Factorial validity and gender invariance of the Patient Health Questionnaire (PHQ-9) in student-athletes.

BACKGROUND/PURPOSE: Depressive symptoms are prevalent in student-athletes. Evidence for the factorial validity of measures assessing depressive symptoms in student-athletes is presently absent from the literature. This study examined the best fitting factorial structure and invariance across sexes of the PHQ-9. METHODS: Data were collected from 1,524 student-athletes from institutions in the North-Eastern United States. Confirmatory factor analyses of 4 factorial structures of the Patient Health Questionnaire-9 (PHQ-9) were conducted, followed by invariance analyses across sexes. RESULTS: All tested models showed an excellent fit for all tested models and a unidimensional model of the PHQ-9 was chosen for further analyses. Metric and scalar invariance for the identified model across sexes was supported. The participants in this study reported an unusually low (3.13%) prevalence of elevated depressive symptoms, which may indicate underreporting of symptoms. CONCLUSION: Using a unidimensional, composite score via the PHQ-9 is a valid assessment of depressive symptoms in male and female student-athletes.

Validation and Clinical Utility of the Patient Health Questionnaire-9 and Center for Epidemiologic Studies Depression Scale as Depression Screening Tools in Collegiate Student-Athletes.

CONTEXT: The National Athletic Trainers' Association recommends including mental health screening measures as part of the preparticipation examination for all student-athletes (SAs). Despite this recommendation, most mental health screening tools have not been validated in the SA population. OBJECTIVE: To validate and examine the clinical utility of 2 depression screening tools in the collegiate SA population. DESIGN: Cross-sectional mixed-methods study. SETTING: Two Northeastern United States university athletics programs. PATIENTS OR OTHER PARTICIPANTS: A total of 881 (men = 426, 48.4%; women = 455, 51.6%; mean age = 19.7 ± 1.4 years) National Collegiate Athletic Association Division II collegiate SAs completed the Patient Health Questionnaire-9 (PHQ-9) and Center for Epidemiologic Studies Depression Scale (CES-D); 290 SAs participated in a Mini-International Neuropsychiatric Interview. MAIN OUTCOME MEASURE(S): Depression symptoms were measured using 2 self-report depression screening tools, the PHQ-9 and CES-D, during the fall preparticipation examination. The SAs were selected using a random stratified sampling technique to participate in a Mini-International Neuropsychiatric Interview as the reference standard comparison for the receiver operating characteristic analysis. RESULTS: A cutoff score of 6 on the PHQ-9 corresponded to 78% sensitivity, 75% specificity, 17.3% positive predictive value, 98.1% negative predictive value (NPV), 3.2 positive likelihood ratio (+LR), and 0.3 negative likelihood ratio (-LR). A cutoff score of 15 on the CES-D corresponded to 83% sensitivity, 78% specificity, 19.7% positive predictive value, 98.6% NPV, 3.7 +LR, and 0.22 -LR. CONCLUSIONS: This was the first study to validate depression screening tools in the collegiate SA population. The results suggest cutoff scores on the PHQ-9 and CES-D in SA may need to be lower than 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 SAs scoring at or above the cutoff thresholds. Given its brevity, inclusion of a suicidality or self-harm question and evidence of -LR and NPV strength, the PHQ-9 is a practical and effective screener for the SA population.

American Medical Society for Sports Medicine Position Statement: Mental Health Issues and Psychological Factors in Athletes: Detection, Management, Effect on Performance, and Prevention-Executive Summary.

The American Medical Society for Sports Medicine convened a panel of experts to provide an evidence-based, best practice document to assist sports medicine physicians and other members of the athletic care network with the detection, treatment, and prevention of mental health (MH) issues in competitive athletes. This statement discusses how members of the sports medicine team, including team physicians, athletic trainers, and MH providers, work together in providing comprehensive psychological care to athletes. It specifically addresses psychological factors in athletes including personality issues and the psychological response to injury and illness. The statement also examines the athletic culture and environmental factors that commonly impact MH, including sexuality and gender issues, hazing, bullying, sexual misconduct, and transition from sport. Specific MH disorders in athletes, such as eating disorders/disordered eating, depression and suicide, anxiety and stress, overtraining, sleep disorders and attention-deficit/hyperactivity disorder, are reviewed with a focus on detection, management, the effect on performance, and prevention. This document uses the Strength of Recommendation Taxonomy to grade level of evidence.

Mental Health Issues and Psychological Factors in Athletes: Detection, Management, Effect on Performance, and Prevention: American Medical Society for Sports Medicine Position Statement.

The American Medical Society for Sports Medicine convened a panel of experts to provide an evidence-based, best practices document to assist sports medicine physicians and other members of the athletic care network with the detection, treatment, and prevention of mental health issues in competitive athletes. This statement discusses how members of the sports medicine team, including team physicians, athletic trainers, and mental health providers, work together in providing comprehensive psychological care to athletes. It specifically addresses psychological factors in athletes including personality issues and the psychological response to injury and illness. The statement also examines the athletic culture and environmental factors that commonly impact mental health, including sexuality and gender issues, hazing, bullying, sexual misconduct, and transition from sport. Specific mental health disorders in athletes, such as eating disorders/disordered eating, depression and suicide, anxiety and stress, overtraining, sleep disorders, and attention-deficit/hyperactivity disorder, are reviewed with a focus on detection, management, the effect on performance, and prevention. This document uses the Strength of Recommendation Taxonomy (SORT) to grade level of evidence.

Mental health issues and psychological factors in athletes: detection, management, effect on performance and prevention: American Medical Society for Sports Medicine Position Statement-Executive Summary.

The American Medical Society for Sports Medicine convened a panel of experts to provide an evidence-based, best practices document to assist sports medicine physicians and other members of the athletic care network with the detection, treatment and prevention of mental health issues in competitive athletes. This statement discusses how members of the sports medicine team, including team physicians, athletic trainers and mental health providers, work together in providing comprehensive psychological care to athletes. It specifically addresses psychological factors in athletes including personality issues and the psychological response to injury and illness. The statement also examines the athletic culture and environmental factors that commonly impact mental health, including sexuality and gender issues, hazing, bullying, sexual misconduct and transition from sport. Specific mental health disorders in athletes, such as eating disorders/disordered eating, depression and suicide, anxiety and stress, overtraining, sleep disorders and attention-deficit/hyperactivity disorder, are reviewed with a focus on detection, management, the effect on performance and prevention. This document uses the Strength of Recommendation Taxonomy to grade level of evidence.