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Patient Health Questionnaire-9 in Patients With Broad-Spectrum Traumatic Brain Injury

      Donders and Pendery
      • Donders J.
      • Pendery A.
      Clinical utility of the Patient Health Questionnaire-9 in the assessment of major depression after broad-spectrum traumatic brain injury.
      examined the ability of the Patient Health Questionnaire-9 (PHQ-9) to screen for symptoms of depression after broad-spectrum traumatic brain injury (TBI). In 137 patients with TBI, PHQ-9 scores≥10 had a sensitivity of 91.7 and a specificity of 60.2 for predicting the diagnosis of major depression. The correlation coefficients between the scores of the PHQ-9 and Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF) demoralization and low positive emotions scales were .64 and .48, respectively. I have some concerns about this study.
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      References

        • Donders J.
        • Pendery A.
        Clinical utility of the Patient Health Questionnaire-9 in the assessment of major depression after broad-spectrum traumatic brain injury.
        Arch Phys Med Rehabil. 2017; 98: 2514-2519
        • Austin P.C.
        • Steyerberg E.W.
        Events per variable (EPV) and the relative performance of different strategies for estimating the out-of-sample validity of logistic regression models.
        Stat Methods Med Res. 2017; 26: 796-808

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      • The Authors Respond
        Archives of Physical Medicine and RehabilitationVol. 99Issue 5
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          We have mixed feelings about this feedback. On the one hand, we acknowledge that the number of events per variable for some of the logistic regression analyses, particularly the one to predict a final diagnosis of major depression on the basis of demographic and injury variables, was suboptimal. This was because of the relatively low number of participants (N=24, 17%) with such a diagnosis. We could have addressed this by limiting the number of predictors in the model but decided against this because (1) they had been selected a priori for theoretical reasons, and (2) the participant-to-variable ratio in the model was acceptable.
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