Operating characteristics of PROMIS four-item depression and anxiety scales in primary care patients with chronic pain

Pain Med. 2014 Nov;15(11):1892-901. doi: 10.1111/pme.12537. Epub 2014 Aug 19.


Objective: Depression and anxiety are prevalent in patients with chronic pain and adversely affect pain, quality of life, and treatment response. The purpose of this psychometric study was to determine the reliability and validity of the four-item Patient Reported Outcomes Measurement Information System (PROMIS) depression and anxiety scales in patients with chronic pain.

Design: Secondary analysis of data from the Stepped Care to Optimize Pain care Effectiveness study, a randomized clinical trial of optimized analgesic therapy.

Setting: Five primary care clinics at the Roudebush VA Medical Center (RVAMC) in Indianapolis, Indiana.

Subjects: Two hundred forty-four primary care patients with chronic musculoskeletal pain.

Methods: All patients completed the four-item depression and anxiety scales from the PROMIS 29-item profile, as well as several other validated psychological measures. The minimally important difference (MID) using the standard error of measurement (SEM) was calculated for each scale, and convergent validity was assessed by interscale correlations at baseline and 3 months. Operating characteristics of the PROMIS measures for detecting patients who had probable major depression or were anxiety-disorder screen-positive were calculated.

Results: The PROMIS scales had good internal reliability, and the MID (as represented by two SEMs) was 2 points for the depression scale and 2.5 points for the anxiety scale. Convergent validity was supported by strong interscale correlations. The optimal screening cutpoint on the 4- to 20-point PROMIS scales appeared to be 8 for both the depression and anxiety scales.

Conclusions: The PROMIS four-item depression and anxiety scales are reasonable options as ultra-brief measures for screening in patients with chronic pain.

Trial registration: ClinicalTrials.gov NCT00926588.

Keywords: Anxiety; Depression; PROMIS; Pain; Psychometrics; Screening.

Publication types

  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Adult
  • Aged
  • Analgesics / therapeutic use
  • Anxiety / diagnosis*
  • Anxiety / etiology
  • Area Under Curve
  • Chronic Pain / drug therapy
  • Chronic Pain / psychology*
  • Depression / diagnosis*
  • Depression / etiology
  • Female
  • Humans
  • Male
  • Middle Aged
  • Psychiatric Status Rating Scales*
  • Psychometrics / methods
  • ROC Curve
  • Reproducibility of Results


  • Analgesics

Associated data

  • ClinicalTrials.gov/NCT00926588