Assessing Depression Following Injury or Illness: Preliminary Validation of the Neuropsychology.Org Measures of Anxiety and Depression (NOMAD) Scale.

ABSTRACT

INTRODUCTION: Evaluation is an important aspect of any evidence-based rehabilitation program, as it helps to determine the course and scope of the prescribed therapy. Several brief, empirically validated measures of depression are available, yet these measures lack a few innovative features that are useful when evaluating rehabilitation and other medical populations. Such features include a retrospective self-report of premorbid psychological status, embedded symptom validity measures, and means of quickly accounting for physiological symptoms directly resulting from injury or illness that may not indicate psychological distress. OBJECTIVE: This was a preliminary study investigating the utility and psychometric properties, including normative data, of the Neuropsychology.Org Measures of Anxiety and Depression (NOMAD) Depression scale. This brief screening measure for rehabilitation and other medical patients provides ratings of current and preinjury/illness depression levels, and a screening for symptom magnification and minimization. DESIGN: Clinical and control participants completed the NOMAD Depression scale. Clinical participants also completed some or all of the following criterion standard measures: Beck Depression Inventory-Second Edition (BDI-II), Hospital Anxiety and Depression Scale (HADS), and Symptom Checklist-90-Revised (SCL-90-R). SETTING: University hospital-based rehabilitation psychology and neuropsychology clinic and a private neuropsychology and pain psychology practice. PARTICIPANTS: Convenience sample of 575 adults referred for neuropsychological or psychological evaluation, along with 85 undergraduate control subjects. MAIN OUTCOME MEASUREMENTS NOMAD Depression scale results were correlated with criterion standards. Diagnostic sensitivity and specificity were calculated. RESULTS: The NOMAD Depression scale demonstrated moderate convergent validity with other brief mood measures: correlation coefficients (r = .76 to .87, P < .001). Adequate diagnostic sensitivity and specificity were found (area under the curve [AUC] = .81). Suggested cut-off scores for severity ranges are presented for the NOMAD Depression scale Total score and separately for the Cognitive-Affective subscale. CONCLUSIONS: These preliminary results suggest that the NOMAD Depression scale may be clinically useful for quick assessment of mood and mood change following injury/illness in rehabilitation and other health care contexts.