NYU School of Medicine, New York, NY, USA.
Yale School of Medicine, New haven, CT, USA.
J Prim Care Community Health. 2020 Jan-Dec;11:2150132720949123. doi: 10.1177/2150132720949123.
We sought to quantify the extent to which a depression screening instrument commonly used in primary care settings provides additional information regarding pain interference symptoms, anxiety, and substance use.
Veterans Aging Cohort Study (VACS) data collected from 2003 through 2015 was used to calculate odds ratios (OR) for associations between positive depression screening result cutoffs and clustering conditions. We assessed the test performance characteristics (likelihood ratio value, positive predictive value, and the percentage of individuals correctly classified) of a positive Patient Health Questionnaire (PHQ-9 & PHQ-2) depression screen for the identification of pain interference symptoms, anxiety, and substance use.
A total 7731 participants were included in the analyses. The median age was 50 years. The PHQ-9 threshold of ≥20 was strongly associated with pain interference symptoms (OR 21.6, 95% CI 17.5-26.7) and anxiety (OR 72.1, 95% CI 52.8-99.0) and yielded likelihood ratio values of 7.5 for pain interference symptoms and 21.8 for anxiety and positive predictive values (PPV) of 84% and 95%, respectively. A PHQ-9 score of ≥10 still showed significant associations with pain interference symptoms (OR 6.1, 95% CI 5.4-6.9) and symptoms of anxiety (OR 11.3, 95% CI 9.7-13.1) and yet yielded lower likelihood ratio values (4.36 & 8.24, respectively). The PHQ-9 was less strongly associated with various forms of substance use.
Depression screening provides substantial additional information regarding the likelihood of pain interference symptoms and anxiety and should trigger diagnostic assessments for these other conditions.
我们旨在量化一种常用于初级保健环境的抑郁筛查工具在多大程度上提供了有关疼痛干扰症状、焦虑和物质使用的额外信息。
使用 2003 年至 2015 年期间收集的退伍军人老龄化队列研究 (VACS) 数据来计算阳性抑郁筛查结果切点与聚类条件之间关联的优势比 (OR)。我们评估了阳性患者健康问卷 (PHQ-9 & PHQ-2) 抑郁筛查对识别疼痛干扰症状、焦虑和物质使用的测试性能特征（似然比值、阳性预测值和正确分类个体的百分比）。
共纳入 7731 名参与者进行分析。中位年龄为 50 岁。PHQ-9 阈值≥20 与疼痛干扰症状（OR 21.6，95%CI 17.5-26.7）和焦虑（OR 72.1，95%CI 52.8-99.0）强烈相关，且似然比值分别为 7.5 和 21.8，阳性预测值（PPV）分别为 84%和 95%。PHQ-9 评分≥10 仍与疼痛干扰症状（OR 6.1，95%CI 5.4-6.9）和焦虑症状（OR 11.3，95%CI 9.7-13.1）显著相关，但似然比值较低（分别为 4.36 和 8.24）。PHQ-9 与各种形式的物质使用相关性较低。
抑郁筛查提供了关于疼痛干扰症状和焦虑可能性的大量额外信息，应触发对这些其他情况的诊断评估。
