title: Validation of Computerized Adaptive Testing in an Outpatient Nonacademic Setting: The VOCATIONS Trial.
abstract: OBJECTIVE
  Computerized adaptive testing (CAT) provides an alternative to fixed-length assessments. The study validated a suite of computerized adaptive tests for mental health (CAT-MH) in a community psychiatric sample.
  
  
  METHODS
  A total of 145 adults from a community outpatient clinic, including 19 with no history of a mental disorder (control group), were prospectively evaluated with CAT for depression (CAD-MDD and CAT-DI), mania (CAT-MANIA), and anxiety symptoms (CAT-ANX). Ratings were compared with gold-standard psychiatric assessments, including the Structured Clinical Interview for DSM-IV-TR (SCID), Hamilton Rating Scale for Depression (HAM-D-25), Patient Health Questionnaire (PHQ-9), Center for Epidemiologic Studies Depression Scale (CES-D), and Global Assessment of Functioning (GAF).
  
  
  RESULTS
  Sensitivity and specificity for CAD-MDD were .96 and .64, respectively (.96 and 1.00 for major depression versus the control group). CAT for depression severity (CAT-DI) correlated well with the HAM-D-25 (r=.79), PHQ-9 (r=.90), and CES-D (r=.90) and had an odds ratio (OR) of 27.88 across its range for current SCID major depressive disorder. CAT-ANX correlated with the HAM-D-25 (r=.73), PHQ-9 (r=.78), and CES-D (r=.81) and had an OR of 11.52 across its range for current SCID generalized anxiety disorder. CAT-MANIA did not correlate well with the HAM-D-25 (r=.31), PHQ-9 (r=.37), and CES-D (r=.39), but it had an OR of 11.56 across its range for a current SCID bipolar diagnosis. Participants found the CAT-MH acceptable and easy to use, averaging 51.7 items and 9.4 minutes to complete the full battery.
  
  
  CONCLUSIONS
  Compared with gold-standard diagnostic and assessment measures, CAT-MH provided an effective, rapidly administered assessment of psychiatric symptoms.
authors.affiliation: Dr. Achtyes, Dr. Halstead, and Ms. Smart are with Pine Rest Christian Mental Health Services, Grand Rapids, Michigan. Dr. Achtyes is also with the Department of Psychiatry and Behavioral Medicine, Michigan State University College of Human Medicine, Grand Rapids (e-mail: achtyes@msu.edu ). Ms. Moore, Dr. Frank, and Dr. Kupfer are with the Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania. Dr. Gibbons is with the Departments of Medicine, Public Health Sciences, and Psychiatry and the Center for Health Statistics, University of Chicago, Illinois.
authors.forename: Eric D
authors.initials: ED
authors.lastname: Achtyes
authors.affiliation: Dr. Achtyes, Dr. Halstead, and Ms. Smart are with Pine Rest Christian Mental Health Services, Grand Rapids, Michigan. Dr. Achtyes is also with the Department of Psychiatry and Behavioral Medicine, Michigan State University College of Human Medicine, Grand Rapids (e-mail: achtyes@msu.edu ). Ms. Moore, Dr. Frank, and Dr. Kupfer are with the Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania. Dr. Gibbons is with the Departments of Medicine, Public Health Sciences, and Psychiatry and the Center for Health Statistics, University of Chicago, Illinois.
authors.forename: Scott
authors.initials: S
authors.lastname: Halstead
authors.affiliation: Dr. Achtyes, Dr. Halstead, and Ms. Smart are with Pine Rest Christian Mental Health Services, Grand Rapids, Michigan. Dr. Achtyes is also with the Department of Psychiatry and Behavioral Medicine, Michigan State University College of Human Medicine, Grand Rapids (e-mail: achtyes@msu.edu ). Ms. Moore, Dr. Frank, and Dr. Kupfer are with the Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania. Dr. Gibbons is with the Departments of Medicine, Public Health Sciences, and Psychiatry and the Center for Health Statistics, University of Chicago, Illinois.
authors.forename: LeAnn
authors.initials: L
authors.lastname: Smart
authors.affiliation: Dr. Achtyes, Dr. Halstead, and Ms. Smart are with Pine Rest Christian Mental Health Services, Grand Rapids, Michigan. Dr. Achtyes is also with the Department of Psychiatry and Behavioral Medicine, Michigan State University College of Human Medicine, Grand Rapids (e-mail: achtyes@msu.edu ). Ms. Moore, Dr. Frank, and Dr. Kupfer are with the Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania. Dr. Gibbons is with the Departments of Medicine, Public Health Sciences, and Psychiatry and the Center for Health Statistics, University of Chicago, Illinois.
authors.forename: Tara
authors.initials: T
authors.lastname: Moore
authors.affiliation: Dr. Achtyes, Dr. Halstead, and Ms. Smart are with Pine Rest Christian Mental Health Services, Grand Rapids, Michigan. Dr. Achtyes is also with the Department of Psychiatry and Behavioral Medicine, Michigan State University College of Human Medicine, Grand Rapids (e-mail: achtyes@msu.edu ). Ms. Moore, Dr. Frank, and Dr. Kupfer are with the Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania. Dr. Gibbons is with the Departments of Medicine, Public Health Sciences, and Psychiatry and the Center for Health Statistics, University of Chicago, Illinois.
authors.forename: Ellen
authors.initials: E
authors.lastname: Frank
authors.affiliation: Dr. Achtyes, Dr. Halstead, and Ms. Smart are with Pine Rest Christian Mental Health Services, Grand Rapids, Michigan. Dr. Achtyes is also with the Department of Psychiatry and Behavioral Medicine, Michigan State University College of Human Medicine, Grand Rapids (e-mail: achtyes@msu.edu ). Ms. Moore, Dr. Frank, and Dr. Kupfer are with the Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania. Dr. Gibbons is with the Departments of Medicine, Public Health Sciences, and Psychiatry and the Center for Health Statistics, University of Chicago, Illinois.
authors.forename: David J
authors.initials: DJ
authors.lastname: Kupfer
authors.affiliation: Dr. Achtyes, Dr. Halstead, and Ms. Smart are with Pine Rest Christian Mental Health Services, Grand Rapids, Michigan. Dr. Achtyes is also with the Department of Psychiatry and Behavioral Medicine, Michigan State University College of Human Medicine, Grand Rapids (e-mail: achtyes@msu.edu ). Ms. Moore, Dr. Frank, and Dr. Kupfer are with the Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania. Dr. Gibbons is with the Departments of Medicine, Public Health Sciences, and Psychiatry and the Center for Health Statistics, University of Chicago, Illinois.
authors.forename: Robert
authors.initials: R
authors.lastname: Gibbons
mesh_terms: D000328:Adult; D001008:Anxiety Disorders / Q000175:diagnosis*; D001714:Bipolar Disorder / Q000175:diagnosis*; D003430:Cross-Sectional Studies; D003865:Major Depressive Disorder / Q000175:diagnosis*; D003936:Diagnosis, Computer-Assisted / Q000592:standards*; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010045:Outpatients / Q000523:psychology*; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index