Brief Report| Volume 19, ISSUE 4, 104558, April 2023

Developing and Implementing a Depression Screening and Referral Protocol Among College Students

Published:February 21, 2023DOI:


      • This project augments the knowledge, skills, and attitudes of nurse practitioners and assists in their ability to appropriately screen college students for depression.
      • This project was implemented in a health clinic at a public university in the United States for 30 business days and included 304 non–mental health student participants.
      • Of the 304 non–mental health student participants, 21 screened positive for depression using the Patient Health Questionnaire-2, 14 screened positive for depression using the Patient Health Questionnaire-9, and 4 screened positive for thoughts of self-harm or suicidal ideation.
      • This article enables the reader to identify appropriate depression screening intervals, depression screening tools, and screening follow-up systems.


      Depression is prevalent among college students but remains underrecognized and undertreated. Evidence supports universal depression screening among college students combined with follow-up systems to ensure appropriate diagnosis and management. Screening tools may include versions of the Patient Health Questionnaire, and follow-up systems may include following up with the current provider or referring the student to a mental health specialist. The purpose of this quality improvement project was to promote the identification of college students with depression and subsequent appropriate referrals.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to The Journal for Nurse Practitioners
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • American College Health Association.
        American College Health Association-National College Health Assessment II: Reference Group Executive Summary Spring 2019.
        American College Health Association, 2019
      1. Mental Health America. Mental health and COVID-19. 2022. Accessed February 17, 2023.

        • American College Health Association
        ACHA clinical benchmarking program. 2017.
        • Gruttadoro D.
        • Crudo D.
        College Students Speak: A Survey Report on Mental Health.
        National Alliance on Mental Illness, 2012
      2. US Preventive Services Task Force. Recommendation: depression in adults: screening. 2016. Accessed February 17, 2023.

        • Centers for Disease Control and Prevention
        10 leading causes of death.
        United States, 2019
        Date accessed: February 17, 2023
        • National Network of Depression Centers
        Get the facts. 2022.
        Date accessed: February 17, 2023
        • English I.
        • Campbell D.G.
        Prevalence and characteristics of universal depression screening in U.S. college health centers.
        Fam Syst Health. 2019; 37: 131-149
      3. US Department of Health and Human Services. Increase the proportion of primary care visits where adolescents and adults are screened for depression – MHMD-08. 2020. Accessed February 17, 2023.

      4. US Department of Health and Human Services. The Surgeon General’s Call to Action to Implement the National Strategy for Suicide Prevention: A Report of the U.S. Surgeon General and of the National Action Alliance for Suicide Prevention. 2021. Accessed February 17, 2023.

        • Maurer D.M.
        • Raymond T.J.
        • Davis B.N.
        Depression: screening and diagnosis.
        Am Fam Physician. 2018; 98: 508-515
        • Mitchell A.J.
        • Yadegarfar M.
        • Gill J.
        • Stubbs B.
        Case finding and screening clinical utility of the Patient Health Questionnaire (PHQ-9 and PHQ-2) for depression in primary care: a diagnostic meta-analysis of 40 studies.
        BJPsych Open. 2016; 2: 127-138
        • Mulvaney-Day N.
        • Marshall T.
        • Piscopo K.D.
        • et al.
        Screening for behavior health conditions in primary care settings: a systematic review of the literature.
        J Gen Intern Med. 2017; 33: 335-346
        • Substance Abuse and Mental Health Services Administration
        Prevention and Treatment of Anxiety, Depression, and Suicidal Thoughts and Behaviors Among College Students. 2021.
        • Slabaugh K.
        • Harris S.
        • Wilcock S.
        Initiation of standardized depression screening in college health: a quality improvement project.
        J Dr Nurs Pract. 2018; 11: 143-150
      5. Suicide Prevention Resource Center. A comprehensive approach to suicide. prevention. 2014. Accessed February 17, 2023.

        • National Institute of Mental Health
        Seasonal affective disorder.


      Maclane Mae Bever, BSN, RN, and Courtney Marie Maks, BSN, RN, are DNP students affiliated with the Department of Graduate Nursing, Winona State University in Rochester, MN.