Poritz Julia M P, Mignogna Joseph, Christie Aimee J, Holmes Sally A, Ames Herb
a TIRR Memorial Hermann , Houston , Texas , USA.
b VISN 17 Center of Excellence for Research on Returning War Veterans , Waco , Texas , USA.
J Spinal Cord Med. 2018 Mar;41(2):238-244. doi: 10.1080/10790268.2017.1294301. Epub 2017 Mar 29.
Although depression is not inevitable following spinal cord injury/dysfunction (SCI/D), it can have a negative impact on rehabilitation. Evidence-based assessment of depression utilizing self-report instruments, such as the Patient Health Questionnaire-9 (PHQ-9), is considered good clinical practice. Although the PHQ-9 has been studied in individuals with SCI/D, little is known about the clinical utility of the Patient Health Questionnaire-2 (PHQ-2). Traditional cutoff scores for the PHQ-2 were examined to explore their operating characteristics as related to PHQ-9 results.
Archival data were collected for 116 Veterans with SCI/D who completed the PHQ-2 and PHQ-9 as one component of their routine, comprehensive SCI annual evaluation at a Veterans Affairs Medical Center. Logistic regressions were performed to determine the impact of different cutoff scores for the PHQ-2 on the likelihood that participants would endorse clinically significant levels of depressive symptoms on the PHQ-9 (≥10).
Using a cutoff score of 3 or greater correctly classified 94.8% of the cases, outperforming the other cutoff scores. A cutoff score of 3 or greater had a sensitivity of 83.3% and specificity of 97.8%, and yielded a positive predictive value of 90.9% and a negative predictive value of 95.7%.
The PHQ-2 shows promise as a clinically useful screener in the community-residing SCI/D population. Findings regarding the presence of suicidal ideation emphasize the importance of routine screening for depressive symptomatology in the SCI/D population. Future research should investigate the role of the PHQ-2 in clinical decision-making and treatment monitoring.
虽然脊髓损伤/功能障碍（SCI/D）后并非必然会出现抑郁，但它会对康复产生负面影响。使用患者健康问卷9项版（PHQ-9）等自我报告工具对抑郁进行循证评估被视为良好的临床实践。虽然PHQ-9已在SCI/D患者中进行过研究，但关于患者健康问卷2项版（PHQ-2）的临床效用知之甚少。研究了PHQ-2的传统临界值，以探讨其与PHQ-9结果相关的操作特征。
收集了116名患有SCI/D的退伍军人的档案数据，他们在退伍军人事务医疗中心完成了PHQ-2和PHQ-9，作为其常规综合SCI年度评估的一部分。进行逻辑回归分析，以确定PHQ-2的不同临界值对参与者在PHQ-9上认可具有临床意义的抑郁症状水平（≥10）可能性的影响。
使用临界值3或更高正确分类了94.8%的病例，优于其他临界值。临界值3或更高的灵敏度为83.3%，特异度为97.8%，阳性预测值为90.9%，阴性预测值为95.7%。
PHQ-2有望成为社区居住的SCI/D人群中一种临床有用的筛查工具。关于自杀意念存在的研究结果强调了对SCI/D人群进行抑郁症状常规筛查的重要性。未来的研究应调查PHQ-2在临床决策和治疗监测中的作用。
