title: Web-based assessment of depression in patients treated in clinical practice: reliability, validity, and patient acceptance.
abstract: OBJECTIVE
  Calls for the use of standardized assessments in clinical practice have been increasing. A Web-based administration of outcome assessments offers several potential advantages over paper-and-pencil assessments, such as patient convenience, reduced missing data, reduced costs, automatic scoring, and generation of large databases. The present study from the Rhode Island Methods to Improve Diagnostic Assessments and Services (MIDAS) project evaluated the acceptability, reliability, and validity of a Web-based administration of a depression scale in patients receiving ongoing care for depression.
  
  
  METHODS
  From June 2009 to July 2010, fifty-three depressed outpatients completed a Web-based and a paper version of the Clinically Useful Depression Outcome Scale (CUDOS). The vast majority of patients met DSM-IV criteria for either major depressive disorder (n = 36) or bipolar disorder (n = 9). Patients were also asked to complete a brief 6-question survey of the acceptability of the 2 modes of scale administration. At the time of the visit, the patients' psychiatrist completed the Montgomery-Asberg Depression Rating Scale (MADRS) and rated patients on the Clinical Global Impressions-Severity of Illness (CGI-S) scale and Global Assessment of Functioning (GAF).
  
  
  RESULTS
  The correlation between the Web-administered and paper versions of the CUDOS was high (P < .001). The mean scores were similar on the paper and Internet administrations. The internal consistency of the paper and Internet administrations of the CUDOS was high (both values, Cronbach α = .93), and all item-scale correlations for the paper and Internet versions were significant (median for paper administration = 0.76; median for Internet administration = 0.74). The paper and Internet versions of the CUDOS were equally correlated with clinicians' ratings on the MADRS, CGI-S, and GAF (all P values < .001). Patients reported high levels of satisfaction with Internet administration and preferred this method of monitoring outcome to paper administration in the office (all P values < .001).
  
  
  CONCLUSIONS
  The results of this first study of the use of a Web-based system of monitoring outcome in routine clinical practice supported the reliability and validity of Internet administration of a depression scale, and patients clearly preferred Internet administration to completion of a paper-and-pencil questionnaire in the office.
authors.affiliation: Department of Psychiatry and Human Behavior, Brown University School of Medicine, Rhode Island Hospital, Providence, Rhode Island, USA. mzimmerman@lifespan.org
authors.forename: Mark
authors.initials: M
authors.lastname: Zimmerman
authors.forename: Jennifer H
authors.initials: JH
authors.lastname: Martinez
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003863:Depression / Q000175:diagnosis*; D005260:Female; D006801:Humans; D020407:Internet; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000379:methods*; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D011569:Psychiatric Status Rating Scales / Q000592:standards* / Q000706:statistics & numerical data; D011594:Psychometrics / Q000379:methods / Q000706:statistics & numerical data; D015203:Reproducibility of Results; D012237:Rhode Island