DSM criteria for major depression: evaluating symptom patterns using latent-trait item response models
DSM criteria for major depression: evaluating symptom patterns using latent-trait item response models
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DOI：
10.1017/s0033291704003563
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发表时间：
2005-04-01
影响因子：
6.9
通讯作者：
Kendler, KS
中科院分区：
文献类型：
--
作者：
Aggen, SH;Neale, MC;Kendler, KS
背景。临床医生专家委员会选择精神疾病的诊断标准，很少有来自测量理论或现代心理测量方法的指导。我们检验了DSM-III-R的重性抑郁症（MD）标准，以确定潜在特质项目反应模型能够提取额外有用信息的程度。采用二分类因子分析和Rasch及2参数logistic项目反应模型对9项DSM-III-R标准加持续时间的维度和测量特性进行评估。定量责任量表与二元DSM-III-R诊断算法变量进行比较，以确定使用每种方法的后果。因子和项目反应模型结果表明，10个MD标准定义了一个合理连贯的单维负债量表。然而，个人风险测量并不是最佳的。标准阈值间距不均匀，使尺度区域测量不佳。标准在区分风险水平上有所不同。与二元抑郁诊断相比，项目反应模型（IRM）倾向量表在(i)阐明抑郁症状与倾向之间的关系，（ii）预测神经质和未来抑郁发作的人格特质，以及（iii）更准确地估计遗传参数方面表现得更好。MD的标准在很大程度上定义了疾病责任的单一维度，尽管个人风险测量的质量不太清楚。定量项目反应量表在预测相关结果和估计双胞胎模型参数方面具有统计学优势。将症状视为有序的风险指标而不是诊断阈值的计数的项目反应模型更充分地利用了症状认可数据模式中提供的信息。
Background. Expert committees of clinicians have chosen diagnostic criteria for psychiatric disorders with little guidance from measurement theory or modern psychometric methods. The DSM-III-R criteria for major depression (MD) are examined to determine the degree to which latent trait item response models can extract additional useful information.Method. The dimensionality and measurement properties of the 9 DSM-III-R criteria plus duration are evaluated using dichotomous factor analysis and the Rasch and 2 parameter logistic item response models. Quantitative liability scales are compared with a binary DSM-III-R diagnostic algorithm variable to determine the ramifications of using each approach.Results. Factor and item response model results indicated the 10 MD criteria defined a reasonably coherent unidimensional scale of liability. However, person risk measurement was not optimal. Criteria thresholds were unevenly spaced leaving scale regions poorly measured. Criteria varied in discriminating levels of risk. Compared to a binary MD diagnosis, item response model (IRM) liability scales performed far better in (i) elucidating the relationship between MD symptoms and liability, (ii) predicting the personality trait of neuroticism and future depressive episodes and (iii) more precisely estimating heritability parameters.Conclusions. Criteria for MD largely defined a single dimension of disease liability although the quality of person risk measurement was less clear. The quantitative item response scales were statistically superior in predicting relevant outcomes and estimating twin model parameters. Item response models that treat symptoms as ordered indicators of risk rather than as counts towards a diagnostic threshold more fully exploit the information available in symptom endorsement data patterns.