Screening for Depression with Chronic Pain: An Educational Intervention for Nurse Practitioners

Abstract

Background: Chronic, non-malignant pain impacts physical and mental well-being. Adults with chronic pain are at significantly increased risk for depression, with symptoms often occurring together. Despite this relationship, the majority of these patients are not routinely screened for depression in the primary care setting. The role of nurse practitioners in primary care is growing, and they are likely to encounter patients suffering from co-morbid pain and depression. Objective: The purpose of this project was to identify primary care nurse practitioners’ knowledge and awareness regarding the relationship between chronic, non-malignant pain and depression, and to identify current practices and barriers to screening for depression with pain. Methods: This project utilized a quasi-experimental pre- and post-test design, in order to compare knowledge, awareness, and practices among primary care nurse practitioners before and after an educational intervention highlighting the relationship between chronic, non-malignant pain and depression. Participants were recruited via email through the Coalition of Arizona Nurses in Advanced Practice (CAZNAP) and the Southern Arizona Advanced Practice Nurse – Nurse Practitioner Society (SAZAPN/NPS) listservs. Results: A total of 12 participants completed both the pre- and post-survey for data analysis. Wilcoxon-signed rank tests on four specific questions related to knowledge and intent to screen revealed p-values greater than 0.05 and median differences in the sample equal to zero, indicating that the educational module was ineffective in improving knowledge or intent to screen. The majority of participants (59.2%) indicated that they were extremely likely to screen patients with chronic pain for depression, prior to completing the educational module. Similarly, over half of participants strongly agreed on the pre-survey that there is a strong relationship between chronic pain and depression, and that routine screening may improve these outcomes. Conclusion: Individual improvements in nurse practitioner knowledge and intent to screen did occur, but not at a statistically significant rate. Participant baseline knowledge was high, making it difficult for an educational module to improve post-survey scores. The data from this project may serve as a baseline for future research, as current literature on the role of primary care nurse practitioners in chronic pain management and depression screening is limited.