Validation and Clinical Utility of the PHQ-9 and CES-D as Depression Screening Tools in Collegiate Student-Athletes.

Abstract

The National Athletic Trainers' Association recommends including mental health screening measures as part of the pre-participation exam (PPE) for all student-athletes. Despite this recommendation, most mental health screening tools have not been validated in the student-athlete (SA) population. To validate and examine clinical utility of two depression screening tools in the collegiate SA population. Cross-sectional mixed methods design. Two Northeastern United States university athletics programs. A total of 881 (male = 426, 48.4%; females = 455, 51.6%; mean age 19.7 ± 1.4 years old) NCAA Division-II collegiate SAs completed the PHQ-9 and CES-D; 290 SAs participated in a MINI clinical interview. Depression symptoms were measured using two self-reported depression screening tools, the PHQ-9 and CES-D, during the fall PPE. SAs were selected using a random stratified sampling technique to participate in a MINI Structured Clinical Interview, as the reference standard comparison for the ROC analysis. A cut-off score of 6 on the PHQ-9 corresponded to 78% sensitivity, 75% specificity, 17.3% PPV, 98.1% NPV, 3.2 LR+, and 0.3 LR-. A cut-off score of 15 on the CES-D corresponded to 83% sensitivity, 78% specificity, 19.7% PPV, 98.6% NPV, 3.7 LR+, and 0.22 LR-. This was the first study to validate depression screening tools in the collegiate SA population. The results suggest cut-off scores on the PHQ-9 and CES-D in SA may need to be lowered when compared to those recommended for the general population and provide strong evidence for use as screeners to rule out depression. Referral and confirmatory testing should be implemented to confirm the presence of depression for SA scoring at or above cutoff thresholds. Given its brevity, inclusion of a suicidality/self-harm question, and evidence of LR-/NPV strength, the PHQ-9 is a practical and effective screener for the SA population.