosis, management, and outcomes at a student-run free clinic.
abstract: OBJECTIVE
  Student-run free clinics (SRFCs) are now present at most medical schools. Reports regarding SRFCs have focused on the infrastructure of established clinics, characteristics of the patient populations served, and their contribution to patient care. Few studies discuss their role in preventive medicine and even fewer discuss mental health care. This study examined the outcomes of a medical student-run universal depression screening, diagnosis, and management program at two SRFC sites.
  
  
  METHODS
  Medical students implemented a universal depression screening, diagnosis, and management program within the electronic health record during routine adult primary care visits utilizing the Patient Health Questionnaire-2 (PHQ-2) as an initial screening tool, with a protocol to administer the Patient Health Questionnaire-9 (PHQ-9) if the PHQ-2 score was ≥3. This is a retrospective medical record review of visits from August 13, 2013, through February 13, 2014, to assess this program.
  
  
  RESULTS
  Overall, 95.8 % (206/215) of the patients received either the PHQ-2 or the PHQ-9. Among the 174 patients without a previous diagnosis of depression, 166 were screened (95.4 %), of which 33 (19.9 %) had a positive PHQ-2 score of ≥3; 30 (of 33; 90.9 %) appropriately received a PHQ-9. Nineteen (of 166 screened; 11.4 %) previously undiagnosed patients were confirmed to have depression. Fourteen patients had two or more PHQ-9 tests at least 4 weeks apart and eight (57.1 %) had a clinically significant improvement, defined as PHQ-9 score decrease of ≥5. The prevalence of depression diagnosed prior to the implementation of this program in this cohort was 19.1 % (41/215) and after was 27.9 % (60/215).
  
  
  CONCLUSIONS
  This study demonstrated that medical students with faculty supervision can successfully implement a universal depression screening, diagnosis, and management program at multiple SRFC sites, identify previously undiagnosed depression, and work with interdisciplinary support services to provide treatment options, leading to a clinically significant improvement in depression severity.
authors.affiliation: University of California, San Diego, CA, USA, msoltani@ucsd.edu.
authors.forename: Maryam
authors.initials: M
authors.lastname: Soltani
authors.forename: Sunny
authors.initials: S
authors.lastname: Smith
authors.forename: Ellen
authors.initials: E
authors.lastname: Beck
authors.forename: Michelle
authors.initials: M
authors.lastname: Johnson
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003863:Depression / Q000175:diagnosis* / Q000628:therapy; D019468:Disease Management; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D010044:Outpatient Clinics, Hospital / Q000458:organization & administration* / Q000592:standards; D010348:Patient Care Team; D015995:Prevalence; D012577:Schools, Medical / Q000458:organization & administration* / Q000592:standards; D013337:Students, Medical; D055815:Young Adult