Comparison of the PHQ9 and ImPACT symptom cluster scores in measuring depression among college athletes

Accurate identification of athletes in need of mental health services is essential. The clinical utility of the Patient Health Questionnaire - 9 (PHQ-9), a stand-alone measure of depression, was explored among Division II college athletes (n = 1,209) completing pre-participation concussion baseline assessments (mean age = 19.28), which also included Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT). ImPACT's symptom inventory can be divided into four clusters: affective, cognitive, physical/somatic, and sleep. Most athletes (81.9%) did not endorse any items on the affective symptom cluster; however, 90 athletes (7.4%) fell above the cutoff of 5 for depression on the PHQ-9, and approximately half of all athletes endorsed one or more PHQ-9 items. Simple linear regressions revealed ImPACT's sleep symptom cluster as the best predictor of PHQ-9 total score; however, affective, cognitive, and physical symptom clusters significantly predicted PHQ-9 total score as well. Due to relative under-endorsement of items on ImPACT's affective symptom cluster compared to the PHQ-9, the clinical utility of incorporating a stand-alone measure of depression such as the PHQ-9 during baseline testing is supported.