title: Screening for mental disorders in heart failure patients using computer-adaptive tests.
abstract: OBJECTIVE
  Item response theory is increasingly used in the development of psychometric tests. This paper evaluates whether these modern psychometric methods can improve self-reported screening for depression and anxiety in patients with heart failure.
  
  
  METHODS
  The mental health status of 194 patients with heart failure was assessed using six screening tools for depression (Patient Health Questionnaire -9 (9 items), Hospital Anxiety and Depression Scale (HADS) (7 items), PROMIS-Depression Short Form 8a (8 items)) and Anxiety (GAD-7 (7 items), Hospital Anxiety and Depression Scale (HADS) (7 items), PROMIS-Anxiety Short Form 8a (8 items)). An in-person structured clinical interview was used as the current gold standard to identify the presence of a mental disorder. The diagnostic accuracy of all static tools was compared when item response theory (IRT)-based person parameter were estimated instead of sum scores. Furthermore, we compared performance of static instruments with post hoc simulated individual-tailored computer-adaptive test (CATs) for both disorders and a common negative affect CAT.
  
  
  RESULTS
  In general, screening for depression was highly efficient and showed a better performance than screening for anxiety with only minimal differences among the assessed instruments. IRT-based person parameters yielded the same diagnostic accuracy as sum scores. CATs showed similar screening performance compared to legacy instruments but required significantly fewer items to identify patients without mental conditions. Ideal cutoffs varied between male and female samples.
  
  
  CONCLUSIONS
  Overall, the diagnostic performance of all investigated instruments was similar, regardless of the methods being used. However, CATs can individually tailor the test to each patient, thus significantly decreasing the respondent burden for patients with and without mental conditions. Such approach could efficiently increase the acceptability of mental health screening in clinical practice settings.
authors: Department of Psychosomatic Medicine, Clinic for Internal Medicine, Charité - Universitätsmedizin, Berlin, Germany, felix.fischer@charite.de.
authors: H Felix
authors: HF
authors: Fischer
authors: Cassandra
authors: C
authors: Klug
authors: Koosje
authors: K
authors: Roeper
authors: Eva
authors: E
authors: Blozik
authors: Frank
authors: F
authors: Edelmann
authors: Marion
authors: M
authors: Eisele
authors: Stefan
authors: S
authors: Störk
authors: Rolf
authors: R
authors: Wachter
authors: Martin
authors: M
authors: Scherer
authors: Matthias
authors: M
authors: Rose
authors: Christoph
authors: C
authors: Herrmann-Lingen
mesh_terms: D000368:Aged; D001007:Anxiety / Q000175:diagnosis* / Q000209:etiology; D003863:Depression / Q000175:diagnosis* / Q000209:etiology; D003936:Diagnosis, Computer-Assisted / Q000379:methods* / Q000592:standards; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000523:psychology*; D006760:Hospitalization; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008403:Mass Screening / Q000379:methods; D008603:Mental Health; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011569:Psychiatric Status Rating Scales; D011594:Psychometrics / Q000295:instrumentation; D011788:Quality of Life; D015203:Reproducibility of Results; D057566:Self Report / Q000592:standards; D011795:Surveys and Questionnaires