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Stochastic Curtailment of Questionnaires for Three-Level Classification: Shortening the CES-D for Assessing Low, Moderate, and High Risk of Depression.

ABSTRACT: In clinical assessment, efficient screeners are needed to ensure low respondent burden. In this article, Stochastic Curtailment (SC), a method for efficient computerized testing for classification into two classes for observable outcomes, was extended to three classes. In a post hoc simulation study using the item scores on the Center for Epidemiologic Studies-Depression Scale (CES-D) of a large sample, three versions of SC, SC via Empirical Proportions (SC-EP), SC via Simple Ordinal Regression (SC-SOR), and SC via Multiple Ordinal Regression (SC-MOR) were compared at both respondent burden and classification accuracy. All methods were applied under the regular item order of the CES-D and under an ordering that was optimal in terms of the predictive power of the items. Under the regular item ordering, the three methods were equally accurate, but SC-SOR and SC-MOR needed less items. Under the optimal ordering, additional gains in efficiency were found, but SC-MOR suffered from capitalization on chance substantially. It was concluded that SC-SOR is an efficient and accurate method for clinical screening. Strengths and weaknesses of the methods are discussed.

SUBMITTER: Smits N

PROVIDER: S-EPMC5978527 | biostudies-literature | 2016 Jan

REPOSITORIES: biostudies-literature

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Stochastic Curtailment of Questionnaires for Three-Level Classification: Shortening the CES-D for Assessing Low, Moderate, and High Risk of Depression.

Smits Niels N Finkelman Matthew D MD Kelderman Henk H

Applied psychological measurement 20150629 1

In clinical assessment, efficient screeners are needed to ensure low respondent burden. In this article, Stochastic Curtailment (SC), a method for efficient computerized testing for classification into two classes for observable outcomes, was extended to three classes. In a post hoc simulation study using the item scores on the Center for Epidemiologic Studies-Depression Scale (CES-D) of a large sample, three versions of SC, SC via Empirical Proportions (SC-EP), SC via Simple Ordinal Regression ...[more]

PMID: 29881034

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Project description:BackgroundDepression is a mood disorder with a prevalence of approximately 1% to 3% worldwide, representing the fourth leading cause of disease burden globally. The current standard treatments of psychological therapy and antidepressant medications are not effective for everyone, and psychotropic drugs may be associated with significant adverse effects. Cranial electrical stimulation (CES) treatment, in which a low intensity electrical current is administered through the use of a small, portable electrical device, has been reported to have efficacy in the treatment of depression with minimal adverse effects. This systematic review investigated the scientific evidence regarding the efficacy and safety of CES in treatment of acute depression compared to sham, or simulated, CES treatment.ObjectivesTo assess the effectiveness and safety of alternating current cranial electrotherapy stimulation (CES) compared with sham CES for acute depression.Search methodsWe searched The Cochrane Collaboration Depression, Anxiety and Neurosis review group's specialized register (CCDANCTR-Studies and CCDANCTR-References) to February 24, 2014 This register contains relevant randomized controlled trials from: The Cochrane Library (all years), MEDLINE (1950 to date), EMBASE (1974 to date), and PsycINFO (1967 to date). We examined reference lists of review papers and books on CES. We contacted authors, other experts in the field and CES manufacturing companies for knowledge of suitable published or unpublished trials.Selection criteriaRandomized controlled trials of CES versus sham CES for the acute treatment of depressive disorder in adults aged 18 to 75 years.Data collection and analysisWe planned to extract data from the original reports of included studies independently by two authors. The main outcomes to be assessed were:(1) the efficacy of CES in reducing symptoms of depression as reflected in change scores on standardized depression rating scales.(2) the tolerability of CES treatment to participants, as reflected in rates of discontinuation due to adverse effects.We planned to analyze data using Review Manager 5.Main resultsNo studies met the inclusion criteria for this review.Authors' conclusionsThere are insufficient methodologically rigorous studies of CES in treatment of acute depression. There is a need for double-blind randomized controlled trials of CES in the treatment of acute depression.

Project description:ObjectivesTo examine the effect of routinely administered psychiatric questionnaires on the recognition, management, and outcome of psychiatric disorders in non-psychiatric settings.Data sourcesEmbase, Medline, PsycLIT, Cinahl, Cochrane Controlled Trials Register, and hand searches of key journals.MethodsA systematic review of randomised controlled trials of the administration and routine feedback of psychiatric screening and outcome questionnaires to clinicians in non-psychiatric settings. Narrative overview of key design features and end points, together with a random effects quantitative synthesis of comparable studies.Main outcome measuresRecognition of psychiatric disorders after feedback of questionnaire results; interventions for psychiatric disorders; and outcome of psychiatric disorders.ResultsNine randomised studies were identified that examined the use of common psychiatric instruments in primary care and general hospital settings. Studies compared the effect of the administration of these instruments followed by the feedback of the results to clinicians, with administration with no feedback. Meta-analytic pooling was possible for four of these studies (2457 participants), which measured the effect of feedback on the recognition of depressive disorders. Routine administration and feedback of scores for all patients (irrespective of score) did not increase the overall rate of recognition of mental disorders such as anxiety and depression (relative risk of detection of depression by clinician after feedback 0.95, 95% confidence interval 0.83 to 1.09). Two studies showed that routine administration followed by selective feedback for only high scorers increased the rate of recognition of depression (relative risk of detection of depression after feedback 2.64, 1.62 to 4.31). This increased recognition, however, did not translate into an increased rate of intervention. Overall, studies of routine administration of psychiatric measures did not show an effect on patient outcome.ConclusionsThe routine measurement of outcome is a costly exercise. Little evidence shows that it is of benefit in improving psychosocial outcomes of those with psychiatric disorder managed in non-psychiatric settings.

Project description:BACKGROUND:The provision of psychometrically valid patient reported outcomes (PROs) improves patient outcomes and reflects their quality of life. Consequently, ad hoc clinician-generated questionnaires of the past are being replaced by more rigorous instruments. This change, while beneficial, risks the loss/orphaning of decades-long information on difficult to capture/chronically ill populations. The goal of this study was to assess to the quality of data retrieved from these legacy questionnaires. METHODS:Participants included 8563 patients who generated a total of 12,626 hospital admissions over the 2004-2014 study period. Items used to screen for issues related to function, mood, symptoms, and social support among patients with chronic disease were identified in our medical center's patient information questionnaire. Cluster and exploratory factor analyses (EFA) followed by multidimensional item response theory (MIRT) analyses were used to select items that defined factors. Scores were derived with summation and MIRT approaches; inter-factor relationships and relationships of factor scores to assigned diagnostic codes were assessed. Rasch analyses assessed the constructs' measurement properties. RESULTS:Literature review and clinician interviews yielded four hypothesized constructs: psychological distress/wellbeing, symptom burden, social support, and physical function. Rasch analyses showed that, while all had good measurement properties, only one, function, separated individuals well. In exploratory factor analyses (EFA), 11 factors representing depression, respiratory symptoms, musculoskeletal pain, family support, mobility, activities of daily living, alcohol consumption, weight loss, fatigue, neurological disorders, and fear at home were identified. Based on the agreement between EFA and cluster analyses as well as Cronbach's alpha, six domains were retained for analyses. Correlations were strong between activities of daily living and mobility (.84), and moderate between pain and mobility (.37) and psychological distress (.59) Known-group validity was supported from the relationships between factor scores and the relevant diagnostic code assignments (.12 to .20). CONCLUSIONS AND DISCUSSION:Items from ad hoc clinician-generated patient information questionnaires can be aggregated into valid factors that assess supportive care domains among chronically ill patients. However, the binary response options offered by many screening items limit their information content and consequently, as highlighted by Rasch analyses, their ability to meaningfully discriminate trait levels in these populations.

Dataset Information

Stochastic Curtailment of Questionnaires for Three-Level Classification: Shortening the CES-D for Assessing Low, Moderate, and High Risk of Depression.

Publications

Stochastic Curtailment of Questionnaires for Three-Level Classification: Shortening the CES-D for Assessing Low, Moderate, and High Risk of Depression.

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