Patient-reported outcome measures for depressive symptoms in adults with spinal cord injury: a COSMIN systematic review.

In 30 seconds

This COSMIN systematic review assessed patient-reported measures of depressive symptoms in adults with traumatic or non-traumatic spinal cord injury. It included 28 reports evaluating 27 scored versions, forms, or subscales from 14 instrument families. The Spinal Cord Injury-Quality of Life Depression Item Bank had the strongest condition-specific development and internal-structure evidence, but gaps and insufficient measurement invariance prevented recommendation. The English PHQ-9 had sufficient case-finding evidence, while the English HADS depression subscale had sufficient evidence for structural validity, internal consistency, and construct validity. No measure had complete evidence for routine use across purposes.

Key findings

• The review covered 28 reports evaluating 27 scored versions, forms, or subscales from 14 instrument families.
• The English PHQ-9 had sufficient case-finding evidence, but insufficient structural validity to support interpreting its total score as a clearly unidimensional severity measure.
• The English HADS depression subscale showed sufficient structural validity, internal consistency, and construct validity.
• Evidence for measurement error and responsiveness was scarce.

Why it matters

Depressive symptom measures may be used for different purposes, including case finding, severity assessment, and tracking change. The review indicates that evidence supporting one purpose does not necessarily establish suitability for another. Recognising these measurement gaps can help clinicians and researchers interpret scores cautiously and avoid assuming that a commonly used instrument is validated for every intended use in spinal cord injury.

What to keep in mind

Evidence for measurement error and responsiveness was scarce, and no measure had sufficiently complete evidence for routine use across screening, severity assessment, and change measurement.