During the twentieth century, Norbert Freinkel studied hormones and diabetes in the US. Freinkel conducted many experiments that enabled him to determine the factors that influence hormones of the thyroid gland to bind to proteins and to determine the effects that those thyroid hormones have on surrounding tissues. Furthermore, Freinkel researched gestational diabetes, which is diabetes that occurs for the first time during a women’s pregnancy. That type of diabetes is caused by a change in the way a woman’s body responds to insulin, a hormone made in the body. Infants who are born from pregnant women with gestational diabetes can possess many different medical conditions such as type 2 diabetes, respiratory distress syndrome, and low blood sugar. Through his research on gestational diabetes, Freinkel found that all pregnant women go through metabolic changes, not just gestational diabetics.

Norbert Freinkel’s lecture Of Pregnancy and Progeny was published by the American Diabetes Association’s journal Diabetes in December of 1980. In the lecture, Freinkel argued that pregnancy changes the way that the female body breaks down and uses food. Through experiments that involved pregnant women as well as infants, Freinkel established the body’s maternal metabolism and how it affects both the mother and the infant. Freinkel’s main focus of research in the latter part of his life was diabetes, specifically in pregnant women. Diabetes occurs in around one to three percent of all pregnancies, which is 30,000 to 90,000 women a year in the US. Freinkel’s article indicates that pregnancy influences the metabolism in all pregnant females and that pregnancy complicated by diabetes is only an exaggeration of what occurs in all pregnant women. Subsequently, many doctors more closely monitored pregnant women and their blood sugar and insulin levels, as doctors were informed that all pregnant women have the capacity to become diabetic.

Gestational diabetes is a medical condition that causes blood sugar levels to become abnormally high, which manifests for the first-time during pregnancy and typically disappears immediately after birth for around ninety percent of affected women. While many women with the condition do not experience any noticeable symptoms, some may experience increased thirst and urination. Although gestational diabetes is treatable, if left unmanaged, the resulting fetus is more likely to have elevated risks of increased birth weight, birth injuries, low blood sugar, stillbirth, and later development of type 2 diabetes. The International Diabetes Federation estimates that worldwide in 2019, gestational diabetes affected one in six pregnant women, with many cases occurring in women living in low and middle-income countries. Despite the prevalence and risks associated with gestational diabetes, as of 2020, researchers have yet to reach a unified consensus on the best guidelines for diagnosis and treatment.

Homeless individuals encounter barriers such as lack of health insurance, increased cost of care and unavailability of resources. They have increased risk of comorbid physical disease and poor mental health. Depression is a prevalent mental health disorder in the US linked to increased risk of mortality. Literature suggests depression screening can identify high-risk individuals with using the patient health questionnaire (PHQ-9).

The objective of this project is to determine if screening identifies depression in the homeless and how it impacts healthcare access. Setting is a local organization in Phoenix offering shelter to homeless individuals. An evidence-based project was implemented over two months in 2019 using convenience sampling. Intervention included depression screening using the PHQ-9, referring to primary care and tracking appointment times. IRB approval obtained from Arizona State University, privacy discussed, and consent obtained prior to data collection. Participants were assigned a random number to protect privacy.

A chart audit tool was used to obtain sociodemographics and insurance status. Descriptive statistics used and analyzed using Intellectus. Sample size was (n = 18), age (M = 35) most were White-non-Hispanic, 44% had a high school diploma and 78% were insured. Mean score was 7.72, three were previously diagnosed and not referred. Three were referred with a turnaround appointment time of one, two and seven days respectively. No significant correlation found between age and depression severity. A significant correlation found between previous diagnosis and depression severity. Attention to PHQ-9 varied among providers and not always addressed. Future projects should focus on improving collaboration between this facility and providers, increasing screening and ensuring adequate follow up and treatment.