The computerized adaptive diagnostic test for major depressive disorder (CAD-MDD): a screening tool for depression.
The computerized adaptive diagnostic test for major depressive disorder (CAD-MDD): a screening tool for depression.
复制标题
DOI：
10.4088/jcp.12m08338
复制
发表时间：
2013-07
期刊：
影响因子：
--
通讯作者：
Kupfer DJ
中科院分区：
文献类型：
--
作者：
Gibbons RD;Hooker G;Finkelman MD;Weiss DJ;Pilkonis PA;Frank E;Moore T;Kupfer DJ
开发一种计算机化自适应诊断（CAD）抑郁症筛查工具，以减轻患者和临床医生的负担，并提高基于临床的DSM-IV诊断重度抑郁症（MDD）的敏感性和特异性。从精神病诊所、社区精神卫生中心和通过公告招募了656名患有或不患有轻度和重度抑郁症的人（没有抑郁症的对照组）。该题库由88个抑郁量表项目组成，取自73个抑郁量表。本研究的重点是基于决策理论方法（随机森林和决策树）的CAD-MDD诊断筛选工具的开发。预测基于临床的SCID - DSM-IV诊断MDD的敏感性和特异性是主要结果。然后将诊断筛选的准确性与PHQ-9进行比较。每位参与者平均需要4个项目（最多6个）。总敏感性和特异性分别为0.95和0.87。PHQ-9的敏感性为0.70，特异性为0.91。在不到一分钟的时间内平均使用4个适应性自我报告项目，可以获得基于临床的DSM-IV抑郁症诊断的高灵敏度和合理的特异性。与目前使用的PHQ-9相比，CAD-MDD在保持相似特异性的同时显著提高了灵敏度。因此，CAD-MDD将比PHQ-9使用一半的项目数量识别出更多的真阳性（更低的假阴性率）。廉价（相对于临床评估）、在初级保健机构、精神流行病学、分子遗传学和全球卫生中有效和准确地筛查抑郁症都是当前系统的直接应用。
To develop a computerized adaptive diagnostic (CAD) screening tool for depression that decreases patient and clinician burden and increases sensitivity and specificity for clinician-based DSM-IV diagnosis of major depressive disorder (MDD). 656 individuals with and without minor and major depression were recruited from a psychiatric clinic, community mental health center, and through public announcements (controls without depression). The item bank consists of 88 depression scale items drawn from 73 depression measures. The focus of this study was the development of the CAD-MDD diagnostic screening tool based on a decision-theoretic approach (random forests and decision trees). Sensitivity and specificity for predicting clinician-based SCID DSM-IV diagnoses of MDD were the primary outcomes. Diagnostic screening accuracy was then compared to the PHQ-9. An average of 4 items per participant was required (maximum of 6 items). Overall sensitivity and specificity were 0.95 and 0.87 respectively. For the PHQ-9, sensitivity was 0.70 and specificity was 0.91. High sensitivity and reasonable specificity for a clinician-based DSM-IV diagnosis of depression can be obtained using an average of 4 adaptively administered self-report items in less than one minute. Relative to the currently used PHQ-9, the CAD-MDD dramatically increased sensitivity while maintaining similar specificity. As such, the CAD-MDD will identify more true positives (lower false negative rate) than the PHQ-9 using half the number of items. Inexpensive (relative to clinical assessment), efficient and accurate screening of depression in primary care settings, psychiatric epidemiology, molecular genetics, and global health are all direct applications of the current system.