Optimizing screening for depression, anxiety disorders, and post-traumatic stress disorder in inpatient addiction treatment: A preliminary investigation.

Abstract Objective Substance use disorders (SUD) are frequently comorbid with other psychiatric conditions, but a comprehensive diagnostic assessment is often not clinically feasible. Efficient psychometrically-validated screening tools exist for many commonly comorbid conditions, but cut-off accuracies have typically not been evaluated in addiction treatment settings. This study examined the performance of several widely-used screening measures in relation to diagnostic status from a clinical interview to identify and validate cut-off scores in an inpatient SUD treatment setting. Method Participants were 99 patients in a large residential SUD treatment program in Ontario, Canada. Participants completed a screening battery, including the Patient Health Questionnaire – 9 (PHQ-9), Generalized Anxiety Disorder – 7 (GAD-7), and Post-Traumatic Stress Disorder Checklist-5 (PCL-5), and underwent a semi-structured diagnostic clinical interview. Receiver operating characteristic curves were used to determine optimal cut-off scores on the screening tool against the interview-based diagnosis. Results Area under the curve (AUC) was statistically significant for all screens and were as follows: PHQ-9 = 0.70 (95% CI = 0.59-0.80), GAD-7 = 0.74 (95% CI = 0.63-0.84), and PCL-5 = 0.79 (95% CI = 0.66-0.91). The optimal accuracy cut-off scores based on sensitivity and specificity were: PHQ-9 ≥16, GAD-7 ≥ 9, the PCL-5 ≥ 42. Conclusions In general, the candidate screeners performed acceptably in this population. However, the optimal cut-off scores were notably higher than existing guidelines for depression and PTSD, potentially due to the general elevations in negative affectivity among individuals initiating SUD treatment. Further validation of these cut-off values is warranted. Public health significance This study provides preliminary modified screening cut-off scores for major depression, anxiety disorders, and post-traumatic stress disorder in addiction treatment settings.