The concurrent validity of brief screening questions for anxiety, depression, social isolation, catastrophization, and fear of movement in people with low back pain

Abstract

Objectives: The aim of this study was to (1) test the concurrent validity of brief screening questions for 5 psychosocial constructs (anxiety, depression, social isolation, catastrophization, and fear of movement) and (2) translate into Danish and validate those screening questions. Materials and Methods: Data were collected from 5 cross-sectional samples (total n=1105) of people seeking care for low back pain in Australian primary care settings and a Danish secondary care hospital. The responses to English and Danish-translated versions of 1-item or 2-item screening questions were compared with those of validated full-length questionnaires. Results: Compared with anxiety, depression, and social isolation scores from full-length questionnaires, screening questionnaire responses demonstrated: a correlation of 0.62 to 0.83, overall accuracy of 78% to 91%, sensitivity of 70% to 82%, specificity of 75% to 95%, positive likelihood ratios of 3.3 to 13.9, and negative likelihood ratios of 0.21 to 0.33. For catastrophization and fear of movement, the results demonstrated: correlation of 0.89 to 0.95, overall accuracy of 88% to 93%, sensitivity of 78% to 88%, specificity of 91% to 96%, positive likelihood ratios of 9.5 to 20.8, and negative likelihood ratios of 0.13 to 0.23. Discussion: The concurrent validity of these screening questions was comparable to, or better than, alternate questions previously reported, and stable across age, sex, pain intensity, pain duration, and counties. On the basis of the observed likelihood ratios, all of the screening questions provided moderate or strong evidence to rule in or out an extreme score on each psychosocial construct. Given the ease of administration of these brief screening questions, their prognostic and treatment implications should be investigated.