Depression Awareness Screener

Please review the following consent form: Consent form: This is the prototype depression screener. You are agreeing to be screened for depression. This is a non-secure prototype, please leave no personal data. Actual text is needed to populate this consent form. The screening test chosen for the prototype screener is the Patient Health Questionnaire (PHQ). PHQ is freely distributed by Pfizer from http://www.phqscreeners.com/. The World Health Organization (WHO) Depression Fact Sheet reports that "Depression is the leading cause of disability worldwide, and is a major contributor to the overall global burden of disease." WHO states that suicide, a possible consequence of untreated depression, is the second leading cause of death in people 15-29 years-old and estimates a total of 800,000 deaths per year due to suicide. WHO describes depression as a condition that has effective treatment options but remains untreated in fewer than half of affected people.

Do you consent to be screened for depression? Yes | No
Name (or study ID number):
Are you 18 years-old or older?: Yes | No
Please choose your doctor:
Have you ever been diagnosed with depression or are you currently receiving treatment for depression?: Yes | No
Are you or have you been pregnant within the past year?: Yes | No or Not Applicable

Graduate project for depression screening in primary care.