Department of Psychology, University of British Columbia, Vancouver, Canada.
Rehabilitation Research Program, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada.
JAMA Netw Open. 2024 Jul 1;7(7):e2424076. doi: 10.1001/jamanetworkopen.2024.24076.
Mental health disorders are common after mild traumatic brain injury (mTBI) and likely exacerbate postconcussive symptoms and disability. Early detection could improve clinical outcomes, but the accuracy of mental health screening tools in this population has not been well established.
To determine the diagnostic accuracy of the Patient Health Questionnaire-9 (PHQ-9), Generalizaed Anxiety Disorder-7 (GAD-7), and Primary Care PTSD (Posttramatic Stress Disorder) Screen for Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) (DSM-5) (PC-PTSD-5) in adults with mTBI.
DESIGN, SETTING, AND PARTICIPANTS: This diagnostic study was performed as a secondary analysis of a cluster randomized clinical trial. Self-report mental health screening tools (PHQ-9, GAD-7, and PC-PTSD-5) were administered online 12 weeks after mTBI and compared against a structured psychodiagnostic interview (Mini-International Neuropsychiatric Interview for DSM-5 (MINI) over videoconference at the same time. Adults with mTBI (N = 537) were recruited from February 1, 2021, to October 25, 2022.
Presence of a major depressive episode, anxiety disorders, and PTSD were determined by a blinded assessor with the MINI. Diagnostic accuracy statistics were derived for the PHQ-9, GAD-7, and PC-PTSD-5. Findings were disaggregated for participants with and without persistent postconcussion symptoms (PPCS) by International and Statistical Classification of Diseases, Tenth Revision criteria.
Data were available for 499 of 537 trial participants, 278 (55.7%) of whom were female; the mean (SD) age was 38.8 (13.9) years. Each screening questionnaire had strong diagnostic accuracy in the overall sample for optimal cut points (area under the curve [AUC], ≥0.80; sensitivity, 0.55-0.94; specificity, 0.64-0.94). The AUC (difference of 0.01-0.13) and specificity (difference, 5-65 percentage points) were lower in those with PPCS present compared with PPCS absent, but the prevalence of at least 1 mental health disorder was 3 to 5 times higher in patients with PPCS present. The GAD-7 had slightly better performance than the PC-PTSD-5 for detecting PTSD (AUC, 0.85 [95% CI, 0.80-0.89] vs 0.80 [95% CI, 0.72-0.87]). The optimal cutoff on the PHQ-9 was 5 or more symptoms experienced on more than half of days; on the GAD-7, a total score of at least 7.
The findings of this diagnostic study suggest that the PHQ-9, GAD-7 and PC-PTSD-5 accurately screen for mental health disorders in patients with mTBI. Future research should corroborate optimal test cutoffs for this population.
轻度创伤性脑损伤（mTBI）后常见精神健康障碍，可能使脑震荡后症状和残疾恶化。早期发现可改善临床结局，但该人群中精神健康筛查工具的准确性尚未得到充分证实。
确定患者健康问卷-9（PHQ-9）、广泛性焦虑障碍-7（GAD-7）和初级保健创伤后应激障碍（PC-PTSD）筛查表在 mTBI 成人中的诊断准确性。用于诊断和统计手册（第五版）（DSM-5）（PC-PTSD-5）。
设计、地点和参与者：这是一项诊断性研究，是一项集群随机临床试验的二次分析。在 mTBI 后 12 周在线进行自我报告的精神健康筛查工具（PHQ-9、GAD-7 和 PC-PTSD-5），并与同一时间通过视频会议进行的结构化精神诊断访谈（MINI-国际神经精神疾病访谈用于 DSM-5（MINI））进行比较。从 2021 年 2 月 1 日至 2022 年 10 月 25 日，从 mTBI 招募了 537 名成年人。
使用 MINI 由盲法评估者确定是否存在重度抑郁发作、焦虑症和 PTSD。为 PHQ-9、GAD-7 和 PC-PTSD-5 得出诊断准确性统计数据。根据国际和疾病与相关健康问题统计分类第十版标准，将有和没有持续性脑震荡后症状（PPCS）的参与者的发现进行了细分。
在 537 名试验参与者中，有 499 名的数据可用，其中 278 名（55.7%）为女性；平均（SD）年龄为 38.8（13.9）岁。每个筛查问卷在总体样本中均具有很强的诊断准确性，最佳切点（曲线下面积[AUC]，≥0.80；敏感性，0.55-0.94；特异性，0.64-0.94）。与 PPCS 不存在的患者相比，存在 PPCS 的患者的 AUC（差异为 0.01-0.13）和特异性（差异为 5-65 个百分点）较低，但存在 PPCS 的患者至少有一种精神健康障碍的患病率高 3 至 5 倍。与 PC-PTSD-5 相比，GAD-7 对检测 PTSD 的性能稍好（AUC，0.85[95%CI，0.80-0.89]与 0.80[95%CI，0.72-0.87]）。PHQ-9 的最佳截断值为 5 个或更多症状，超过一半的日子出现；在 GAD-7 中，总分至少为 7。
这项诊断研究的结果表明，PHQ-9、GAD-7 和 PC-PTSD-5 可准确筛查 mTBI 患者的精神健康障碍。未来的研究应证实该人群的最佳测试截止值。
