{"id":64709,"date":"2016-04-16T13:00:39","date_gmt":"2016-04-16T17:00:39","guid":{"rendered":"http:\/\/1boringoldman.com\/?p=64709"},"modified":"2016-04-16T15:19:35","modified_gmt":"2016-04-16T19:19:35","slug":"i-wonder","status":"publish","type":"post","link":"https:\/\/1boringoldman.com\/index.php\/2016\/04\/16\/i-wonder\/","title":{"rendered":" i wonder <\/strike>…"},"content":{"rendered":"
\n
Test-Retest Reliability of a Computerized Adaptive Depression Screener <\/a> <\/div>\n
by David Beiser, Milkie Vu, and Robert Gibbons<\/div>\n
Psychiatric Services.<\/font><\/strong> Published online: April 15, 2016<\/div>\n

<\/p>\n

Objective<\/font><\/strong><\/em><\/u>: Computerized adaptive testing [CAT] provides improved precision and decreased test burden compared with traditional, fixed-length tests. Concerns have been raised regarding reliability of CAT-based measurements because the items administered vary both between and within individuals over time. The study measured test-retest reliability of the CAT Depression Inventory [CAT-DI] for assessment of depression in a screening setting where most scores fall in the normal range.<\/div>\n
Methods<\/font><\/strong><\/em><\/u>: A random sample of adults [N=101] at an academic emergency department [ED] was screened twice with the CAT-DI during their visit. Test-retest scores, bias, and reliability were assessed.<\/div>\n
Results<\/font><\/strong><\/em><\/u>: Fourteen percent of patients scored in the mild range for depression, 4% in the moderate range, and 3% in the severe range. Test-retest scores were without significant bias and had excellent reliability [r=.92].<\/div>\n
Conclusions<\/font><\/strong><\/em><\/u>: The CAT-DI provided reliable screening results among ED patients. Concerns about whether changes in item presentation during repeat testing would affect test-retest reliability were not supported.<\/div>\n<\/blockquote>\n
This story is so convoluted that it can’t be quickly summarized so I won’t even try [see why…<\/a>, when…<\/a>, what…<\/a>, why again…<\/a>, open letter to the APA…<\/a>]. I’ll stick to just this article:<\/div>\n
\n
Patients who had a critical illness, were age 17 or younger, were non–English speaking, were without decisional capacity, or had a behavioral health–related chief complaint were excluded<\/font><\/strong>. After written consent was obtained, the CAT-DI was administered twice by research assistants using tablet computers. The second test was administered within one to three minutes following the end of the first test.<\/div>\n<\/blockquote>\n
They’re screening people in the Emergency Department Waiting Room who have come for some other reason than their mental health for depression:<\/div>\n
\n
Depression is associated with increased mortality, adverse health outcomes, and increased overall treatment-related costs. The emergency department [ED] is an important safety net for patients with behavioral health problems and thus may be an ideal setting to diagnose and initiate treatment for patients with depression<\/font><\/strong>. Current estimates suggest that between 8% and 32% of ED patients present with depression. However, conducting the detailed assessments of depression severity required to initiate treatment is often infeasible in the ED because of high patient volumes and limited access to behavioral health expertise. Therefore, any strategy that reduces the burden of empirically based assessment of depression has the potential to improve outcomes…<\/div>\n<\/blockquote>\n
So based on this 93 second assessment [average time to take a CAT-DI test on a computer tablet], we’re going to prescribe an antidepressant medication? See, I can’t even talk about this without getting sarcastic.<\/font><\/em> Let me start over. There’s a whole line of thinking that conceptualizes depression as if it’s an epidemic medical disease. The logic begins with some allusion to the prevalence in the population and the notion that it is rapidly increasing, then progresses to some kind of estimate of the cost in lost productivity and things like over-use of medical services etc. The end point of this logic train is that we need early detection, rapid treatment [antidepressants], and better drugs than the ones we currently have.<\/div>\n

I hope this article comes to us as an anachronism past it’s prime. It started in 2002 when Dr. Gibbons, a statistician at the University of Chicago, got an NIMH Grant to develop computerized screening instruments [what!…<\/a>]. That same year, Dr. David Kupfer et al published A Research Agenda for the DSM-V<\/a>, laying out a plan for a biologically-based medical psychiatry, the dream of many since the 1980 DSM-III. And 2002 was also the year Tom Insel was appointed head of the NIMH [Psychiatry as a Clinical Neuroscience Discipline<\/a>]. Robert Gibbons part in this story has been a dogged determination to undermine the Black Box warning on the antidepressants and an equally persistent campaign to advance this screening instrument. The CAT-DI tools were developed with NIMH funds and then turned into a for-profit enterprise in concert with David Kupfer, his wife Elizabeth Frank, and others on the sly [When is Disclosure Not Disclosure?<\/a>]. So there’s an attempt to capitalize on this screening instrument. <\/p>\n

If this article is about evaluating the test-retest reliability of his CAT-DI instrument, and using the ER patients was a way to get a spread out cohort for that test, it didn’t come out so well. Only 2\/5 in the severe range and 2\/5 in the moderate range were reliable – that’s 4\/10 in the ranges that mattered:<\/p>\n

<\/p>\n

But beyond being a weak test [… Not Ready for Prime Time<\/a>], the gross improprieties in its development, and the obvious profit motives involved, I wonder<\/font><\/em> about the whole idea of screening people for depression. The questions asked on any such instrument that would register significant depression aren’t subtle. If a person is answering them honestly enough to generate a high score, they’re not trying to hide being depressed, so it’s going to show to anyone who is engaged and looking. <\/p>\n

Actually, saying I wonder <\/font><\/em>is ingenuous. I can’t find a way to exactly say why, but my reaction to this screening for depression business is overwhelmingly negative, and more visceral than cognitive. It just feels like yet another step down a bad road – the movement to mechanize patient contact, to objectify the obvious. When I’m handed a PHQ9 in my own physician’s office, I cringe. I’m on Medicare, and apparently he can charge more for a visit if he screens for depression. I’m glad to increase his revenue. He’s a good doctor. But I have to suppress an urge to fill it out as if I’m a homicidal ax murderer just to see if it gets read. If your doctor can’t detect severe depression just by looking, go find a real doctor…<\/div>\n","protected":false},"excerpt":{"rendered":"

Test-Retest Reliability of a Computerized Adaptive Depression Screener by David Beiser, Milkie Vu, and Robert Gibbons Psychiatric Services. Published online: April 15, 2016 Objective: Computerized adaptive testing [CAT] provides improved precision and decreased test burden compared with traditional, fixed-length tests. Concerns have been raised regarding reliability of CAT-based measurements because the items administered vary both […]<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_bbp_topic_count":0,"_bbp_reply_count":0,"_bbp_total_topic_count":0,"_bbp_total_reply_count":0,"_bbp_voice_count":0,"_bbp_anonymous_reply_count":0,"_bbp_forum_subforum_count":0,"footnotes":""},"categories":[5],"tags":[],"class_list":["post-64709","post","type-post","status-publish","format-standard","hentry","category-opinion"],"_links":{"self":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/64709","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/comments?post=64709"}],"version-history":[{"count":17,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/64709\/revisions"}],"predecessor-version":[{"id":64731,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/64709\/revisions\/64731"}],"wp:attachment":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/media?parent=64709"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/categories?post=64709"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/tags?post=64709"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}