title: The Diagnostic Validity and Reliability of an Internet-Based Clinical Assessment Program for Mental Disorders.
abstract: BACKGROUND
  Internet-based assessment has the potential to assist with the diagnosis of mental health disorders and overcome the barriers associated with traditional services (eg, cost, stigma, distance). Further to existing online screening programs available, there is an opportunity to deliver more comprehensive and accurate diagnostic tools to supplement the assessment and treatment of mental health disorders.
  
  
  OBJECTIVE
  The aim was to evaluate the diagnostic criterion validity and test-retest reliability of the electronic Psychological Assessment System (e-PASS), an online, self-report, multidisorder, clinical assessment and referral system.
  
  
  METHODS
  Participants were 616 adults residing in Australia, recruited online, and representing prospective e-PASS users. Following e-PASS completion, 158 participants underwent a telephone-administered structured clinical interview and 39 participants repeated the e-PASS within 25 days of initial completion.
  
  
  RESULTS
  With structured clinical interview results serving as the gold standard, diagnostic agreement with the e-PASS varied considerably from fair (eg, generalized anxiety disorder: κ=.37) to strong (eg, panic disorder: κ=.62). Although the e-PASS' sensitivity also varied (0.43-0.86) the specificity was generally high (0.68-1.00). The e-PASS sensitivity generally improved when reducing the e-PASS threshold to a subclinical result. Test-retest reliability ranged from moderate (eg, specific phobia: κ=.54) to substantial (eg, bulimia nervosa: κ=.87).
  
  
  CONCLUSIONS
  The e-PASS produces reliable diagnostic results and performs generally well in excluding mental disorders, although at the expense of sensitivity. For screening purposes, the e-PASS subclinical result generally appears better than a clinical result as a diagnostic indicator. Further development and evaluation is needed to support the use of online diagnostic assessment programs for mental disorders.
  
  
  BACKGROUND
  Australian and New Zealand Clinical Trials Registry ACTRN121611000704998; http://www.anzctr.org.au/trial_view.aspx?ID=336143 (Archived by WebCite at http://www.webcitation.org/618r3wvOG).
authors.affiliation: National eTherapy Centre, Swinburne University of Technology, Hawthorn, VIC, Australia. dpnguyen@outlook.com.
authors.forename: David Phong
authors.identifier: http://orcid.org/0000-0003-1818-3557
authors.initials: DP
authors.lastname: Nguyen
authors.forename: Britt
authors.identifier: http://orcid.org/0000-0003-2912-8043
authors.initials: B
authors.lastname: Klein
authors.forename: Denny
authors.identifier: http://orcid.org/0000-0002-9902-0858
authors.initials: D
authors.lastname: Meyer
authors.forename: David William
authors.identifier: http://orcid.org/0000-0002-1296-3555
authors.initials: DW
authors.lastname: Austin
authors.forename: Jo-Anne M
authors.identifier: http://orcid.org/0000-0003-1632-8417
authors.initials: JA
authors.lastname: Abbott
mesh_terms: D000328:Adult; D006801:Humans; D020407:Internet / Q000706:statistics & numerical data*; D008297:Male; D008403:Mass Screening; D001523:Mental Disorders / Q000175:diagnosis / Q000453:epidemiology*; D011446:Prospective Studies; D015203:Reproducibility of Results; D055815:Young Adult
keywords: Internet; anxiety; assessment; depression; diagnosis; mental health; online; reliability; screening; validity