Cheng Abby L, Downs Dana L, Brady Brian K, Hong Barry A, Park Peter, Prather Heidi, Hunt Devyani M
Division of Physical Medicine and Rehabilitation, Department of Orthopaedic Surgery, Washington University in St. Louis School of Medicine, St. Louis, Missouri.
Department of Psychiatry, Washington University in St. Louis School of Medicine, St. Louis, Missouri.
JB JS Open Access. 2023 Jan 24;8(1). doi: 10.2106/JBJS.OA.22.00110. eCollection 2023 Jan-Mar.
There is growing awareness among orthopaedic clinicians that mental health directly impacts clinical musculoskeletal outcomes. The Patient-Reported Outcomes Measurement Information System (PROMIS) is increasingly used for mental health screening in this context, but proper interpretation of patient scores remains unclear. The purpose of the present study was to compare musculoskeletal patients' PROMIS Depression and Anxiety scores with a board-certified clinical psychologist's assessment of their depression and/or anxiety diagnoses, as defined by Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria.
In this cross-sectional analysis, existing medical records were reviewed for 50 patients who presented to an interdisciplinary program within a tertiary care orthopaedic department for the treatment of ≥1 musculoskeletal condition. All patients completed PROMIS Depression and Anxiety measures and were evaluated by a board-certified clinical psychologist. Receiver operating characteristic (ROC) curve analyses were performed to assess the diagnostic accuracy of PROMIS Depression and Anxiety scores as compared with the psychologist's diagnosis of a DSM-5 depressive or anxiety disorder.
Twenty-eight patients (56%) were diagnosed by the psychologist with a DSM-5 depressive disorder, and 15 (30%) were diagnosed with a DSM-5 anxiety disorder. The ROC analysis for PROMIS Depression had an area under the curve (AUC) of 0.82. The optimal score cutoff to predict a diagnosis of a DSM-5 depressive disorder was ≥53 (sensitivity, 79% [95% CI, 63% to 94%]; specificity, 86% [72% to 100%]; positive predictive value [PPV], 88% [75% to 100%]; negative predictive value [NPV], 76% [59% to 93%]). The ROC analysis for PROMIS Anxiety had an AUC of 0.67. The optimal score cutoff to predict a diagnosis of a DSM-5 anxiety disorder was ≥59 (sensitivity, 60% [95% CI, 35% to 85%]; specificity, 74% [60% to 89%]; PPV, 50% [27% to 73%]; and NPV, 81% [68% to 95%]).
Modestly elevated PROMIS Depression scores were suggestive of the presence of a DSM-5 depressive disorder, whereas elevations in PROMIS Anxiety scores seemed to have less association with DSM-5 anxiety disorders. Nevertheless, neither PROMIS measure demonstrated adequate discriminant ability to definitively identify patients who met DSM-5 criteria.
Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
骨科临床医生越来越意识到心理健康直接影响肌肉骨骼疾病的临床治疗效果。在这种情况下，患者报告结果测量信息系统（PROMIS）越来越多地用于心理健康筛查，但对患者得分的正确解读仍不明确。本研究的目的是将肌肉骨骼疾病患者的PROMIS抑郁和焦虑得分与一名获得委员会认证的临床心理学家根据《精神疾病诊断与统计手册》第五版（DSM-5）标准对其抑郁和/或焦虑诊断进行比较。
在这项横断面分析中，回顾了50名到三级护理骨科部门的跨学科项目就诊以治疗≥1种肌肉骨骼疾病的患者的现有病历。所有患者均完成了PROMIS抑郁和焦虑测量，并由一名获得委员会认证的临床心理学家进行评估。进行了受试者操作特征（ROC）曲线分析，以评估PROMIS抑郁和焦虑得分与心理学家对DSM-5抑郁或焦虑障碍诊断相比的诊断准确性。
心理学家诊断出28名患者（56%）患有DSM-5抑郁障碍，15名患者（30%）患有DSM-5焦虑障碍。PROMIS抑郁的ROC分析曲线下面积（AUC）为0.82。预测DSM-5抑郁障碍诊断的最佳得分临界值为≥53（敏感性，79%[95%CI，63%至94%]；特异性，86%[72%至100%]；阳性预测值[PPV]，88%[75%至100%]；阴性预测值[NPV]，76%[59%至93%]）。PROMIS焦虑的ROC分析AUC为0.67。预测DSM-5焦虑障碍诊断的最佳得分临界值为≥59（敏感性，60%[95%CI，35%至85%]；特异性，74%[60%至89%]；PPV，50%[27%至73%]；NPV，81%[68%至95%]）。
PROMIS抑郁得分适度升高提示存在DSM-5抑郁障碍，而PROMIS焦虑得分升高似乎与DSM-5焦虑障碍的关联较小。然而，两种PROMIS测量方法均未显示出足够的判别能力来明确识别符合DSM-5标准的患者。
预后III级。有关证据水平的完整描述，请参阅作者指南。
