Can nurse practitioners tackle increased rates of anxiety and depression since the rise of COVID-19?

Depression and anxiety are the most common mental illnesses treated by today’s doctors, nurses, and nurse practitioners.  Untreated depression and anxiety can worsen a patient’s ability to cope with other illnesses like heart disease and diabetes.  The COVID-19 pandemic showed how important depression and/or anxiety need to be treated in every patient. Nurse practitioners have the skills to help decrease rates of anxiety and depression in our communities.

Anxiety and Depression

Common symptoms of anxiety and depression include sadness and lonlieness. Anxiety and depression are exists with other chronic illnesses like diabetes, named diabetes distress (CDC, 2023).  Diabetes distress occurs when a diabetic patient becomes sad or frustration on daily tasks coping with diabetes.  Many diabetic patients become sad if A1C is too high/too low or become angry from the pain of pricking their fingers constantly (CDC, 2023).  According to data from the Behavioral Risk Factor Surveillance System Survey 2020, 30% of people who answered the survey reported experiencing anxiety or depression in the last four weeks.

Signs of depression include:

• feelings of loneliness/hopelessness

• sadness

• decreased appetite/increased appetite

• sleepiness

• unable to sleep/sleeping too much

• lack of motivation 

The complexity of mental illness is even more evident in older adults with other chronic conditions such as dementia. Dementia makes accurate assessment and diagnosis difficult to complete.  Signs of dementia can mimic depression symptoms (Alzheimer’s, 2023). Up to 40% of people with Alzheimer's disease suffer from significant depression, and the symptoms of depression can also occur under Alzheimer's dementia (Alzheimer’s, 2023). 

COVID-19 fatigue was a term coined during the pandemic from high rates of mental illness in healthcare workers (Adam, 2021). Interestingly, COVID-19 has played an important role in exposing our society to the needs of mental health patients. COVID-19 helped mental illness become understood as an acceptable, treatable disease (Adam, 2021).  However, mentally ill patients continue to be undertreated in some communities due to delays in receiving psychiatric referrals or small number of mental health clinics available in communities.

Nurse Practitioners’ Treatment

Nurse practitioners can play a crucial role in treating anxiety and depression. With their excellent assessment and diagnosis skills, they can utilize evidence-based screening tools like PHQ-9 for reliable and fast testing.

The PHQ-9 comprises nine questions that can screen for depression in various patient populations. If the patient scores higher than three after the first two questions, the remaining questions will provide a more detailed analysis of the depression severity. It is a quick and easy tool that can be completed at clinic visit without the patient's knowledge.

Many nurse practitioners work in primary care clinics or family medicine offices.   Doctors do have basic training in mental health disorders, but more difficult mental health illnesses are referred to psychiatry or community-based behavioral health centers. Psychiatric Mental Health Nurse Practitioners (PMHNPs) are trained to care for patients with simple to complex mental illnesses. PMHNPs can employ a combination of therapy and medication to treat depression and anxiety. The specific treatments may vary based on how serious the illness and the patient's needs.

Conclusion

            Barriers to adequate mental health treatment can be overcome as many nurse practitioners practice as PCPs.  Nurse practitioners can effectively manage mental health disorders with effective screening tools, conduct counseling, and prescribe medications.  Nurse practitioners can stand in the gap for the most vulnerable patients in our communities. 

References

Adams, S., & Vanderhoef, D. (2021). The critical role of primary care providers in meeting mental health care needs in 2021. The Journal for Nurse Practitioners, 17(1), 3–4. https://doi.org/10.1016/j.nurpra.2020.12.014

Depression. (n.d.). Alzheimer’s Disease and Dementia. https://www.alz.org/help-support/caregiving/stages-behaviors/depression#:~:text=Experts%20estimate%20that%20up%20to,Apathy

Diabetes and mental health. (2023, May 15). Centers for Disease Control and Prevention. https://cdc.gov/diabetes/managing/mental-health.html#:

Mental health care in the last 4 weeks | Data | Centers for Disease Control and Prevention. (n.d.). https://data.cdc.gov/NCHS/Mental-Health-Care-in-the-Last-4-Weeks/yni7-er2q/explore/query/SELECT%20%60indicator%60%2C%20%60subgroup%60%2C%20median%28%60value%60%29%20AS%20%60median_value%60%0AGROUP%20BY%20%60indicator%60%2C%20%60subgroup%60/page/aggregate