title: Survey conditioning in self-reported mental health service use: randomized comparison of alternative instrument formats.
abstract: OBJECTIVE
  To test the effect of survey conditioning (whether observed survey responses are affected by previous experience in the same survey or similar surveys) in a survey instrument used to assess mental health service use.
  
  
  METHODS
  Primary data collected in the National Latino and Asian American Study, a cross-sectional household survey of Latinos and Asian Americans residing in the United States.
  
  
  METHODS
  Study participants are randomly assigned to a Traditional Instrument with an interleafed format placing service use questions after detailed questions on disorders, or a Modified Instrument with an ensemble format screening for service use near the beginning of the survey. We hypothesize the ensemble format to be less susceptible to survey conditioning than the interleafed format. We compare self-reported mental health services use measures (overall, aggregate categories, and specific categories) between recipients of the two instruments, using 2x2 chi(2) tests and logistic regressions that control for key covariates.
  
  
  METHODS
  In-person computer-assisted interviews, conducted in respondent's preferred language (English, Spanish, Mandarin Chinese, Tagalog, or Vietnamese).
  
  
  RESULTS
  Higher service use rates are reported with the Modified Instrument than with the Traditional Instrument for all service use measures; odds ratios range from 1.41 to 3.10, all p-values <.001. Results are similar across ethnic groups and insensitive to model specification.
  
  
  CONCLUSIONS
  Survey conditioning biases downward reported mental health service use when the instrument follows an interleafed format. An ensemble format should be used when it is feasible for measures that are susceptible to survey conditioning.
authors.affiliation: UCLA Health Services Research Center, 10920 Wilshire Blvd., Suite 300, Los Angeles, CA 90024, USA.
authors.forename: Naihua
authors.initials: N
authors.lastname: Duan
authors.forename: Margarita
authors.initials: M
authors.lastname: Alegria
authors.forename: Glorisa
authors.initials: G
authors.lastname: Canino
authors.forename: Thomas G
authors.initials: TG
authors.lastname: McGuire
authors.forename: David
authors.initials: D
authors.lastname: Takeuchi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001213:Asian; D003430:Cross-Sectional Studies; D004522:Educational Status; D005260:Female; D006630:Hispanic or Latino; D006801:Humans; D007182:Income; D008297:Male; D001523:Mental Disorders / Q000208:ethnology / Q000628:therapy*; D008605:Mental Health Services / Q000706:statistics & numerical data*; D008875:Middle Aged; D015203:Reproducibility of Results; D011795:Surveys and Questionnaires; D014481:United States