精神健康障碍在轻度创伤性脑损伤(mTBI)后很常见,并可能加剧脑震荡后症状和残疾。早期发现可以改善临床结果,但心理健康筛查工具在这一人群中的准确性尚未得到很好的确立。
■为了确定患者健康问卷-9(PHQ-9)的诊断准确性,广泛性焦虑症-7(GAD-7),和初级保健PTSD(产后应激障碍)屏幕精神疾病诊断和统计手册(第五版)(DSM-5)(PC-PTSD-5)在成人mTBI。
■本诊断研究作为集群随机临床试验的二次分析进行。mTBI后12周在线管理自我报告心理健康筛查工具(PHQ-9,GAD-7和PC-PTSD-5),并与结构化心理诊断访谈(DSM-5的迷你国际神经精神病学访谈(MINI)同时通过视频会议。从2021年2月1日至2022年10月25日招募患有mTBI(N=537)的成年人。
■出现严重抑郁发作,焦虑症,和创伤后应激障碍由具有MINI的盲评估者确定。PHQ-9、GAD-7和PC-PTSD-5的诊断准确性统计得到。根据国际疾病和统计分类,对有和没有持续脑震荡症状(PPCS)的参与者的研究结果进行了分类。第十修订标准。
■数据可用于537名试验参与者中的499名,其中278名(55.7%)为女性;平均年龄(SD)为38.8(13.9)岁。每个筛选问卷在总体样本中具有很强的诊断准确性,以获得最佳切点(曲线下面积[AUC],≥0.80;灵敏度,0.55-0.94;特异性,0.64-0.94)。AUC(差异为0.01-0.13)和特异性(差异,5-65个百分点)与没有PPCS的人相比,有PPCS的人较低,但在PPCS患者中,至少1种精神健康障碍的患病率高出3至5倍。GAD-7在检测PTSD方面比PC-PTSD-5具有略好的性能(AUC,0.85[95%CI,0.80-0.89]vs0.80[95%CI,0.72-0.87])。PHQ-9的最佳截止值是在超过一半的天中经历的5个或更多个症状;在GAD-7上,总分至少为7。
■这项诊断研究的结果表明,PHQ-9,GAD-7和PC-PTSD-5可以准确筛查mTBI患者的心理健康障碍。未来的研究应该证实这一人群的最佳测试截止值。
UNASSIGNED: Mental health disorders are common after mild traumatic brain injury (mTBI) and likely exacerbate postconcussive symptoms and disability. Early detection could improve clinical outcomes, but the accuracy of mental health screening tools in this population has not been well established.
UNASSIGNED: To determine the diagnostic accuracy of the Patient Health Questionnaire-9 (PHQ-9), Generalizaed Anxiety Disorder-7 (GAD-7), and Primary Care PTSD (Posttramatic Stress Disorder) Screen for Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) (DSM-5) (PC-PTSD-5) in adults with mTBI.
UNASSIGNED: This diagnostic study was performed as a secondary analysis of a cluster randomized clinical trial. Self-report mental health screening tools (PHQ-9, GAD-7, and PC-PTSD-5) were administered online 12 weeks after mTBI and compared against a structured psychodiagnostic interview (Mini-International Neuropsychiatric Interview for DSM-5 (MINI) over videoconference at the same time. Adults with mTBI (N = 537) were recruited from February 1, 2021, to October 25, 2022.
UNASSIGNED: Presence of a major depressive episode, anxiety disorders, and PTSD were determined by a blinded assessor with the MINI. Diagnostic accuracy statistics were derived for the PHQ-9, GAD-7, and PC-PTSD-5. Findings were disaggregated for participants with and without persistent postconcussion symptoms (PPCS) by International and Statistical Classification of Diseases, Tenth Revision criteria.
UNASSIGNED: Data were available for 499 of 537 trial participants, 278 (55.7%) of whom were female; the mean (SD) age was 38.8 (13.9) years. Each screening questionnaire had strong diagnostic accuracy in the overall sample for optimal cut points (area under the curve [AUC], ≥0.80; sensitivity, 0.55-0.94; specificity, 0.64-0.94). The AUC (difference of 0.01-0.13) and specificity (difference, 5-65 percentage points) were lower in those with PPCS present compared with PPCS absent, but the prevalence of at least 1 mental health disorder was 3 to 5 times higher in patients with PPCS present. The GAD-7 had slightly better performance than the PC-PTSD-5 for detecting PTSD (AUC, 0.85 [95% CI, 0.80-0.89] vs 0.80 [95% CI, 0.72-0.87]). 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.
UNASSIGNED: The findings of this diagnostic study suggest that the PHQ-9, GAD-7 and PC-PTSD-5 accurately screen for mental health disorders in patients with mTBI. Future research should corroborate optimal test cutoffs for this population.