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Predictive Utility of In-Hospital Screening for Postdischarge Depression Symptoms Among Survivors of Critical Illness
Isabella Shubert1, Emily Poehlein1, Deepshikha C Ashana1
1Department of Biostatistics (I. S., E. P., M. K., J. A. G., and M. K. O.), the Division of Pulmonary and Critical Care Medicine (D. C. A. and C. E. C.), the Program to Support People and Enhance Recovery (D. C. A. and C. E. C.), the Department of Psychiatry and Behavioral Sciences (L. S. P.), Duke University, the Veterans Administration (M. K. O.), Durham, NC; the Division of Pulmonary Sciences and Critical Care Medicine (M. M.), University of Colorado School of Medicine, Aurora, CO; and the Department of Medicine (C. L. H.), Oregon Health & Science University, Portland, OR.
Background:
Although postdischarge symptoms of depression are highly prevalent after critical illness, the best timing and strategies for screening are unclear.
Research Question:
What is the value of using the 2-item Patient Health Questionnaire (PHQ-2) depression scale in the hospital to predict elevated postdischarge depression symptoms?
Study Design And Methods:
This was a secondary analysis from a randomized factorial trial designed to optimize a postdischarge distress intervention among survivors of cardiorepiratory failure managed in ICUs in 3 states. The primary outcome was the 9-item Patient Health Questionnaire (PHQ-9) score measured immediately after discharge, whereas the key predictor was in-hospital PHQ-2 score. Performance metrics of the PHQ-2 across different score cut points were compared to identify the optimal threshold value for predicting clinically important postdischarge symptoms. Linear and logistic regression models examined the PHQ-2's performance as a continuous and binary variable alone, as well as with the addition of sociodemographic and clinical characteristics.
Results:
Among 164 participants, clinically important depression symptoms were present after discharge among 72%, as defined by a PHQ-9 score of ≥ 5, and among 39%, as defined by a PHQ-9 score of ≥ 10. Compared with a PHQ-2 score threshold of ≥ 2, a value of ≥ 1 provided higher sensitivity (78% vs 58%), although lower specificity (61% vs 80%) among those with a PHQ-9 score of ≥ 5; metrics were similar with the use of a PHQ-9 score of ≥ 10. Compared with models with binary PHQ-2 scores alone, continuous PHQ-2 scores provided better discrimination (area under the receiver operating characteristic curve [AUC], 0.61-0.69 vs 0.74, respectively), but similar prediction accuracy (Brier score, 0.17-0.19 vs 0.17, respectively). The addition of sociodemographic and clinical characteristics improved the PHQ-2's discrimination (AUC range, 0.61-0.74 vs 0.77-0.83, respectively) and amount of variance explained (R 2 range, 0.18-0.36 vs 0.37-0.48, respectively).
Interpretation:
Our results show that the in-hospital PHQ-2 demonstrated moderate predictive performance as a screening tool for postdischarge depression symptoms among survivors of critical illness. The addition of sociodemographic and clinical variables improved performance.
Clinical Trial Registration:
ClinicalTrials.gov; No.: NCT04038567; URL: www.clinicaltrials.gov.
