Abstract

Aims

This quality improvement project aimed to increase awareness and better integrate mental health screening in a GI clinic by educating staff and providers. The project evaluated changes in depression literacy, attitudes toward mental illness assessment, perceived training effectiveness, use of the training in clinical practice, and referrals to the Resiliency Clinic.

Background

Patients with chronic GI disorders commonly experience anxiety and depression, yet mental health concerns are often overlooked in specialty care. Although annual depression screening was already a part of the standard care at the Digestive Disease Center at Loma Linda University Faculty Medical Clinics, staff education and a standardized process for referring patients to behavioral health services were limited.

Methods

This Johns Hopkins Evidence-Based Practice Model and the Neuman Systems Model guided the project. GI clinic staff and providers received education on the gut-brain axis, anxiety and depression among patients with GI disease, use of the PHQ-9 and GAD-7, and referral procedures to the School of Behavioral Health Resiliency Clinic. A standardized referral form was also introduced. Outcomes were assessed using the D-Lit, MICA-4, CDC post-course and delayed evaluations, demographic surveys, and chart reviews of referral activity.

Results

Ten GI clinic staff and providers participated. The median D-Lit score decreased from 68.18 before the intervention to 63.64 afterward, with no statistically significant difference identified (p = .380). Seven participants completed the MICA-4 at approximately 12 weeks. Median attitude scores before and after education were similar, increasing from 40.5 to 41.0, with higher scores indicating more negative attitudes. Nine participants completed the delayed evaluation, and six reported using some or a lot of the educational content in practice. Seven participants rated the education as very or extremely relevant to their work, and eight reported that they would use what they learned. While no referrals to the Resiliency Clinic were identified during the post-implementation period, no reintervention referral data were available, preventing comparison of referral activity before and after the intervention.

Conclusion

Although the intervention did not improve depression literacy or overall attitude scores, most participants viewed the education as relevant and reported using at least some of the content in practice. The findings suggest that education and a referral form alone may not be sufficient to change referral practices. Future initiatives should include ongoing education, reminders, stronger integration of the referral process into the clinical workflow, improved baseline referral tracking, and longer follow-up periods. Greater on-site implementation support and expansion to additional specialty clinics may also improve participation and sustainability.

Keywords: Gastrointestinal, GI, Depression, Anxiety, Mental Health, Screening

LLU Discipline

Nursing

School

School of Nursing

First Advisor

Robin Dudley Pueschel

Second Advisor

Salem Dehom

Degree Name

Doctor of Nursing Practice (DNP)

Year Degree Awarded

2026

Date (Title Page)

Spring 2026

Language

English

Type

Doctoral Project

Page Count

90 p., 1 p.

Digital Format

PDF

Digital Publisher

Loma Linda University Libraries

Usage Rights

This title appears here courtesy of the author, who has granted Loma Linda University a limited, non-exclusive right to make this publication available to the public. The author retains all other copyrights.

Collection

Loma Linda University Electronic Theses and Dissertations

Collection Website

http://scholarsrepository.llu.edu/etd/

Repository

Loma Linda University. Del E. Webb Memorial Library. University Archives

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