Key Points - Athletic trainers have the unique opportunity to incorporate mental health screening measures into clinical practice during the preparticipation examination and throughout clinical practice.< - A cutoff of 6 on the Patient Health Questionnaire-9 or 15 on the Center for Epidemiologic Studies Depression Scale provides strong evidence for clinical utility in ruling out depression in the collegiate student-athlete population; clinicians should carefully select measures and cutoff scores based on the available evidence and resources. - Clinicians may consider lowering the cutoff scores for both the Patient Health Questionnaire-9 and Center for Epidemiologic Studies Depression Scale in the student-athlete population from those previously reported for the general population. 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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