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
Bibliographic record
Abstract
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.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.005 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".