Clinical validity of PROMIS Depression, Anxiety, and Anger across diverse clinical samples

Abstract

Objectives: The purpose of this study was to evaluate the responsiveness to change of the PROMIS negative affect measures (depression, anxiety, and anger) using longitudinal data collected in six chronic health conditions.

Study design and setting: Individuals with major depressive disorder (MDD), back pain, chronic obstructive pulmonary disease (COPD), chronic heart failure (CHF), and cancer completed PROMIS negative affect instruments as computerized adaptive test or as fixed-length short form at baseline and a clinically relevant follow-up interval. Participants also completed global ratings of health. Linear mixed effects models and standardized response means (SRM) were estimated at baseline and follow-up.

Results: A total of 903 individuals participated (back pain, n = 218; cancer, n = 304; CHF, n = 60; COPD, n = 125; MDD, n = 196). All three negative affect instruments improved significantly for treatments of depression and pain. Depression improved for CHF patients (anxiety and anger not administered), whereas anxiety improved significantly in COPD groups (stable and exacerbation). Response to treatment was not assessed in cancer. Subgroups of patients reporting better or worse health showed a corresponding positive or negative average SRM for negative affect across samples.

Conclusion: This study provides evidence that the PROMIS negative affect scores are sensitive to change in intervention studies in which negative affect is expected to change. These results inform the estimation of meaningful change and enable comparative effectiveness research.

Keywords: Anger; Anxiety; Chronic conditions; Depression; Item bank; PROMIS.

Figure 1. PROMIS Negative Affect Scores in Different Clinical Groups over Time

Higher scores indicate more negative affect. A T-score of 50 reflects the mean (and 10 the standard deviation) in the US general population sample that was used to center the T-scores.[28] Cancer (Group 1) patients reported improvement on depression/anxiety on the domain-specific global change rating. Cancer (Group 2) reported more depression/anxiety on domain-specific global change rating. Abbreviations: COPD, chronic obstructive pulmonary disease; CHF, chronic heart failure.