title: Evaluation of Computerized Adaptive Tests (CATs) for longitudinal monitoring of depression, anxiety, and stress reactions.
abstract: BACKGROUND
  Computerized adaptive testing (CAT) based on Item Response Theory, (IRT) offers an efficient way for accurate measurement of patient reported outcomes. The efficiency lies within a minimal response burden and a high measurement precision over a broad measurement range. The objective of the study was to evaluate and compare the responsiveness of CATs measuring anxiety, depression, and stress reaction to standard static self-assessment tools.
  
  
  METHODS
  Longitudinal data of n=595 psychosomatic inpatients were analyzed for evaluating retest-reliability and sensitivity to change of the CATs compared to static measures (GAD-7, PHQ-9, and PSQ) using correlational and ANOVA statistics. The study hypothesized that CATs are at least as retest-reliable and as sensitive to change as static tools.
  
  
  RESULTS
  The three CATs show a low burden for patients, administering on average 5-7 (±2-6SD) items with similar retest-reliability compared to the static tools applied (A-CAT: r=.78 vs. GAD-7: r=.75, D-CAT: r=.71 vs. PHQ-9: r=.75, S-CAT: r=.80 vs. PSQworries scale: r=.80). The CATs were overall as sensitive to change as the static tools (Cohen׳s d ranged between .19 and .69).
  
  
  CONCLUSIONS
  This is a monocenter, observational, longitudinal study without external clinical criteria; thus generalization to other settings may be limited.
  
  
  CONCLUSIONS
  The tested CATs belong to the first generation of CATs being used in daily routine for more than a decade. They are as retest reliable and sensitive to change as static tools. Newer CATs may provide further practical advantages.
authors.affiliation: Department of Psychosomatic Medicine, Center for Internal Medicine and Dermatology, Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany. Electronic address: janine.devine@web.de.
authors.forename: Janine
authors.initials: J
authors.lastname: Devine
authors.affiliation: Federal Foreign Office Health Service, Department 106-9, Werderscher Markt 1, 10117 Berlin, Germany. Electronic address: herbert.fliege@auswaertiges-amt.de.
authors.forename: Herbert
authors.initials: H
authors.lastname: Fliege
authors.affiliation: Center of Psychosocial Medicine, University Hospital Hamburg-Eppendorf, Martinistrasse 52 (Haus W26), 20246 Hamburg, Germany. Electronic address: r.kocalevent@uke.de.
authors.forename: Rüya
authors.initials: R
authors.lastname: Kocalevent
authors.affiliation: Department of Psychosomatic Medicine, Center for Internal Medicine and Dermatology, Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany.
authors.forename: Annett
authors.initials: A
authors.lastname: Mierke
authors.affiliation: Department of Psychosomatic Medicine, Center for Internal Medicine and Dermatology, Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany.
authors.forename: Burghard F
authors.initials: BF
authors.lastname: Klapp
authors.affiliation: Department of Psychosomatic Medicine, Center for Internal Medicine and Dermatology, Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany; University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655, USA. Electronic address: matthias.rose@charite.de.
authors.forename: Matthias
authors.initials: M
authors.lastname: Rose
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001007:Anxiety / Q000175:diagnosis*; D003863:Depression / Q000175:diagnosis*; D003936:Diagnosis, Computer-Assisted; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D018670:Monitoring, Ambulatory / Q000379:methods*; D015203:Reproducibility of Results; D012647:Self-Assessment; D013315:Stress, Psychological / Q000175:diagnosis*; D055815:Young Adult
keywords: Computer Adaptive Test; Item Response Theory; Mental health; Monitor; Questionnaire; Sensitivity to change