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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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.


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.


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.


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.

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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    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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