Measuring Specific Mental Illness Diagnoses with Functional Impairment Workshop Summary (2016) / Chapter Skim
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5 Innovative Approaches to Measurement
5 Innovative Approaches to Measurement
Pages 59-76
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From page 59... ...
An alternative to administering the same set of six items to each individual would be to keep the "K600" and use computerized adaptive testing (CAT) to produce a score using a subset of the items, averaging six items -- plus or minus two items -- that are best suited for each person.
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From page 60... ...
This has particular advantages when measuring concepts such as depression, which are inherently multidimensional, with items drawn from cognitive or somatic domains, or domains related to mood, suicidality, or functional impairment. He said that the model used in CAT is complex, because different items may have different numbers of categories, different severity thresholds, and different abilities to discriminate high and low levels of the underlying latent variable of interest.
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From page 61... ...
Generally, polytomous items, ordinal items, or multicategorical items work best in multidimensional IRT-based CAT models. Gibbons also described work in which he has participated to develop the first computerized adaptive diagnostic screener.
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From page 62... ...
. Validation of computerized adaptive testing in an outpatient non-academic setting.
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From page 63... ...
Gibbons said he will also be using CAT as part of the Kiddie CAT study to assess the dimensions of depression, anxiety, mania, attention deficit hyperactivity disorder, oppositional defiant disorder, and conduct disorder. The study involves an item bank of 1,200 items for parents and 1,200 items for children, and the goal is to develop diagnostic screeners and measures for each of the dimensions.
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From page 64... ...
discussed the Patient Reported Outcome Measurement Information System (PROMIS) , a project under the Common Fund, which supports cross-cutting, trans-NIH programs.
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From page 65... ...
PROMIS also has fixed length forms that cover seven domain health profiles: anxiety, depression, fatigue, pain, sleep, physical function, and role satisfaction. These profiles can also be used as short forms that are pulled from the calibrated item banks.
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From page 66... ...
Cella also discussed how PROMIS measures are being used by Centers for Disease Control and Prevention and the Healthy People 2020 initiative. The measures have been approved for use in Healthy People 2020 and the National Health Interview Survey.
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From page 67... ...
NOTE: Data (except data by age group) are age adjusted to the 2000 standard population.
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From page 68... ...
has about four or five dozen tables that show different instruments linked and calibrated onto a common metric.4 Using the example of depression to link measures, the researchers first coadministered the PROMIS depression measure, the Center for Epidemiological Studies Depression (CES-D) measure, the [Patient Health Questionnaire]
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From page 69... ...
For example, the PROMIS depression metric is on a near-interval level scale, so it is possible to begin to understand this underlying trait in a way that is not tied to DSM-IV
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From page 70... ...
Gibbons also said that as part of one of his current projects he and his colleagues are working with 300 items on depression, mania, and psychosis, and are trying to produce an overall single-value index of severe mental illness that maintains the inherent multidimensionality of the item bank. One could then also score the individual subdomains, but that is not something his team has done yet.
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From page 71... ...
In work with others, he and his colleagues looked at the structure of mental disorders using data from the National Comorbidity Survey Replication Adolescent Supplement.5 They found a meaningful general factor that tends to bifurcate into internalizing and externalizing kinds of presentations, as well as further layers to the structure. Krueger noted that there is some recognition in DSM-5 that mental disorders have an underlying structure.
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From page 72... ...
Cella noted that on ClinicalTrials.gov, where people using PROMIS tools have the opportunity to use CAT, custom forms, or off-the-shelf short forms, the choice has been short forms, by a 5-to-1 margin over other options. He said that the reason might be that the CAT technology is not very accessible.
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From page 73... ...
His team will only do suicide screening face to face so that if there is an issue, appropriate follow-up can be done. The question is whether something should be done even for untreated depression, and the right answer is, of course, yes, he said, because untreated depression leads to high health care costs and is also associated with a high suicide rate.
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From page 74... ...
commented that he considers computerized adaptive testing to be very useful in certain circumstances, but in the interest of transparency, government agencies need to be able to include in their datasets not just the scores, but also every item that the person responded to and exactly how the person responded. This is not impossible, but the documentation may be very extensive.
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From page 75... ...
about the possible use of CAT, and they plan on giving the VA an executable version of the program that can be uploaded to their computers. Ultimately, from the perspective of Gibbons and his colleagues, the vision would be a cloud computing environment in which CAT could be administered on home computers, tablets, or cell phones.
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