A Two Question Screen for Mental Health Opportunities

Background: Shortened versions of validated PRO measures of coping strategies e.g. PSEQ-۲, may facilitatescreening and monitoring of psychological conditions such as depression and anxiety. The primary researchquestion in this study assesses the sensitivity and specificity of a PSEQ-۲ score of less than ۱۰ for importantsymptoms of depression (a PHQ-۲ score greater than ۲), anxiety (GAD-۲ score greater than ۲), any impactfulprior episode of psychological trauma, and QuickDASH greater than ۴۹. Secondarily we assess the associationsbetween self-efficacy and other demographic and psychological factors on the magnitude of limitations and painintensity.Methods: We performed a retrospective PRO evaluation in ۹۲۶ adult patients attending upper extremity clinicbetween ۱st January ۲۰۱۸ and ۳۱st January ۲۰۱۹. Demographic factors were assessed using electronic medicalrecords and PRO data using an online platform. Patients included ۵۵۶ (۶۰%) women, ۳۷۰ (۴۰%) men (mean ۵۱years + ۱۴ (range, ۱۹-۸۸), mostly (n=۵۸۴, ۶۳%) with safety net insurance.Results: A PSEQ-۲ scoring threshold of less than ۱۰ was ۸۱% sensitive for a PHQ-۲ score of ۳ or greater, ۸۴%sensitive for a GAD-۲ score of ۳ or greater, ۸۴% sensitive for one or more important psychological traumas, and ۸۲%sensitive for a QuickDASH of ۵۰ or greater. PSEQ-۲ less than ۱۰ was independently associated with greater upperextremity limitations (β=۱۱ [۶.۳ to ۱۷, ۹۵% Confidence interval [C.I], p <۰.۰۰۱) and pain intensity (β=۰.۹۲ (۰.۳۱ to ۱.۵,۹۵% C.I) P=۰.۰۰۳) amongst other psychological and demographic factors.Conclusion: A PSEQ-۲ score less than ۱۰ might, along with verbal and non-verbal signs of distress, be a usefulway 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 thishypothesis. Level of evidence: III

Keywords:

Anxiety , Depression , patient outcomes , Psychological factors , Resiliency , stress , Self-efficacy