Validation of a Computerized Adaptive Test Suicide Scale (CAT-SS) among United States Military Veterans.
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ABSTRACT:
SUBMITTER: Brenner LA
PROVIDER: S-EPMC8782529 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:To describe long-term national trends in health insurance coverage among US veterans from 2000 to 2016 in the context of recent health care reform.We used 2000 to 2016 National Health Interview Survey data on veterans aged 18 to 64 years to examine trends in insurance coverage and uninsurance by year, income, and state Medicaid expansion status. We also explored the current proportions of veterans with each type of insurance by age group.The percentage of veterans with private insurance decreased from 70.8% in 2000 to 56.9% in 2011, whereas between 2000 and 2016 Department of Veterans Affairs (VA) health care coverage (only) almost tripled, Medicaid (without concurrent TRICARE or private coverage) doubled, and TRICARE coverage of any type tripled. After 2011, the percentage of veterans who were uninsured decreased. In 2016, low-income veterans in Medicaid expansion states had double the Medicaid coverage (41.1%) of low-income veterans in nonexpansion states (20.1%).Our estimates, which are nationally representative of noninstitutionalized veterans, show marked increases in military-related coverage through TRICARE and VA health care. In 2016, only 7.2% of veterans aged 18 to 64 years and 3.7% of all veterans (aged 18 years or older) remained uninsured.
| S-EPMC5803799 | biostudies-other
Project description:INTRODUCTION:Suicide among military personnel and young Veterans remains a health concern. This study examined stateside distribution of suicides by U.S. county to help focus prevention efforts. METHODS:Using 2005-2012 National Violent Death Reporting System data from 16 states (963 counties, or county-equivalent entities), this study mapped the county-level distribution of suicides among current military and Veteran decedents aged 18-35 years. This study also compared incident circumstances of death between decedents in high-density counties (i.e., counties with the highest proportion of deaths) versus those in medium/low-density counties to better understand the precipitators of suicide in counties most affected. Last, this study identified potential military and Veteran Health Administration intervention sites. All analyses were conducted in 2015. RESULTS:Within the National Violent Death Reporting System participating states, an estimated 262 (33%) current military suicides occurred in just ten (1.0%) counties, and 391 (33%) Veteran suicides occurred in 33 (3.4%) counties. Mental health and intimate partner problems were common precipitating circumstances, and some circumstances differed between cases in high- versus those in medium/low-density counties. Multiple potential intervention sites were identified in high-density counties. CONCLUSIONS:These findings suggest that military and Veteran suicides are concentrated in a small number of counties. Increased efforts at these locales might be beneficial.
| S-EPMC6046215 | biostudies-literature
Project description:ImportanceVeterans from recent and past conflicts have high rates of posttraumatic stress disorder (PTSD). Adaptive testing strategies can increase accuracy of diagnostic screening and symptom severity measurement while decreasing patient and clinician burden.ObjectiveTo develop and validate a computerized adaptive diagnostic (CAD) screener and computerized adaptive test (CAT) for PTSD symptom severity.Design, setting, and participantsA diagnostic study of measure development and validation was conducted at a Veterans Health Administration facility. A total of 713 US military veterans were included. The study was conducted from April 25, 2017, to November 10, 2019.Main outcomes and measuresThe participants completed a PTSD-symptom questionnaire from the item bank and provided responses on the PTSD Checklist for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) (PCL-5). A subsample of 304 participants were interviewed using the Clinician-Administered Scale for PTSD for DSM-5.ResultsOf the 713 participants, 585 were men; mean (SD) age was 52.8 (15.0) years. The CAD-PTSD reproduced the Clinician-Administered Scale for PTSD for DSM-5 PTSD diagnosis with high sensitivity and specificity as evidenced by an area under the curve of 0.91 (95% CI, 0.87-0.95). The CAT-PTSD demonstrated convergent validity with the PCL-5 (r = 0.88) and also tracked PTSD diagnosis (area under the curve = 0.85; 95% CI, 0.79-0.89). The CAT-PTSD reproduced the final 203-item bank score with a correlation of r = 0.95 with a mean of only 10 adaptively administered items, a 95% reduction in patient burden.Conclusions and relevanceUsing a maximum of only 6 items, the CAD-PTSD developed in this study was shown to have excellent diagnostic screening accuracy. Similarly, using a mean of 10 items, the CAT-PTSD provided valid severity ratings with excellent convergent validity with an extant scale containing twice the number of items. The 10-item CAT-PTSD also outperformed the 20-item PCL-5 in terms of diagnostic accuracy. The results suggest that scalable, valid, and rapid PTSD diagnostic screening and severity measurement are possible.
| S-EPMC8267606 | biostudies-literature
Project description:An important component of neuropsychological testing is assessment of premorbid intelligence to estimate a patient's ability independent of neurological impairment. A common test of premorbid IQ-namely, the Reading section of the Wide Range Achievement Test (WRAT)-has been shown to have high measurement error in the high ability range, is unnecessarily long (55 items), and is proprietary. We describe the development of an alternative, nonproprietary, computerized adaptive test for premorbid IQ, the Penn Reading Assessment (PRA-CAT). PRA-CAT items were calibrated using a 1-parameter item response theory model in a large community sample (N = 9,498), Ages 8 to 21, and the resulting parameters were used to simulate computerized adaptive testing sessions. Simulations demonstrated that the PRA-CAT achieves low measurement error (0.25; equivalent to Cronbach's alpha = .94) and acceptable measurement error (0.40; Cronbach's alpha = .84) after only 18 and 6 items, respectively (on average). Correlation of WRAT and PRA-CAT scores with numerous clinical, cognitive, demographic, and neuroimaging criteria suggests that validity of PRA-CAT score interpretation is comparable (and sometimes superior) with the WRAT. The fully functioning PRA-CAT for public use (including item parameter estimates reported here) has been built using the open-source program Concerto, and can be installed by anyone on a local computer or on the "cloud." Given the length and proprietary nature of the WRAT, the PRA-CAT shows promise as a potential alternative (and with minimal or no cost). Further validation in the context of neurological injury is needed. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
| S-EPMC6706308 | biostudies-literature
Project description:Despite evidence linking increased risk of opioid use disorder with specific opioid-prescribing patterns, the relationship between these patterns and heroin use is less understood. This study aimed to determine whether dose and duration of opioid prescriptions predict subsequent heroin use in United States veterans. We analyzed data from 2002 to 2012 from the Veterans Aging Cohort Study, a prospective cohort study. We used inverse probability of censoring weighted Cox regression to examine the relationship between self-reported past year heroin use and 2 primary predictors: (1) prior receipt of a high-dose opioid prescription (?90 mg morphine equivalent daily dose), and (2) prior receipt of a long-term opioid prescription (?90 days). Heroin use was ascertained using most recent value of time-updated self-reported past year heroin use. Models were adjusted for HIV and hepatitis C virus infection status, sociodemographics, pain interference, posttraumatic stress disorder, depression, and use of marijuana, cocaine, methamphetamines, and unhealthy alcohol use. In the final model, prior receipt of a high-dose opioid prescription was associated with past year heroin use (adjusted hazard ratio use = 2.54, 95% confidence interval: 1.26-5.10), whereas long-term opioid receipt was not (adjusted hazard ratio = 1.09, 95% confidence interval: 0.75-1.57). Patients receiving high-dose opioid prescriptions should be monitored for heroin use. These findings support current national guidelines recommending against prescribing high-dose opioids for treating pain.
| S-EPMC6699915 | biostudies-literature
Project description:CONTEXT Unlike other areas of medicine, psychiatry is almost entirely dependent on patient report to assess the presence and severity of disease; therefore, it is particularly crucial that we find both more accurate and efficient means of obtaining that report. OBJECTIVE To develop a computerized adaptive test (CAT) for depression, called the Computerized Adaptive Test-Depression Inventory (CAT-DI), that decreases patient and clinician burden and increases measurement precision. DESIGN Case-control study. SETTING A psychiatric clinic and community mental health center. PARTICIPANTS A total of 1614 individuals with and without minor and major depression were recruited for study. MAIN OUTCOME MEASURES The focus of this study was the development of the CAT-DI. The 24-item Hamilton Rating Scale for Depression, Patient Health Questionnaire 9, and the Center for Epidemiologic Studies Depression Scale were used to study the convergent validity of the new measure, and the Structured Clinical Interview for DSM-IV was used to obtain diagnostic classifications of minor and major depressive disorder. RESULTS A mean of 12 items per study participant was required to achieve a 0.3 SE in the depression severity estimate and maintain a correlation of r = 0.95 with the total 389-item test score. Using empirically derived thresholds based on a mixture of normal distributions, we found a sensitivity of 0.92 and a specificity of 0.88 for the classification of major depressive disorder in a sample consisting of depressed patients and healthy controls. Correlations on the order of r = 0.8 were found with the other clinician and self-rating scale scores. The CAT-DI provided excellent discrimination throughout the entire depressive severity continuum (minor and major depression), whereas the traditional scales did so primarily at the extremes (eg, major depression). CONCLUSIONS Traditional measurement fixes the number of items administered and allows measurement uncertainty to vary. In contrast, a CAT fixes measurement uncertainty and allows the number of items to vary. The result is a significant reduction in the number of items needed to measure depression and increased precision of measurement.
| S-EPMC3551289 | biostudies-literature
Project description:BackgroundSchizotypal traits in adolescents from the general population represent the behavioral expression of liability for psychotic disorders. Schizotypy assessment in this sector of population has advanced considerably in the last few years; however, it is necessary to incorporate recent advances in psychological and educational measurement.ObjectiveThe main goal of this study was to develop a Computerized Adaptive Test (CAT) to evaluate schizotypy through "The Oviedo Questionnaire for Schizotypy Assessment" (ESQUIZO-Q), in non-clinical adolescents.MethodsThe final sample consisted of 3,056 participants, 1,469 males, with a mean age of 15.9 years (SD=1.2).ResultsThe results indicated that the ESQUIZO-Q scores presented adequate psychometric properties under both Classical Test Theory and Item Response Theory. The Information Function estimated using the Gradual Response Model indicated that the item pool effectively assesses schizotypy at the high end of the latent trait. The correlation between the CAT total scores and the paper-and-pencil test was 0.92. The mean number of presented items in the CAT with the standard error fixed at ? 0.30 was of 34 items.ConclusionThe CAT showed adequate psychometric properties for schizotypy assessment in the general adolescent population. The ESQUIZO-Q adaptive version could be used as a screening method for the detection of adolescents at risk for psychosis in both educational and mental health settings.
| S-EPMC3760882 | biostudies-literature
Project description:Computer adaptive tests provide important measurement advantages over traditional fixed-item tests, but research on the psychological reactions of test takers to adaptive tests is lacking. In particular, it has been suggested that test-taker engagement, and possibly test performance as a consequence, could benefit from the control that adaptive tests have on the number of test items examinees answer correctly. However, previous research on this issue found little support for this possibility. This study expands on previous research by examining this issue in the context of a mathematical ability assessment and by considering the possible effect of immediate feedback of response correctness on test engagement, test anxiety, time on task, and test performance. Middle school students completed a mathematics assessment under one of three test type conditions (fixed, adaptive, or easier adaptive) and either with or without immediate feedback about the correctness of responses. Results showed little evidence for test type effects. The easier adaptive test resulted in higher engagement and lower anxiety than either the adaptive or fixed-item tests; however, no significant differences in performance were found across test types, although performance was significantly higher across all test types when students received immediate feedback. In addition, these effects were not related to ability level, as measured by the state assessment achievement levels. The possibility that test experiences in adaptive tests may not in practice be significantly different than in fixed-item tests is raised and discussed to explain the results of this and previous studies.
| S-EPMC5978472 | biostudies-literature
Project description:Death by suicide and suicidal behavior are major concerns among U.S. military veterans; however, no genome-wide association studies (GWAS) studies of suicidal behavior have been conducted among U.S. military veterans to date, despite the elevated rate of suicidal behavior observed within this population. Accordingly, the primary objective of the present research was to conduct the first GWAS of suicide attempts and suicidal ideation in a large and well-characterized sample of U.S. military veterans. The gene most significantly associated (p = 9.28 × 10-7) with suicide attempts was the Potassium Calcium-Activated Channel Subfamily M Regulatory Beta Subunit 2 (KCNMB2) gene, which plays a key role in neuronal excitability. In addition, replication analyses provided additional support for the potential role of the ABI Family Member 3 Binding Protein (ABI3BP) gene in the pathogenesis of suicidal behavior, as numerous nominal associations were found between this gene and both suicide attempts and suicidal ideation. Additional work aimed at replicating and extending these findings is needed.
| S-EPMC6207450 | biostudies-literature
Project description:Previous studies have found an association between recessions and increased rates of suicide. In the present study we widened the focus to examine the association between economic uncertainty and suicides. We used monthly suicide data from the US at the State level from 2000 to 2017 and combined them with the monthly economic uncertainty index. We followed a panel data econometric approach to study the association between economic uncertainty and suicide, controlling for unemployment and other indicators. Economic uncertainty is positively associated with suicide when controlling for unemployment [coeff: 8.026; 95% CI: 3.692-12.360] or for a wider range of economic and demographic characteristics [coeff: 7.478; 95% CI: 3.333-11.623]. An increase in the uncertainty index by one percent is associated with an additional 11-24.4 additional monthly suicides in the US. Economic uncertainty is likely to act as a trigger, which underlines the impulsive nature of some suicides. This highlights the importance of providing access to suicide prevention interventions (e.g. hotlines) during periods of economic uncertainty.
| S-EPMC8191707 | biostudies-literature