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Article Title

THE OVERLAP BETWEEN THE PATIENT HEALTH QUESTIONNAIRE-9 AND THE POST-CONCUSSION SYMPTOM SCALE IN CONCUSSION

Abstract

Chelsea Frascoia1, Melissa N. Womble2, Sabrina Jennings2, Katie Stephenson1, Philip Schatz3, R.J. Elbin1

1University of Arkansas, Fayetteville, Arkansas; 2INOVA Sports Medicine Concussion Program, Fairfax, Virginia; 3Saint Joseph’s University, Philadelphia, Pennsylvania

The assessment of depression following concussion is an important clinical consideration as this co-morbidity is linked to worse outcomes. The Patient Health Questionnaire-9 (PHQ-9) is recognized as a Common Data Element for concussion (CDE) by the National Institute for Neurological Disease and Stroke (NINDS), and this measure is commonly used in conjunction with concussion symptom inventories such as the Post-Concussion Symptom Scale (PCSS). Given the need to assess both depression- and concussion-related symptoms, delineation between the two is clinically necessary. There are numerous items included on the PHQ-9 that may be endorsed due to concussion-related symptoms. Thus, the PHQ9 and PCSS demonstrate overlap in emotional, sleep/fatigue, and cognitive symptom domains. However, this overlap is understudied, and the possible confounding effects of concussion symptoms resulting in the misclassification of depression following concussion has yet to be investigated in the literature. PURPOSE: 1) To document the overlap between PHQ-9 and PCSS items in individuals with concussion; and 2) to describe the frequency of moderate to severe depression levels as indicated by the PHQ-9 in a concussed sample. METHODS: One hundred sixteen participants (M=15years, SD= 1.7years, 51.3% female) with a sport related concussion (SRC) completed the PHQ-9 and PCSS within 30 days of injury. A series of Pearson Product Moment Correlations were used to evaluate the relationship between PHQ-9 and PCSS items that were qualitatively grouped into emotional, sleep/fatigue, and cognitive symptom domains. Descriptive statistics were used to describe clinical depression on the PHQ-9 (PHQ-9 ≥ 10). RESULTS: The shared symptom domains were moderately correlated (r = .51 to .58). Nineteen percent (22/116) of athletes exhibited PHQ-9 scores indicative of clinical depression, however 100% of patients endorsed the same items for the emotion (18/18), sleep/fatigue (22/22), and cognitive (21/21) domains. CONCLUSION: There is significant overlap between items on the PHQ-9 and PCSS assessments, which may prove difficult for clinicians to differentiate between concussion symptoms and clinically significant levels of depression.

ACKNOWLEDGEMENTS: No specific grant funding was utilized for this project.

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