Diagnostic Accuracy of Mental Health Screening Tools After Mild Traumatic Brain Injury
JAMA Netw Open. 2024 Jul 1;7(7):e2424076. doi: 10.1001/jamanetworkopen.2024.24076.
Importance: Mental health disorders are common after mild traumatic brain injury (mTBI) and can worsen postconcussive symptoms and disability. Detecting these disorders early can improve clinical outcomes, but the accuracy of mental health screening tools in this population is not well established.
Objective: To assess the diagnostic accuracy of the Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), and Primary Care PTSD Screen for Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) (PC-PTSD-5) in adults with mTBI.
Design, Setting, and Participants: This study analyzed data from a cluster randomized clinical trial. Self-report mental health screening tools (PHQ-9, GAD-7, and PC-PTSD-5) were compared against a structured psychodiagnostic interview (MINI) in adults with mTBI. Participants were recruited from February 1, 2021, to October 25, 2022.
Main Outcomes and Measures: The presence of major depressive episode, anxiety disorders, and PTSD was determined by a blinded assessor with the MINI. Diagnostic accuracy statistics were derived for the PHQ-9, GAD-7, and PC-PTSD-5.
Results: Each screening questionnaire showed strong diagnostic accuracy in the overall sample. The GAD-7 had slightly better performance than the PC-PTSD-5 for detecting PTSD. 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.
Conclusions and Relevance: The study suggests that the PHQ-9, GAD-7, and PC-PTSD-5 accurately screen for mental health disorders in patients with mTBI. Future research should confirm optimal test cutoffs for this population.
PMID: 39042406 | DOI: 10.1001/jamanetworkopen.2024.24076
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