Single-Item Depression Screening With the Neurobehavioral Symptom Inventory (NSI): Do Scores Assist Clinicians With Predicting Need for Mental Health Interventions?

• Published in: Psychological services Vol. 20; no. 3; pp. 690 - 696
• Main Authors: Palmer, Glen A., Palmer, Daniel G., McMillen, Taylor N.
• Format: Journal Article
• Language: English
• Published: United States Educational Publishing Foundation 01-08-2023
• Subjects: Clinicians; Depression Screening; Female; Health Screening; Health Service Needs; Human; Intervention; Inventories; Major Depression; Male; Mental Health; Psychometrics; Screening Tests; Symptoms; Test Items; Traumatic Brain Injury; BDI-II; veterans; Traumatic brain injury; depression; polytrauma
• ISSN: 1541-1559; 1939-148X
• DOI: 10.1037/ser0000652

The purpose of this study was to examine the relationship between a single item for depression from the Neurobehavioral Symptom Inventory (NSI) and a common depression screening measure to predict need for further mental health consultation for veterans with traumatic brain injury (TBI). Three hundred eighty veterans referred to a Veterans Affairs Health Care System TBI clinic for evaluation were administered the NSI and a common depression screening measure (Beck Depression Inventory-Second Edition; BDI-II). Receiver Operating Characteristic (ROC) curve analyses were conducted to determine best cutoff scores on the BDI-II corresponding with a single item of the NSI item pertaining to depression (i.e., "depressed or sad"). Using multiclass ROC curve analyses, results suggested that a minimum score of 3 (severe) on the specific NSI item indicated need for further mental health referral without warranting additional screening for depression. Analyses further demonstrated that removal of invalid NSI protocols did not significantly change ROC curve findings. Therefore, the NSI item for depression can still be used for making clinical decisions despite the protocol being considered otherwise invalid. Implications for treatment and recommendations for screening are discussed.
Impact Statement
This article provides valuable information for clinicians working in rehabilitation/polytrauma settings to assist with interpretation of a single-item screening for depression in individuals with mild traumatic brain injury (mTBI). The article provides guidance regarding when scores based on the Neurobehavioral Symptom Inventory item for subjective depression (i.e., depressed or sad), may indicate need for further mental health interventions.