BACKGROUND Depression is common in spine surgery candidates and may influence postoperative outcomes. Ecological momentary assessments (EMAs) can overcome limitations of existing depression screening methods (e.g., recall bias, inaccuracy of historical diagnoses) by longitudinally monitoring depression symptoms in daily life. In this study, we compared EMA-based depression assessment with retrospective self-report (a 9-item Patient Health Questionnaire [PHQ-9]) and chart-based depression diagnosis in lumbar spine surgery candidates. We further examined the associations of each depression assessment method with surgical outcomes. METHODS Adult patients undergoing lumbar spine surgery (n = 122) completed EMAs quantifying depressive symptoms up to 5 times daily for 3 weeks preoperatively. Correlations (rank-biserial or Spearman) among EMA means, a chart-based depression history, and 1-time preoperative depression surveys (PHQ-9 and Psychache Scale) were analyzed. Confirmatory factor analysis was used to categorize PHQ-9 questions as somatic or non-somatic; subscores were compared with a propensity score-matched general population cohort. The associations of each screening modality with 6-month surgical outcomes (pain, disability, physical function, pain interference) were analyzed with multivariable regression. RESULTS The association between EMA Depression scores and a depression history was weak (r rb = 0.34 [95% confidence interval (CI), 0.14 to 0.52]). Moderate correlations with EMA-measured depression symptoms were observed for the PHQ-9 (r s = 0.51 [95% CI, 0.37 to 0.63]) and the Psychache Scale (r s = 0.68 [95% CI, 0.57 to 0.76]). Compared with the matched general population cohort, spine surgery candidates endorsed similar non-somatic symptoms but significantly greater somatic symptoms on the PHQ-9. EMA Depression scores had a stronger association with 6-month surgical outcomes than the other depression screening modalities did. CONCLUSIONS A history of depression in the medical record is not a reliable indication of preoperative depression symptom severity. Cross-sectional depression assessments such as PHQ-9 have stronger associations with daily depression symptoms but may conflate somatic depression symptoms with spine-related disability. As an alternative to these methods, mobile health technology and EMAs provide an opportunity to collect real-time, longitudinal data on depression symptom severity, potentially improving prognostic accuracy. LEVEL OF EVIDENCE Diagnostic Level III . See Instructions for Authors for a complete description of levels of evidence.

中文翻译：

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使用多模式评估重新评估脊柱手术候选者的抑郁症指定。


背景抑郁症在脊柱手术候选人中很常见，并且可能影响术后结果。生态瞬时评估（EMA）可以通过纵向监测日常生活中的抑郁症状来克服现有抑郁症筛查方法的局限性（例如回忆偏差、历史诊断不准确）。在这项研究中，我们将基于 EMA 的抑郁症评估与回顾性自我报告（包含 9 项的患者健康问卷 [PHQ-9]）以及腰椎手术候选者基于图表的抑郁症诊断进行了比较。我们进一步检查了每种抑郁症评估方法与手术结果的关联。方法 接受腰椎手术的成年患者 (n = 122) 在术前完成 EMA 量化抑郁症状，每天最多 5 次，持续 3 周。分析了 EMA 平均值、基于图表的抑郁症病史和 1 次术前抑郁症调查（PHQ-9 和心理量表）之间的相关性（等级二列或 Spearman）。使用验证性因素分析将 PHQ-9 问题分类为躯体问题或非躯体问题；将子分数与倾向分数匹配的一般人群队列进行比较。通过多变量回归分析每种筛查方式与 6 个月手术结果（疼痛、残疾、身体功能、疼痛干扰）的关联。结果 EMA 抑郁评分与抑郁病史之间的关联较弱（r rb = 0.34 [95% 置信区间 (CI)，0.14 至 0.52]）。 PHQ-9（rs = 0.51 [95% CI，0.37 至 0.63]）和心理量表（rs = 0.68 [95% CI，0.57 至 0.76]）与 EMA 测量的抑郁症状存在中度相关性。 与匹配的一般人群队列相比，脊柱手术候选者在 PHQ-9 上认可类似的非躯体症状，但躯体症状明显更严重。与其他抑郁症筛查方式相比，EMA 抑郁症评分与 6 个月手术结果的关联性更强。结论 病历中的抑郁病史并不是术前抑郁症状严重程度的可靠指标。诸如 PHQ-9 之类的横断面抑郁症评估与日常抑郁症状有更强的关联，但可能会将躯体抑郁症状与脊柱相关的残疾混为一谈。作为这些方法的替代方案，移动健康技术和 EMA 提供了收集有关抑郁症状严重程度的实时纵向数据的机会，有可能提高预后准确性。证据级别 诊断级别 III。有关证据级别的完整描述，请参阅作者须知。