Screening for Anxiety and Depressive Symptoms in Adolescents With Complex Health Conditions From a Longitudinal Registry Study in Los Angeles County: Comparative Performance of the EQ-5D-5L and PedsQL

OBJECTIVES: To compare the EQ-5D-5L with the PedsQL in measuring anxiety or depression symptoms among adolescent patients with special healthcare needs at increased risk for chronic physical, developmental, behavioral, or emotional conditions.

METHODS: Participants >18 years completed the EQ-5D-5L, PedsQL, PHQ-9 for depression, and GAD-7 for anxiety. Symptoms of anxiety or depression were defined using PHQ-9/GAD-7 score ≥10 to represent clinically significant and, scores ≥15 suggesting moderate-to-severe symptoms. We estimated the sensitivity and specificity of the EQ-5D-5L anxiety/depression levels, quintiles of utilities, and PedsQL total scores in classifying symptoms of anxiety or depression. Area under receiver-operator-curves (AUROC) was evaluated for predictive performances.

RESULTS: Of 36 respondents, 10 (27.8%) had depressive symptoms, 7 (19.4%) had moderate/severe depression, 9 (25.0%) had anxiety, 3 (8.3%) had moderate-severe anxiety, 8 (22%) had symptoms of both anxiety and depression, and 3 (8.3%) had moderate-severe anxiety and depression. Sensitivity of the EQ-5D-5L in classifying anxiety and depression was highest for anxiety/depression domain level 4 (AUROC range: 0.59-0.72), while specificity was highest in level 2 (AUROC: 0.70-0.75). AUROC was highest for level 3 in predicting anxiety and depressive symptoms (range: 0.73 – 0.86), and higher for utility score quintile 2 (range: 0.71-0.79) vs. quintile 1 (range: 0.61-0.72). With PedsQL, total score quintile 3 had the best sensitivity in predicting moderate/severe anxiety (AUROC: 0.62-0.68), whereas quintile 1 had the highest specificity for predicting anxiety and depression (AUROC: 0.50-0.77). Overall AUROC was highest for PedsQL total score quintile 2 (range: 0.76-0.81).

CONCLUSIONS: The EQ-5D-5L performed moderately well to classify symptoms of anxiety or depression in this pediatric sample, with better overall sensitivity, specificity, and AUROC than the PedsQL. Given the small sample size, future analyses will validate these findings as data collection continues.