Using Multimodal Assessments to Reevaluate Depression Designations for Spine Surgery Candidates.
Journal
The Journal of bone and joint surgery. American volume
ISSN: 1535-1386
Titre abrégé: J Bone Joint Surg Am
Pays: United States
ID NLM: 0014030
Informations de publication
Date de publication:
25 Jul 2024
25 Jul 2024
Historique:
medline:
26
7
2024
pubmed:
26
7
2024
entrez:
25
7
2024
Statut:
aheadofprint
Résumé
Depression is common in spine surgery candidates and may influence postoperative outcomes. Ecological momentary assessments (EMAs) can overcome limitations of existing depression screening methods (e.g., recall bias, inaccuracy of historical diagnoses) by longitudinally monitoring depression symptoms in daily life. In this study, we compared EMA-based depression assessment with retrospective self-report (a 9-item Patient Health Questionnaire [PHQ-9]) and chart-based depression diagnosis in lumbar spine surgery candidates. We further examined the associations of each depression assessment method with surgical outcomes. Adult patients undergoing lumbar spine surgery (n = 122) completed EMAs quantifying depressive symptoms up to 5 times daily for 3 weeks preoperatively. Correlations (rank-biserial or Spearman) among EMA means, a chart-based depression history, and 1-time preoperative depression surveys (PHQ-9 and Psychache Scale) were analyzed. Confirmatory factor analysis was used to categorize PHQ-9 questions as somatic or non-somatic; subscores were compared with a propensity score-matched general population cohort. The associations of each screening modality with 6-month surgical outcomes (pain, disability, physical function, pain interference) were analyzed with multivariable regression. The association between EMA Depression scores and a depression history was weak (rrb = 0.34 [95% confidence interval (CI), 0.14 to 0.52]). Moderate correlations with EMA-measured depression symptoms were observed for the PHQ-9 (rs = 0.51 [95% CI, 0.37 to 0.63]) and the Psychache Scale (rs = 0.68 [95% CI, 0.57 to 0.76]). Compared with the matched general population cohort, spine surgery candidates endorsed similar non-somatic symptoms but significantly greater somatic symptoms on the PHQ-9. EMA Depression scores had a stronger association with 6-month surgical outcomes than the other depression screening modalities did. A history of depression in the medical record is not a reliable indication of preoperative depression symptom severity. Cross-sectional depression assessments such as PHQ-9 have stronger associations with daily depression symptoms but may conflate somatic depression symptoms with spine-related disability. As an alternative to these methods, mobile health technology and EMAs provide an opportunity to collect real-time, longitudinal data on depression symptom severity, potentially improving prognostic accuracy. Diagnostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Sections du résumé
BACKGROUND
BACKGROUND
Depression is common in spine surgery candidates and may influence postoperative outcomes. Ecological momentary assessments (EMAs) can overcome limitations of existing depression screening methods (e.g., recall bias, inaccuracy of historical diagnoses) by longitudinally monitoring depression symptoms in daily life. In this study, we compared EMA-based depression assessment with retrospective self-report (a 9-item Patient Health Questionnaire [PHQ-9]) and chart-based depression diagnosis in lumbar spine surgery candidates. We further examined the associations of each depression assessment method with surgical outcomes.
METHODS
METHODS
Adult patients undergoing lumbar spine surgery (n = 122) completed EMAs quantifying depressive symptoms up to 5 times daily for 3 weeks preoperatively. Correlations (rank-biserial or Spearman) among EMA means, a chart-based depression history, and 1-time preoperative depression surveys (PHQ-9 and Psychache Scale) were analyzed. Confirmatory factor analysis was used to categorize PHQ-9 questions as somatic or non-somatic; subscores were compared with a propensity score-matched general population cohort. The associations of each screening modality with 6-month surgical outcomes (pain, disability, physical function, pain interference) were analyzed with multivariable regression.
RESULTS
RESULTS
The association between EMA Depression scores and a depression history was weak (rrb = 0.34 [95% confidence interval (CI), 0.14 to 0.52]). Moderate correlations with EMA-measured depression symptoms were observed for the PHQ-9 (rs = 0.51 [95% CI, 0.37 to 0.63]) and the Psychache Scale (rs = 0.68 [95% CI, 0.57 to 0.76]). Compared with the matched general population cohort, spine surgery candidates endorsed similar non-somatic symptoms but significantly greater somatic symptoms on the PHQ-9. EMA Depression scores had a stronger association with 6-month surgical outcomes than the other depression screening modalities did.
CONCLUSIONS
CONCLUSIONS
A history of depression in the medical record is not a reliable indication of preoperative depression symptom severity. Cross-sectional depression assessments such as PHQ-9 have stronger associations with daily depression symptoms but may conflate somatic depression symptoms with spine-related disability. As an alternative to these methods, mobile health technology and EMAs provide an opportunity to collect real-time, longitudinal data on depression symptom severity, potentially improving prognostic accuracy.
LEVEL OF EVIDENCE
METHODS
Diagnostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Identifiants
pubmed: 39052762
doi: 10.2106/JBJS.23.01195
pii: 00004623-990000000-01160
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
Copyright © 2024 by The Journal of Bone and Joint Surgery, Incorporated.
Déclaration de conflit d'intérêts
Disclosure: This study was funded by grants from AO Spine North America, the Cervical Spine Research Society, the Scoliosis Research Society, the Foundation for Barnes-Jewish Hospital, the Washington University/BJC Healthcare Big Ideas Competition, and the National Institute of Mental Health (1F31MH124291-01A). The sponsors had no role in the study design, data collection, data interpretation, manuscript preparation, or decision to submit the manuscript for publication. The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJS/I120).
Références
Chen Z, Luo R, Yang Y, Xiang Z. The prevalence of depression in degenerative spine disease patients: a systematic review and meta-analysis. Eur Spine J. 2021 Dec;30(12):3417-27.
Cushnie D, Soroceanu A, Stratton A, Dea N, Finkelstein J, Bailey CS, Weber MH, Paquet J, Glennie A, Hall H, Rampersaud R, Ahn H, Kelly A, Christie S, Nataraj A, Johnson M, Abraham E, Attabib N, Fisher C, Manson N, Thomas K. Outcome of spine surgery in patients with depressed mental states: a Canadian spine outcome research network study. Spine J. 2022 Oct;22(10):1700-7.
Toivonen L, Häkkinen A, Pekkanen L, Salonen A, Kautiainen H, Neva MH. Influence of depressive symptoms on the outcome of lumbar spine fusion-a 5-year follow-up study. Spine (Phila Pa 1976). 2021 Mar 15;46(6):408-12.
Javeed S, Benedict B, Yakdan S, Saleem S, Zhang JK, Botterbush K, Frumkin MR, Hardi A, Neuman B, Kelly MP, Steinmetz MP, Piccirillo JF, Goodin BR, Rodebaugh TL, Ray WZ, Greenberg JK. Implications of preoperative depression for lumbar spine surgery outcomes: a systematic review and meta-analysis. JAMA Netw Open. 2024 Jan 2;7(1):e2348565.
Zakaria HM, Mansour TR, Telemi E, Asmaro K, Macki M, Bazydlo M, Schultz L, Nerenz DR, Abdulhak M, Schwalb JM, Park P, Chang V. Use of Patient Health Questionnaire-2 scoring to predict patient satisfaction and return to work up to 1 year after lumbar fusion: a 2-year analysis from the Michigan Spine Surgery Improvement Collaborative. J Neurosurg Spine. 2019 Aug 23;31(6):794-801.
Eich E, Reeves JL, Jaeger B, Graff-Radford SB. Memory for pain: relation between past and present pain intensity. Pain. 1985 Dec;23(4):375-80.
Colombo D, Fernández-Álvarez J, Patané A, Semonella M, Kwiatkowska M, García-Palacios A, Cipresso P, Riva G, Botella C. Current state and future directions of technology-based ecological momentary assessment and intervention for major depressive disorder: a systematic review. J Clin Med. 2019 Apr 5;8(4):465.
May M, Junghaenel DU, Ono M, Stone AA, Schneider S. Ecological momentary assessment methodology in chronic pain research: a systematic review. J Pain. 2018 Jul;19(7):699-716.
Armey MF, Schatten HT, Haradhvala N, Miller IW. Ecological momentary assessment (EMA) of depression-related phenomena. Curr Opin Psychol. 2015 Aug 1;4:21-5.
Greenberg JK, Javeed S, Zhang JK, Benedict B, Frumkin MR, Xu Z, Zhang J, Rodebaugh TL, Lu C, Piccirillo JF, Steinmetz M, Ghogawala Z, Bydon M, Ray WZ. Current and future applications of mobile health technology for evaluating spine surgery patients: a review. J Neurosurg Spine. 2023 Jan 20;38(5):617-26.
Holmes A, Christelis N, Arnold C. Depression and chronic pain. Med J Aust. 2013 Sep 16;199(S6):S17-20.
De La Rosa JS, Brady BR, Ibrahim MM, Herder KE, Wallace JS, Padilla AR, Vanderah TW. Co-occurrence of chronic pain and anxiety/depression symptoms in U.S. adults: prevalence, functional impacts, and opportunities. Pain. 2024 Mar 1;165(3):666-73.
Bianchi R, Verkuilen J, Toker S, Schonfeld IS, Gerber M, Brähler E, Kroenke K. Is the PHQ-9 a unidimensional measure of depression? A 58,272-participant study. Psychol Assess. 2022 Jun;34(6):595-603.
Kroenke K, Spitzer RL, Williams JBW. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001 Sep;16(9):606-13.
Elhai JD, Contractor AA, Tamburrino M, Fine TH, Prescott MR, Shirley E, Chan PK, Slembarski R, Liberzon I, Galea S, Calabrese JR. The factor structure of major depression symptoms: a test of four competing models using the Patient Health Questionnaire-9. Psychiatry Res. 2012 Oct 30;199(3):169-73.
Kapfhammer HP. Somatic symptoms in depression. Dialogues Clin Neurosci. 2006;8(2):227-39.
Estlander AM, Takala EP, Verkasalo M. Assessment of depression in chronic musculoskeletal pain patients. Clin J Pain. 1995 Sep;11(3):194-200.
Taylor R, Lovibond PF, Nicholas MK, Cayley C, Wilson PH. The utility of somatic items in the assessment of depression in patients with chronic pain: a comparison of the Zung Self-Rating Depression Scale and the Depression Anxiety Stress Scales in chronic pain and clinical and community samples. Clin J Pain. 2005 Jan-Feb;21(1):91-100.
Miller JA, Derakhshan A, Lubelski D, Alvin MD, McGirt MJ, Benzel EC, Mroz TE. The impact of preoperative depression on quality of life outcomes after lumbar surgery. Spine J. 2015 Jan 1;15(1):58-64.
Theologis AA, Ailon T, Scheer JK, Smith JS, Shaffrey CI, Bess S, Gupta M, Klineberg EO, Kebaish K, Schwab F, Lafage V, Burton D, Hart R, Ames CP; International Spine Study Group. Impact of preoperative depression on 2-year clinical outcomes following adult spinal deformity surgery: the importance of risk stratification based on type of psychological distress. J Neurosurg Spine. 2016 Oct;25(4):477-85.
Nayar G, Elsamadicy AA, Zakare-Fagbamila R, Farquhar J, Gottfried ON. Impact of affective disorders on recovery of baseline function in patients undergoing spinal surgery: a single institution study of 275 patients. World Neurosurg. 2017 Apr;100:69-73.
Greenberg JK, Frumkin MR, Javeed S, Zhang JK, Dai R, Molina CA, Pennicooke BH, Agarwal N, Santiago P, Goodwin ML, Jain D, Pallotta N, Gupta MC, Buchowski JM, Leuthardt EC, Ghogawala Z, Kelly MP, Hall BL, Piccirillo JF, Lu C, Rodebaugh TL, Ray WZ. Feasibility and acceptability of a preoperative multimodal mobile health assessment in spine surgery candidates. Neurosurgery. 2023 Mar 1;92(3):538-46.
Holden RR, Mehta K, Cunningham EJ, McLeod LD. Development and preliminary validation of a scale of Psychache. Canadian Journal of Behavioural Science. 2001;33(4):224-32.
DeLisle MM, Holden RR. Differentiating between depression, hopelessness, and Psychache in university undergraduates. Meas Eval Couns Dev. 2009;42(1):46-63.
Conejero I, Olié E, Calati R, Ducasse D, Courtet P. Psychological pain, depression, and suicide: recent evidences and future directions. Curr Psychiatry Rep. 2018 Apr 5;20(5):33.
Cella D, Riley W, Stone A, Rothrock N, Reeve B, Yount S, Amtmann D, Bode R, Buysse D, Choi S, Cook K, Devellis R, DeWalt D, Fries JF, Gershon R, Hahn EA, Lai JS, Pilkonis P, Revicki D, Rose M, Weinfurt K, Hays R; PROMIS Cooperative Group. The Patient-Reported Outcomes Measurement Information System (PROMIS) developed and tested its first wave of adult self-reported health outcome item banks: 2005-2008. J Clin Epidemiol. 2010 Nov;63(11):1179-94.
Khalifeh JM, Dibble CF, Hawasli AH, Ray WZ. Patient-Reported Outcomes Measurement Information System Physical Function and Pain Interference in spine surgery. J Neurosurg Spine. 2019 Apr 26;31(2):165-74.
Wertli MM, Burgstaller JM, Weiser S, Steurer J, Kofmehl R, Held U. Influence of catastrophizing on treatment outcome in patients with nonspecific low back pain: a systematic review. Spine (Phila Pa 1976). 2014 Feb 1;39(3):263-73.
Frumkin MR, Greenberg JK, Boyd P, Javeed S, Shayo B, Shin J, Wilson EA, Zhang JK, Sullivan MJL, Haroutounian S, Rodebaugh TL. Establishing the reliability, validity, and prognostic utility of the Momentary Pain Catastrophizing Scale for use in ecological momentary assessment research. J Pain. 2023 Aug;24(8):1423-33.
Bollen KA. Structural Equations with Latent Variables. New York: Wiley; 1989.
Brown TA. Confirmatory Factor Analysis for Applied Research. 2nd ed. New York: The Guilford Press; 2015.
National Center for Health Statistics (NCHS). National Health and Nutrition Examination Survey Data. 2021. Accessed 2024 May 28. https://www.cdc.gov/nchs/nhanes/index.htm.
Greene WH. Econometric Analysis. 5th ed. Upper Saddle River, NJ: Prentice Hall; 2002.