Archives of physical medicine and rehabilitation 2017 06 21() pii S0003-9993(17)30410-0
To determine the predictive validity of the Patient Health Questionnaire-9 (PHQ-9) when screening for symptoms of depression following traumatic brain injury.
Retrospective analysis of data collected as part of routine clinical outpatient care over a period of 30 months.
Persons with mild to severe traumatic brain injury who were referred for neuropsychological evaluation within 1-12 months (N = 137).
MAIN OUTCOME MEASURES
PHQ-9 and Minnesota Multiphasic Personality Inventory, Second Edition, Restructured Form (MMPI-2-RF).
PHQ-9 scores > 10 had a sensitivity of 91.7 and a specificity of 60.2 in predicting a diagnosis of major depression. Correlations between PHQ-9 scores and MMPI-2-RF scales Demoralization (0.64) and Low Positive Emotions (0.48) ranged from large to medium. Premorbid outpatient psychiatric treatment was the most consistent predictor of PHQ-9 elevations as well as final diagnoses of major depression.
The PHQ-9 has adequate clinical utility as a screening instrument for depression in outpatients with traumatic brain injury. Elevations on this instrument can, however, not be automatically be attributed to neuropathology; especially not in the context of premorbid psychiatric dysfunction. Clinicians should conduct more thorough follow-up assessment in those with highly elevated PHQ-9 scores.