title: Using computerized adaptive testing to reduce the burden of mental health assessment.
abstract: OBJECTIVE
  This study investigated the combination of item response theory and computerized adaptive testing (CAT) for psychiatric measurement as a means of reducing the burden of research and clinical assessments.
  
  
  METHODS
  Data were from 800 participants in outpatient treatment for a mood or anxiety disorder; they completed 616 items of the 626-item Mood and Anxiety Spectrum Scales (MASS) at two times. The first administration was used to design and evaluate a CAT version of the MASS by using post hoc simulation. The second confirmed the functioning of CAT in live testing.
  
  
  RESULTS
  Tests of competing models based on item response theory supported the scale's bifactor structure, consisting of a primary dimension and four group factors (mood, panic-agoraphobia, obsessive-compulsive, and social phobia). Both simulated and live CAT showed a 95% average reduction (585 items) in items administered (24 and 30 items, respectively) compared with administration of the full MASS. The correlation between scores on the full MASS and the CAT version was .93. For the mood disorder subscale, differences in scores between two groups of depressed patients--one with bipolar disorder and one without--on the full scale and on the CAT showed effect sizes of .63 (p<.003) and 1.19 (p<.001) standard deviation units, respectively, indicating better discriminant validity for CAT.
  
  
  CONCLUSIONS
  Instead of using small fixed-length tests, clinicians can create item banks with a large item pool, and a small set of the items most relevant for a given individual can be administered with no loss of information, yielding a dramatic reduction in administration time and patient and clinician burden.
authors: Center for Health Statistics, University of Illinois at Chicago, Psychiatric Institute 457, M/C 912, Chicago, IL 60680-6998, USA. rdgib@uic.edu
authors: Robert D
authors: RD
authors: Gibbons
authors: David J
authors: DJ
authors: Weiss
authors: David J
authors: DJ
authors: Kupfer
authors: Ellen
authors: E
authors: Frank
authors: Andrea
authors: A
authors: Fagiolini
authors: Victoria J
authors: VJ
authors: Grochocinski
authors: Dulal K
authors: DK
authors: Bhaumik
authors: Angela
authors: A
authors: Stover
authors: R Darrell
authors: RD
authors: Bock
authors: Jason C
authors: JC
authors: Immekus
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000379:Agoraphobia / Q000175:diagnosis; D001008:Anxiety Disorders / Q000175:diagnosis; D001714:Bipolar Disorder / Q000175:diagnosis; D003936:Diagnosis, Computer-Assisted; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis*; D008875:Middle Aged; D019964:Mood Disorders / Q000175:diagnosis; D009771:Obsessive-Compulsive Disorder / Q000175:diagnosis; D016584:Panic Disorder / Q000175:diagnosis; D010698:Phobic Disorders / Q000175:diagnosis; D015203:Reproducibility of Results; D011795:Surveys and Questionnaires; D013997:Time Factors