A Two Question Screen for Mental Health Opportunities

Document Type : RESEARCH PAPER

Authors

1 UK Harkness Fellowship in Health Care Policy and Practice Innovations, The Value Institute / Department of Surgery and Peri-operative Care, The University of Texas at Austin, Dell Medical School, Austin, TX, USA

2 Department of Surgery and Peri-operative Care, The University of Texas at Austin, Dell Medical School, Austin, TX, USA

3 Center for Health Communication, The University of Texas at Austin, Dell Medical School, Austin, TX, USA

Abstract

Background: Shortened versions of validated PRO measures of coping strategies e.g. PSEQ-2, may facilitate
screening and monitoring of psychological conditions such as depression and anxiety. The primary research
question in this study assesses the sensitivity and specificity of a PSEQ-2 score of less than 10 for important
symptoms of depression (a PHQ-2 score greater than 2), anxiety (GAD-2 score greater than 2), any impactful
prior episode of psychological trauma, and QuickDASH greater than 49. Secondarily we assess the associations
between self-efficacy and other demographic and psychological factors on the magnitude of limitations and pain
intensity.
Methods: We performed a retrospective PRO evaluation in 926 adult patients attending upper extremity clinic
between 1st January 2018 and 31st January 2019. Demographic factors were assessed using electronic medical
records and PRO data using an online platform. Patients included 556 (60%) women, 370 (40%) men (mean 51
years + 14 (range, 19-88), mostly (n=584, 63%) with safety net insurance.
Results: A PSEQ-2 scoring threshold of less than 10 was 81% sensitive for a PHQ-2 score of 3 or greater, 84%
sensitive for a GAD-2 score of 3 or greater, 84% sensitive for one or more important psychological traumas, and 82%
sensitive for a QuickDASH of 50 or greater. PSEQ-2 less than 10 was independently associated with greater upper
extremity limitations (β=11 [6.3 to 17, 95% Confidence interval [C.I], p <0.001) and pain intensity (β=0.92 (0.31 to 1.5,
95% C.I) P=0.003) amongst other psychological and demographic factors.
Conclusion: A PSEQ-2 score less than 10 might, along with verbal and non-verbal signs of distress, be a useful
way to introduce the use of more sensitive screening questionnaires about anxiety or depression, or open up
the option of speaking directly to mental or social health professionals. Future studies are required to test this
hypothesis.
Level of evidence: III

Keywords

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The Archives of Bone and Joint Surgery
Volume 9, Issue 3
May 2021
Pages 338-344

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History

  • Receive Date: 24 July 2019
  • Revise Date: 04 November 2020
  • Accept Date: 07 November 2020

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