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Using Multimodal Assessments to Reevaluate Depression Designations for Spine Surgery Candidates
Braeden Benedict1, Madelyn Frumkin2, Kathleen Botterbush1
1Department of Neurological Surgery, Washington University, St. Louis, Missouri.
The Journal of Bone and Joint Surgery. American Volume
|July 25, 2024
Summary
Ecological momentary assessments (EMAs) better predict surgical outcomes than traditional depression screening in spine surgery patients. This mobile health approach offers more accurate, real-time depression severity data for improved prognoses.
Area of Science:
- Spine Surgery Outcomes Research
- Mental Health Assessment in Surgical Populations
- Digital Health and Mobile Technology Applications
Background:
- Depression is prevalent in lumbar spine surgery candidates, potentially impacting postoperative results.
- Existing depression screening methods (e.g., retrospective self-report, chart review) have limitations like recall bias and diagnostic inaccuracy.
- Ecological momentary assessments (EMAs) offer a method for longitudinal, real-time monitoring of depression symptoms in daily life.
Purpose of the Study:
- To compare EMA-based depression assessment with retrospective self-report (PHQ-9) and chart-based diagnoses in lumbar spine surgery candidates.
- To evaluate the association of each depression assessment method with 6-month postoperative surgical outcomes.
Main Methods:
- 122 adult patients undergoing lumbar spine surgery completed EMAs up to 5 times daily for 3 weeks preoperatively.
- Correlations were analyzed between EMA depression scores, chart-based depression history, and 1-time surveys (PHQ-9, Psychache Scale).
- Multivariable regression assessed the association of each screening modality with 6-month surgical outcomes (pain, disability, function).
Main Results:
- The association between EMA depression scores and prior depression history was weak (r_rb = 0.34).
- EMA scores showed moderate correlations with the PHQ-9 (r_s = 0.51) and Psychache Scale (r_s = 0.68).
- EMA depression scores demonstrated a stronger association with 6-month surgical outcomes compared to other methods.
Conclusions:
- Preoperative depression symptom severity is not reliably indicated by historical depression diagnoses in medical records.
- Cross-sectional assessments like the PHQ-9 correlate with daily symptoms but may confound somatic symptoms with spinal disability.
- Mobile health technology and EMAs provide real-time, longitudinal data for potentially improved prognostic accuracy in spine surgery patients.
