Abstract
BackgroundTo examine the performance of the EQ-5D-3L in screening for anxiety and depressive symptoms in hospital and community settings compared to other patient-reported screening tools.MethodsData from a prospective cohort of patients discharged from general internal medicine wards from two hospitals in Edmonton, Alberta were used in this study. Two waves of measurements (discharge and 90-days post-discharge) were analyzed. The performance of the EQ-5D-3L was compared to other self-report screening tools: Generalized Anxiety Disorder 2-item questionnaire was used to categorize anxiety symptoms into absent (< 3) and present (≥ 3), and the Patient Health Questionnaire 9-items was used to categorize depressive symptoms by two severity cut-points: no (< 10) vs. mild (≥ 10), and no (< 15) vs. moderate-severe (≥ 15). Performance of EQ-5D-3L in screening for anxiety and depressive symptoms was evaluated using receiver operating curve (ROC) analysis.ResultsAverage age of participants (n = 493) was 62.9 years (SD 18.6); 51% were female. At discharge, 30.0% screened positive for mild and 12.8% for moderate-severe depressive symptoms, while 27.6% screened positive for anxiety symptoms. For co-morbid symptoms, 17.1% screened positive for anxiety and any depressive symptoms, while 10.8% for anxiety and moderate-severe depressive symptoms. While the EQ-5D-3L had limited screening ability in hospital, the anxiety/depression dimension performed well in the community setting (90-days post-discharge) in screening for anxiety (area under ROC 0.79), depressive symptoms (any: 0.78, moderate-severe: 0.84), and a combination of both (any: 0.86; moderate-severe: 0.91).ConclusionsThe EQ-5D-3L anxiety/depression dimension could be a useful tool in screening for anxiety and depressive symptoms in community settings compared to other self-report screening tools. The usefulness of the EQ-5D-3L as a screening tool in other settings and populations is warranted.
Highlights
To examine the performance of the EQ-5D-3L in screening for anxiety and depressive symptoms in hospital and community settings compared to other patient-reported screening tools
At the time of discharge, the mean Generalized Anxiety Disorder 2-item (GAD-2) score was 1.7 (SD 1.8), and 28% screened positive for anxiety symptoms (GAD-2 ≥ 3), while the mean Patient Health Questionnaire 9-items (PHQ-9) score was 7.4 (SD 5.8), and 30% screened positive for any depressive symptoms (PHQ-9 ≥ 10), and 12.8% screened positive for moderate-severe depressive symptoms (PHQ-9 ≥ 15)
17% screened positive for co-morbid anxiety and any depressive symptoms (GAD-2 ≥ 3 and PHQ-9 ≥ 10), and 11% screened positive for co-morbid anxiety and moderate-severe depressive symptoms (GAD-2 ≥ 3 and PHQ-9 ≥ 15)
Summary
To examine the performance of the EQ-5D-3L in screening for anxiety and depressive symptoms in hospital and community settings compared to other patient-reported screening tools. Significant mental disorders occur in about 30% of hospitalized inpatients [5], less than 5% of admissions receive a mental health assessment [6,7,8]. Hospitalized patients with undiagnosed, and untreated, mental disorders have poorer outcomes [9, 12, 13], increased mortality [14], extended hospitalization [9, 12, 13, 15], greater risk for hospital readmission [11,12,13], greater use of medical services [16, 17], and reduced compliance with treatment [9]. Many individuals may suffer from mental disorders for years before receiving appropriate treatment, resulting in significant morbidity for those who suffer from these disorders in addition to social and economic costs [18]
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