PC2124: Use of PHQ-4 Tool to Assess Anxiety and Depression in Children and Adults in Medically Underserved Santo Domingo, Ecuador

Background: The University of Kentucky sponsors medical brigades to improve the health and well-being of an underserved community in Santo Domingo, Ecuador. Physicians, residents, medical students, therapists, and other health professionals take part. The University of Kentucky partners with a year-round health clinic in Santo Domingo to provide education, service, and research opportunities while sustainably serving the community.

On the August 2020 brigade, psychologists administered PHQ-4 screenings to assess mental health. These providers then followed up with patients who scored positively to provide mental health resources and treatment. Mental health is largely unstudied in this geographic location. In fact, outside a prior study examining PHQ-4 on patients in Columbia, mental health screening data in South America is scarce.

Methods: PHQ is an acronym for patient health questionnaire, with the PHQ-4 being a short patient survey that screens for anxiety and depression with a total of 4 questions. The first two questions screen for anxiety on a scale of 1-3. A score of 3 or greater is positive. Similarly, the last two questions screen for depression on a scale of 1-3 with a score of 3 or greater being positive. Total scores range from 0-12, with 0-5 designated as mild, 6-8 as moderate, and 9-12 as severe. The questionnaire also includes gender and age.

Data was input into Microsoft Excel and statistical analysis was performed with IBM SPSS Statistics. Methods include one-way ANOVA, Pearson's correlation, independent samples t-tests, Pearson's chi-square, and Fisher's exact test. Patient ages were classified into the following categories: 10-21 years (pediatric group), 22-40 years, 41-60 years, 61-80 years, and greater than 80 years of age. Data was compared per age range or pediatric versus adult and male versus female.

Results: Thirty-two percent of pediatric patients scored positively for anxiety and 32% scored positively for depression. Anxiety and depression positivity increased as patient age increased, though the data was not statistically significant. There was a statistically significant correlation of scoring positive for both depression and anxiety, with a positive scoring patient being four times more likely to score positive in the other category. Furthermore, more females than males scored positively for both anxiety and depression across every age group. In the pediatric population specifically, there was a statistically significant increase in positive anxiety score and total score in females.

Conclusion: This data illustrates the important of the consideration of mental health in the Ecuadorian population. Anxiety and depression are present in a large portion of this population, including pediatric patients. With the current mental health crisis in the pediatric population, it is imperative to understand the incidence of these conditions. The PHQ-4 screen is an inexpensive and easily administered tool which can be further utilized in global communities.