Anxiety Screening in Polytrauma Patients by Use of Single-Item Reporting With the Neurobehavioral Symptom Inventory: How Brief Is Too Brief?

Abstract

This study examined the clinical utility of a single item for anxiety from the Neurobehavioral Symptom Inventory (NSI) in determining the need for mental health referral for veterans with traumatic brain injury (TBI). Three hundred eighty veterans referred for TBI evaluation were administered the NSI and a common anxiety screening measure (Beck Anxiety Inventory; BAI). Receiver Operating Characteristic (ROC) curve analyses were conducted to determine ideal BAI total cutoff scores for a single item of the NSI pertaining to anxiety (i.e., "anxious or tense"). Using multiclass ROC curve analyses, NSI scores of 3 and 4 for the sample were comparable to scores of 11 and 22 on the BAI, respectively. Post hoc ROC curve analyses were then conducted on the sample after removal of potentially invalid NSI protocols (i.e., Validity-10 scores greater than 22), and NSI scores 3 and 4 corresponded with scores of 11 and 20, respectively. A minimum score of 3 (severe) on the NSI item was deemed sufficient to indicate the need for further mental health referral without warranting additional screening for anxiety. Further analyses also revealed that removal of positive Validity-10 protocols did not significantly change ROC curve findings, suggesting that the particular NSI item for anxiety can still be used for clinical purposes despite an otherwise invalid protocol. Implications for treatment and recommendations pertaining to when additional screening might be required are discussed.