Citation

Warren AM, Reynolds M, Foreman ML, Bennett MM, Weddle J, Austin JD, Roden-Foreman K, Petrey LB. J. Trauma Acute Care Surg. 2015; 80(2): 318-323.

Affiliation

Associate Investigator of Trauma Research Baylor University Medical Center- Division of Trauma T Boone Pickens Cancer Hospital 3409 Worth Street, Ste. C2.500 Dallas, Texas 75246 annmariw@baylorhealth.edu Baylor Research Institute 3500 Gaston Avenue 4th floor Roberts Room 428 Dallas, Texas, 75246 Megan.reynolds@baylorhealth.edu Medical Director Trauma Baylor University Medical Center 2701 Swiss Avenue Dallas, Texas 75204 michaefo@baylorhealth.edu Biostatistician 8080 N. Central Expressway Suite 500 Dallas, TX 75206 Monica.Bennett@baylorhealth.edu Baylor University Medical Center 3500 Gaston Avenue 4th floor Roberts Room 428 Dallas, Texas, 75246 Baylor Scott & White Health Jessica.austin@baylorhealth.edu Baylor Research Institute T Boone Pickens Cancer Hospital 3409 Worth Street, Ste. C2.500 Dallas, Texas 75246 Kenleigh.roden-foreman1@baylorhealth.edu Baylor University Medical Center 2701 Swiss Avenue Dallas, Texas 75204 laurabru@baylorhealth.edu.

Copyright

(Copyright © 2015, Lippincott Williams and Wilkins)

DOI

10.1097/TA.0000000000000898

PMID

26491807

Abstract

INTRODUCTION: Increasingly, depression following traumatic injury is recognized as a complication of injury. Unlike mandated screening for risky alcohol use in trauma centers, screening for psychological risks is not required by the American College of Surgeons Committee on Trauma (ACS-COT). Limited resources and time constraints are commonly given reasons against routine screening. The purpose of this study was to determine if a two item screen was as valid as an eight question screen for depression.

METHODS: 421 patients were given the Patient Health Questionnaire-8 (PHQ-8) during initial hospitalization to assess depression in a prospective study at a level I trauma center. A cut off score ≥10 (possible range of 0-24) on the PHQ-8 is used as diagnostic for depression. The PHQ-2 (possible range 0-6) is derived from the first two questions of the PHQ-8 and contains items assessing sad mood and loss of interest/pleasure over the previous two weeks. A cut off score ≥3 was considered to be a positive screen. Discriminatory ability of the PHQ-2 was calculated.

RESULTS: The sample was predominantly male (65%) and Caucasian (67%). The majority (85%) sustained a blunt trauma, the primary cause of injury was motor vehicle collision (37%), with a mean Injury Severity Score of 11.6. 142 (34%) were positive for depression on the PHQ-8. When comparing the PHQ-2 to the PHQ-8, a sensitivity of 76.1 and specificity of 92.8 were found, as well as a positive predictive value of 84.4.

CONCLUSIONS: The result of our study confirms that depression is a frequent condition (34%) among individuals who sustain physical injury. The PHQ-2 appears to have acceptable sensitivity and specificity to identify depression in this population. The use of a two item screening questionnaire is a minimal addition to the evaluation of patients after injury, allowing for earlier intervention and better outcomes. LEVEL OF EVIDENCE: III.

Language: en