Interpretation of PROMIS Depression and Anxiety Measures Compared with DSM-5 Diagnostic Criteria in Musculoskeletal Patients

Abstract

Background: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.Methods: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.Results: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%]).Conclusions: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.Level of Evidence:Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Prenatal Exposure to the Genocide against the Tutsi in Rwanda is associated with DNA methylation at candidate genes in early adulthood: the role of trauma severity and postnatal adversity

“…36 They reported an average of 5.6 (sd = 2.65) adverse childhood events. The mean depression T- score (48.7, sd= 10.1) and anxiety T - score (51.5, sd = 10.1) were below published screening cutoffs for depressive (≥ 53) and anxiety disorders (≥ 59) 37 , suggesting relatively good mental health in the sample (with the caveat that no clinical cutoffs have been validated in Rwandan samples to date). 22…”

“…The mean depression T-score (48.7, sd= 10.1) and anxiety T -score (51.5, sd = 10.1) were below published screening cutoffs for depressive (≥ 53) and anxiety disorders (≥ 59) 37 , suggesting relatively good mental health in the sample (with the caveat that no clinical cutoffs have been validated in Rwandan samples to date). 22 Associations between genocide exposure, early life adversity, and DNA methylation in candidate genes 211 CpG sites across 17 genes were associated with genocide trauma group status (see Supplemental Table S3-S4); of these, only two survived correction for multiple testing, and only in the double-exposed vs. control contrast: cg06979684 located in BDNF and cg26438554 located in SLC6A4 (see Table 2.)…”

Personal factors and baseline function in patients undergoing non-operative management for chronic hip-related groin pain: a cross-sectional study

“…Prospective studies are needed to better understand the temporal relationship between depressive symptoms and perceived limitations in patients seeking non-operative management for HRGP. Previous reports suggest that the presence of depression is associated with risk of worse outcomes after orthopaedic surgical procedures, 36 but we do not know if this relationship exists between depressive symptoms and non-operative management.…”

Impact of psychosocial factors on the success of neuromodulation treatment for patients with persistent pain

“…Importantly, those patients who had unsuccessful trials had higher PROMIS CAT scores for depression and anxiety with their scores reaching levels consistent with the Diagnostic and Statistical Manual of Mental Disorders-5 diagnostic criteria. 27 Of note, the majority of these patients had no prior documented history of a depressive or anxiety disorder in our health system. The neuropsychiatric evaluation each patient receives is used to identify contraindications for neuromodulation therapy and not to determine the position of a patient's symptoms on the spectrum of depression or anxiety.…”