Validation of the Computerized Adaptive Test for Mental Health in Primary Care
Validation of the Computerized Adaptive Test for Mental Health in Primary Care
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DOI：
10.1370/afm.2316
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发表时间：
2019-01-01
影响因子：
4.4
通讯作者：
Laiteerapong, Neda
中科院分区：
文献类型：
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作者：
Graham, Andrea K.;Minc, Alexa;Laiteerapong, Neda
目的 美国预防服务工作组建议对一般成年人群进行抑郁症筛查。尽管初级保健机构中存在抑郁症和焦虑症筛查问卷，但基于项目反应理论的计算机化适应性测试等电子健康工具可以推进筛查实践。本研究评估了计算机化适应性心理健康测试 (CAT-MH) 在成人初级保健患者中筛查重度抑郁症 (MDD) 以及评估 MDD 和焦虑严重程度的有效性。 方法 我们联系了 402 名来自初级保健诊所的讲英语的成年人，其中 271 名成年人（71% 为女性，65% 为黑人）参与。参与者完成了 CAT-MH（MDD 计算机自适应诊断测试、CAT 抑郁量表、CAT 焦虑量表）的模块；简短的纸质问卷（9 项患者健康问卷 [PHQ-9]、2 项患者健康问卷 [PHQ-2]、广泛性焦虑症 7 项量表 [GAD-7]）；以及参考标准访谈，即 DSM-5（精神障碍诊断与统计手册，第五版）诊断的结构化临床访谈。 结果 根据访谈，31 名参与者符合 MDD 标准，29 名参与者符合 GAD 标准。对于 MDD 筛查，计算机自适应诊断测试的诊断准确性（曲线下面积 [AUC] = 0.85）与 PHQ-9 (AUC = 0.84) 相似，高于 PHQ-2 (AUC = 0.76)。以访谈作为参考标准，CAT焦虑量表（AUC = 0.93）评估焦虑严重程度的准确性与GAD-7（AUC = 0.97）相似。患者首选的筛查方法是通过带有音频的平板电脑/计算机进行评估。结论计算机化自适应测试可能是一种有效且高效的以患者为中心的初级保健机构抑郁和焦虑筛查策略。
PURPOSE The US Preventive Services Task Force recommends screening for depression in the general adult population. Although screening questionnaires for depression and anxiety exist in primary care settings, electronic health tools such as computerized adaptive tests based on item response theory can advance screening practices. This study evaluated the validity of the Computerized Adaptive Test for Mental Health (CAT-MH) for screening for major depressive disorder (MDD) and assessing MDD and anxiety severity among adult primary care patients.METHODS We approached 402 English-speaking adults for participation from a primary care clinic, of whom 271 adults (71% female, 65% black) participated. Participants completed modules from the CAT-MH (Computerized Adaptive Diagnostic Test for MDD, CAT Depression Inventory, CAT Anxiety Inventory); brief paper questionnaires (9-item Patient Health Questionnaire [PHQ-9], 2-item Patient Health Questionnaire [PHQ-2], Generalized Anxiety Disorder 7-item Scale [GAD-7]); and a reference-standard interview, the Structured Clinical Interview for DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition) Diagnoses.RESULTS On the basis of the interview, 31 participants met criteria for MDD and 29 met criteria for GAD. The diagnostic accuracy of the Computerized Adaptive Diagnostic Test for MDD (area under curve [AUC] = 0.85) was similar to that of the PHQ-9 (AUC = 0.84) and higher than that of the PHQ-2 (AUC = 0.76) for MDD screening. Using the interview as the reference standard, the accuracy of the CAT Anxiety Inventory (AUC = 0.93) was similar to that of the GAD-7 (AUC = 0.97) for assessing anxiety severity. The patient-preferred screening method was assessment via tablet/computer with audio.CONCLUSIONS Computerized adaptive testing could be a valid and efficient patient-centered screening strategy for depression and anxiety screening in primary care settings.