Comparison of PROMIS Anxiety and Depression, PHQ-8, and GAD-7 to screen for anxiety and depression among patients presenting for spine surgery

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OBJECTIVE

In this paper, the authors demonstrate to spine surgeons the prevalence and severity of anxiety and depression among patients presenting for surgery and explore the relationships between different legacy and Patient-Reported Outcomes Measurement Information System (PROMIS) screening measures.

METHODS

A total of 512 adult spine surgery patients at a single institution completed the 7-item Generalized Anxiety Disorder questionnaire (GAD-7), 8-item Patient Health Questionnaire (PHQ-8) depression scale, and PROMIS Anxiety and Depression computer-adaptive tests (CATs) preoperatively. Correlation coefficients were calculated between PROMIS scores and GAD-7 and PHQ-8 scores. Published reference tables were used to determine the presence of anxiety or depression using GAD-7 and PHQ-8. Sensitivity and specificity of published guidance on the PROMIS Anxiety and Depression CATs were compared. Guidance from 3 sources was compared: published GAD-7 and PHQ-8 crosswalk tables, American Psychiatric Association scales, and expert clinical consensus. Receiver operator characteristic curves were used to determine data-driven cut-points for PROMIS Anxiety and Depression. Significance was accepted as p < 0.05.

RESULTS

In 512 spine surgery patients, anxiety and depression were prevalent preoperatively (55% with any anxiety, 24% with generalized anxiety screen-positive; and 54% with any depression, 24% with probable major depression). Correlations were moderately strong between PROMIS Anxiety and GAD-7 scores (r = 0.72; p < 0.001) and between PROMIS Depression and PHQ-8 scores (r = 0.74; p < 0.001). The observed correlation of the PROMIS Depression score was greater with the PHQ-8 cognitive/affective score (r = 0.766) than with the somatic score (r = 0.601) (p < 0.001). PROMIS Anxiety and Depression CATs were able to detect the presence of generalized anxiety screen-positive (sensitivity, 86.0%; specificity, 81.6%) and of probable major depression (sensitivity, 82.3%; specificity, 81.4%). Receiver operating characteristic curve analysis demonstrated data-driven cut-points for these groups.

CONCLUSIONS

PROMIS Anxiety and Depression CATs are reliable tools for identifying generalized anxiety screen-positive spine surgery patients and those with probable major depression.

ABBREVIATIONS AUC = area under the curve; CAT = computer-adaptive testing; DSM-IV = Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition; GAD-7 = 7-item Generalized Anxiety Disorder questionnaire; PHQ-8 = 8-item Patient Health Questionnaire; PROMIS = Patient-Reported Outcomes Measurement Information System; ROC = receiver operating characteristic.

Article Information

Correspondence Richard L. Skolasky: The Johns Hopkins University, Baltimore, MD. editorialservices@jhmi.edu.

INCLUDE WHEN CITING Published online January 18, 2019; DOI: 10.3171/2018.9.SPINE18521.

Disclosures Dr. Neuman: support of non–study-related clinical or research effort from DePuy Synthes. Dr. Riley: direct stock ownership in Avitus and Spinal Kinetics, and board of directors of LifeNet Health.

© AANS, except where prohibited by US copyright law.

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Figures

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    Receiver operator characteristic curves for the identification of screen-positive generalized anxiety (A) or probable major depression (B) using PROMIS Depression computer-adaptive testing.

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