Validation of a brief, two-question depression screen in trauma patients.
BACKGROUND
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. 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
A total of 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 cutoff score of 10 or higher (possible range, 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 during the previous 2 weeks. A cutoff score of 3 or higher was considered to be a positive screen result. Discriminatory ability of the PHQ-2 was calculated.


RESULTS
The sample was predominantly male (65%) and white (67%). The majority (85%) sustained a blunt trauma, and the primary cause of injury was motor vehicle collision (37%), with a mean Injury Severity Score (ISS) of 11.6. A total of 142 patients (34%) were positive for depression on the PHQ-8. When comparing the PHQ-2 with the PHQ-8, a sensitivity of 76.1 and a 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 seems 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.


METHODS
Diagnostic study, level IV; prognostic/epidemiologic study, level III.
From the Baylor University Medical Center, Division of Trauma (A.M.W., M.L.F., L.B.P.), and Baylor Research Institute (M.R., R.J.W., K.R.-F.), Baylor Research Institute and Baylor Scott & White Health (M.M.B., J.D.A.), Dallas, Texas.
Ann Marie
AM
Warren
Megan
M
Reynolds
Michael L
ML
Foreman
Monica M
MM
Bennett
Rebecca Joanne
RJ
Weddle
Jessica Danielle
JD
Austin
Kenleigh
K
Roden-Foreman
Laura B
LB
Petrey
D000328:Adult; D003866:Depressive Disorder / Q000175:diagnosis* / Q000209:etiology; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011795:Surveys and Questionnaires; D014193:Trauma Centers; D014947:Wounds and Injuries / Q000175:diagnosis / Q000209:etiology / Q000523:psychology*; D055815:Young Adult