Screening for depression misses people with suicidal ideation in patients with persistent musculoskeletal pain attending private physiotherapy.

IF 1.5 4区医学 Q2 REHABILITATION

Physiotherapy Theory and Practice Pub Date : 2025-10-01 Epub Date: 2025-04-10 DOI:10.1080/09593985.2025.2490036

Davy Vancampfort, Tine Van Damme, Wim Dankaerts, Dieter Van Assche, Brendon Stubbs, Ryan L McGrath

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引用次数: 0

Abstract

Background: Patients with persistent musculoskeletal pain face an increased risk of suicidal ideation, yet suicide risk is not routinely assessed in physiotherapy. Many primary care professionals use a two-stage screening approach, assessing depression first and only asking about suicide if depressive symptoms are present.

Objective: This study examines the appropriateness of this approach in private musculoskeletal physiotherapy practicein Belgium and whether physiotherapists' observations of patients' distress align with patient self-reports.

Methods: Four-hundred fifty patients completed thePatient Health Questionnaire-9 (PHQ-9), which includes the PHQ-2 and a suicide ideation item, while 84 physiotherapists completed an observer-report PHQ-2. Cross-tabulation and logistic regression compared observer ratings with patient-reported distress.

Results: Mean scores on the observer-report and self-report PHQ-2 were similar (1.6 ± 1.6 vs. 1.6 ± 1.5, p = .79)and moderately correlated (r = 0.50, p < .001). Among patients reporting suicidal ideation (16.4%; n = 74), 41.9% (n = 31) scored below the PHQ-2 cutoff of 3, and 52.7% (n = 31) scored below on the observer-report version. A self-report PHQ-2 score of 3 or above was more strongly associated with suicidal ideation (odds ratio[OR] = 6.76; 95%CI = 3.96-11.53) than an observer-report PHQ-2 score of 3 or above (OR = 3.72; 95%CI = 2.21-6.28), though the latter had higher classification accuracy (83.6% vs. 76.2%). Physiotherapists were more likely to recommend professional support for patients with suicidal ideation (50.0% vs. 34.6%, p = .012), but coping advice did not differ by suicide risk.

Conclusion: Many patients with suicidal ideation did not meet the PHQ-2 depression threshold, highlighting the limitations of a two-stage screening approach in physiotherapy. Based on these findings, this approach is not recommended.

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抑郁症筛查漏掉了参加私人物理治疗的持续性肌肉骨骼疼痛患者中有自杀意念的人。

背景：持续性肌肉骨骼疼痛的患者面临自杀意念的风险增加，但自杀风险在物理治疗中没有常规评估。许多初级保健专业人员使用两阶段筛选方法，首先评估抑郁症，只有在出现抑郁症状时才询问自杀。目的：本研究考察了这种方法在比利时私人肌肉骨骼物理治疗实践中的适当性，以及物理治疗师对患者痛苦的观察是否与患者自我报告一致。方法：450例患者完成了患者健康问卷-9 (PHQ-9)，其中包括PHQ-2和自杀意念项目，84名物理治疗师完成了PHQ-2观察报告。交叉表列和逻辑回归比较了观察者评分和患者报告的痛苦。结果：观察者报告和自我报告的PHQ-2平均得分相似（1.6±1.6 vs. 1.6±1.5,p = 0.79），中度相关（r = 0.50, p = 74）， 41.9% （n = 31）的得分低于PHQ-2的临界值3,52.7% （n = 31）的得分低于观察者报告版本。自我报告的PHQ-2得分在3分或以上与自杀意念的相关性更强(优势比[or] = 6.76；95%CI = 3.96-11.53)高于观察者报告的PHQ-2评分3分(or = 3.72；95%CI = 2.21-6.28)，但后者的分类准确率更高（83.6%对76.2%）。物理治疗师更倾向于为有自杀意念的患者推荐专业支持（50.0% vs. 34.6%, p = 0.012），但应对建议没有因自杀风险而异。结论：许多自杀意念患者未达到PHQ-2抑郁阈值，突出了两阶段筛查方法在物理治疗中的局限性。基于这些发现，不推荐这种方法。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Physiotherapy Theory and Practice REHABILITATION-

CiteScore

3.40

自引率

10.00%

发文量

300

期刊介绍： The aim of Physiotherapy Theory and Practice is to provide an international, peer-reviewed forum for the publication, dissemination, and discussion of recent developments and current research in physiotherapy/physical therapy. The journal accepts original quantitative and qualitative research reports, theoretical papers, systematic literature reviews, clinical case reports, and technical clinical notes. Physiotherapy Theory and Practice; promotes post-basic education through reports, reviews, and updates on all aspects of physiotherapy and specialties relating to clinical physiotherapy.