Skip to main content

Advertisement

SpringerLink
Log in

Development of a Computer-adaptive Test for Depression (D-CAT)

  • Published:
Quality of Life Research Aims and scope Submit manuscript

Abstract

Depression is one of the most prevalent mental health problems and measuring depressive symptoms becomes increasingly important in science as well as medical practice. Computer Adaptive Tests (CAT) based on the Item Response Theory (IRT) promise to enhance measurement precision and reduce respondent’s burden. Our aim was to develop a CAT application to measure depressive symptoms. Three thousand two hundred seventy psychosomatic patients answered an overall of 11 mental health questionnaires at the University Clinic in Berlin. Three independent reviewers rated 144 items out of these questionnaires as indicative of depressive symptoms. All items underwent six empirical steps to analyze unidimensionality, local independence and item discrimination. Finally 64 items could be used to calculate item parameters applying a Generalized Partial Credit Model (GPCM). CAT scores were estimated using an ‘expected a posteriori’ algorithm (EAP). Two simulation experiments showed that for theta values within the range of 2SD around the mean (98% of the cases), the latent trait can be estimated out of approximately six items with a predefined standard error of ⩽ 0.32 (reliability ρ ⩾ 0.90). The CAT-scores correlated high with scores of all depression items (r = 0.95), with the Beck Depression Inventory (r = 0.79) and with a CES-D 8 item short form (r = 0.76). We conclude that the Depression-CAT measures depressive symptoms with high precision and low respondent burden.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. W Katon MD Sullivan (1990) ArticleTitleDepression and chronic medical illness J Clin Psychiat 51 IssueID6 3–11

    Google Scholar 

  2. CC Attkisson JM Zich (1990) Depression in primary care: screening and detection University Press San Fransisco

    Google Scholar 

  3. BN Gaynes BJ Burns DL Tweed P Erickson (2002) ArticleTitleDepression and health-related quality of life J Nerv Ment Dis 190 799–806 Occurrence Handle10.1097/00005053-200212000-00001 Occurrence Handle12486367

    Article  PubMed  Google Scholar 

  4. W Katon P Ciechanowski (2002) ArticleTitleImpact of major depression on chronic medical illness J Psychosom Res 53 859–863 Occurrence Handle10.1016/S0022-3999(02)00313-6 Occurrence Handle12377294

    Article  PubMed  Google Scholar 

  5. S Gilbody A House T Sheldon (2001) ArticleTitleRoutinely administered questionnaires for depression and anxiety: a systematic review Brit Med J 322 406–409 Occurrence Handle11179161 Occurrence Handle1:STN:280:DC%2BD3M7lvVeiuw%3D%3D

    PubMed  CAS  Google Scholar 

  6. L Baer D Jacobs J Meszler-Reizes et al. (2000) ArticleTitleDevelopment of a brief screening instrument: The HANDS Psychother Psychosom 69 35–41 Occurrence Handle10.1159/000012364 Occurrence Handle10601833 Occurrence Handle1:STN:280:DC%2BD3c%2FntVajuw%3D%3D

    Article  PubMed  CAS  Google Scholar 

  7. L Olsen D Jensen V Noerholm K Martiny P Bech (2003) ArticleTitleThe internal and external validity of the Major Depression Inventory in measuring severity of the depressive states Psychol Med 33 351–356 Occurrence Handle10.1017/S0033291702006724 Occurrence Handle12622314 Occurrence Handle1:STN:280:DC%2BD3s7gvFeqsw%3D%3D

    Article  PubMed  CAS  Google Scholar 

  8. P Bech N Rasmussen L Raabaek Olsen V Noerholm W Abildgaard (2001) ArticleTitleThe sensitivity and specificity of the Major Depression Inventory, using the Present State Examination as the index of diagnostic validity J Affect Disorders 66 159–164 Occurrence Handle11578668 Occurrence Handle1:STN:280:DC%2BD3Mrjt1eitA%3D%3D

    PubMed  CAS  Google Scholar 

  9. M Orlando C Sherbourne D Thissen (2000) ArticleTitleSummed-score linking using item response theory: application to depression measurement Psychol Assessment 12 354–359 Occurrence Handle1:STN:280:DC%2BD3cvmslOktA%3D%3D

    CAS  Google Scholar 

  10. K Chan M Orlando B Gosh-Dastidar N Duan C Sherbourne (2004) ArticleTitleThe interview mode effect on the Center for Epidemiological Studies Depression (CES-D) scale: an item response theory analysis Med Care 42 281–289 Occurrence Handle15076828

    PubMed  Google Scholar 

  11. AT Beck RH Steer (2003) Manual for the Beck Depression Inventory Psychological Corporation San Antonio TX

    Google Scholar 

  12. D Cella C-H Chang (2000) ArticleTitleA discussion of item response theory and its applications in health status assessment Med Care 38 II66–72 Occurrence Handle10982091 Occurrence Handle1:STN:280:DC%2BD3cvntlOqsA%3D%3D

    PubMed  CAS  Google Scholar 

  13. JE Ware SuffixJr JB Bjorner M Kosinski (2000) ArticleTitlePractical implications of item response theory and computerized adaptive testing: a brief summary of ongoing studies of widely used headache impact scales Med Care 38 IssueID9 1173–1182

    Google Scholar 

  14. W Gardner KJ Kelleher KA Pajer (2002) ArticleTitleMultidimensional adaptive testing for mental health problems in primary care Med Care 40 812–823 Occurrence Handle12218771

    PubMed  Google Scholar 

  15. H Wainer (2000) Computerized Adaptive Testing EditionNumber2 Erlbaum Hillsdale, NJ

    Google Scholar 

  16. SE Embretson SP Reise (2000) Item Response Theory for Psychologists Lawrence Erlbaum Associates London

    Google Scholar 

  17. InstitutionalAuthorNameAmerican Psychiatric Association (1994) Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) American Psychiatric Association Washington, DC

    Google Scholar 

  18. H Fliege M Rose E Bronner BF Klapp (2002) ArticleTitlePrädiktoren des Behandlungsergebnisses stationärer psychosomatischer Therapie Psychother Psychosom med Psychol 52 IssueID2 47–55 Occurrence Handle10.1055/s-2002-20184 Occurrence Handle11850853

    Article  PubMed  Google Scholar 

  19. M Rose V Hess G Scholler E Brähler BF Klapp (1999) ArticleTitleMobile computerized psychometrical diagnostics – results concerning economic benefit and test reliability [Mobile computergestütze psychometrische Diagnostik: – Oekonomische Vorteile und Ergebnisse zur Teststabilität] Psychother Psychosom Med Psychol 49 202–207 Occurrence Handle10416340 Occurrence Handle1:STN:280:DyaK1MzksVyhuw%3D%3D

    PubMed  CAS  Google Scholar 

  20. H Fliege M Rose L Cotta M Bullinger BF Klapp (2002) ArticleTitleDer Fragebogen Alltagsleben: Restrukturierung und klinische Validierung Z Med Psychol 2 121–128

    Google Scholar 

  21. M Hörhold BF Klapp (1993) ArticleTitleTestungen der Invarianz und der Hierarchie eines mehrdimensionalen Stimmungsmodells auf der Basis von Zweipunkterhebungen an Patienten-und Studentenstichproben Z Med Psychol 2 IssueID1 27–35

    Google Scholar 

  22. E Brähler JW Scheer (1995) Giessener Beschwerdebogen GBB. Testmappe mit 2., ergänzter und revidierter Auflage des Handbuchs Huber Bern

    Google Scholar 

  23. D Beckmann E Brähler HE Richter (1991) Der Giessen-Test. Ein Test für Individual- und Guppendiagnostik Huber Bern

    Google Scholar 

  24. FA Muthny (1991) Lebenszufriedenheits-Inventar (LZI) M Bullinger M Ludwig Nv Steinbüchel (Eds) Lebensqualität bei kardiovaskulären Erkrankungen. Grundlagen, Messverfahren und Ergebnisse Hogrefe Göttingen 196–210

    Google Scholar 

  25. F Schoeneich M Rose G Danzer P Thier C Weber BF Klapp (2000) ArticleTitleNarzissmusinventar-90 (NI-90).c Empiriegeleitete Itemreduktion und Identifikation veraenderungssensitiver Items des Narzissmusinventars zur Messung selbstregulativer Parameter Psychother Psychosom Med Psychol 50 IssueID9–10 396–405 Occurrence Handle11076173 Occurrence Handle1:STN:280:DC%2BD3M%2FkslWmsA%3D%3D

    PubMed  CAS  Google Scholar 

  26. M Hautzinger M Bailer (1993) Allgemeine Depressionsskala. ADS. Testmappe mit Handanweisung Beltz Weinheim

    Google Scholar 

  27. M Hautzinger M Bailer H Worall F Keller (1994) Beck-Depressions-Inventar. BDI. Testmappe mit Manual Huber Bern

    Google Scholar 

  28. M Bullinger I Kirchberger (1998) Fragebogen zum Gesundheitszustand. SF36. Testmappe mit Handanweisung Hogrefe Göttingen

    Google Scholar 

  29. L Laux P Glanzmann P Schaffner CD Spielberger (1981) State-Trait-Angstinventar. STAI. Testmappe mit Handanweisung Beltz Weinheim

    Google Scholar 

  30. G Scholler H Fliege BF Klapp (1999) ArticleTitleFragebogen zu Selbstwirksamkeit, Optimismus und Pessimismus Restrukturierung, Itemselektion und Validierung eines Instrumentes an Untersuchungen klinischer Stichproben Psychother Psychosom Med Psychol 49 IssueID8 275–283 Occurrence Handle10488648 Occurrence Handle1:STN:280:DyaK1MvhvVaksA%3D%3D

    PubMed  CAS  Google Scholar 

  31. JB Bjorner M Kosinski JE Ware (2003) ArticleTitleCalibration of an item pool for assessing the burden of headaches: an application of item response theory to the Headache Impact Test (HIT TM) Quality Life Res 12 913–933

    Google Scholar 

  32. GN Masters BD Wright (1984) ArticleTitleThe essential process in a family of measurement models Psychometrika 49 529–544

    Google Scholar 

  33. E Muraki (1997) A generalized partial credit model WJ Linden RK Hambleton (Eds) Handbook of Modern Item Response Theory Springer Berlin 153–164

    Google Scholar 

  34. LK Muthén BO Muthén (1998) Mplus. The Comprehensive Modeling Program for Applied Researchers. User’s Guide Muthén & Muthén Los Angeles

    Google Scholar 

  35. J Nunnally (1978) Psychometric Theory EditionNumber2 MacGraw-Hill New York

    Google Scholar 

  36. F Drasgow C Parsons (1983) ArticleTitleApplications of unidimensional item response theory models to multidimensional data Appl Psych Meas 7 189–199

    Google Scholar 

  37. M Reckase (1979) ArticleTitleUnifactor latent trait models applied to multifactor tests: results and implications J Educ Stat 4 207–230

    Google Scholar 

  38. JO Ramsay (1995) TestGraf. A Program for the Graphical Analysis of Multiple Choice Test and Questionnaire Data McGill University Montreal

    Google Scholar 

  39. PW Holland H Wainer (1993) Differential item functioning Erlbaum Hillsdale NJ

    Google Scholar 

  40. H Swaminathan JH Rogers (1990) ArticleTitleDetecting differential item functioning using logistic regression procedures J Educ Meas 27 361–370

    Google Scholar 

  41. BD Zumbo (1999) A Handbook on the Theory and Methods of Differential Item Functioning (DIF): Logistic Regression Modeling as a Unitary Framework for Binary and Likert-type (Ordinal) Item Scores Directorate of Human Resources Research and Evaluation, Directorate of National Defense Ottawa

    Google Scholar 

  42. NJD Nagelkerke (1991) ArticleTitleMiscellanea. A note on a general definition of the coefficient of determination Biometrika 78 IssueID3 691–692

    Google Scholar 

  43. E Muraki (1992) ArticleTitleA generalized partial credit model: application of an EM algorithm Appl Psych Meas 16 159–176

    Google Scholar 

  44. JB Bjorner M Kosinski JE Ware SuffixJr (2003) ArticleTitleThe feasibility of applying item response theory to measures of migraine impact: a re-analysis of three clinical studies Quality Life Res 12 887–902

    Google Scholar 

  45. RD Bock RJ Mislevy (1982) ArticleTitleAdaptive EAP estimation of ability in a microcomputer environment Appl Psych Meas 12 261–280

    Google Scholar 

  46. Wang S. The Accuracy of Ability Estimation Methods for Computerized Adaptive Testing using the Generalized Partial Credit Model. University of Pittsburgh, 1999 (Advisor: Hsu, Tse-chi).

  47. J McBride (1997) Research antecedents of applied adaptive testing W Sands B Waters (Eds) Computerized Adaptive Testing: From Inquiry to Operation American Psychological Association Washington DC 47–57

    Google Scholar 

  48. W Gardner K Shear KJ Kelleher et al. (2004) ArticleTitleComputerized adaptive measurement of depression: a simulation study BMC Psychiatry 4 13 Occurrence Handle10.1186/1471-244X-4-13 Occurrence Handle15132755

    Article  PubMed  Google Scholar 

  49. R MacCallum M Browne H Sugawara (1996) ArticleTitlePower analysis and determination of sample size for covariance structure modeling Psychol Meth 1 130–149

    Google Scholar 

  50. M Browne R Cudeck (1993) Alternative ways of assessing model fit K Bollen J Long (Eds) Testing Structural Equation Models Sage Newbury Park, CA 136–162

    Google Scholar 

  51. L Hu PM Bentler (1999) ArticleTitleCutoff criteria for fit indexes in covariance structure analysis: conventional criteria versus new alternatives Structural Equation Modeling 6 1–55 Occurrence Handle10.1080/10705519909540118

    Article  Google Scholar 

  52. W Gallo E Bradley M Siegel S Kasl (2000) ArticleTitleHealth effects of involuntary job loss among older workers: findings from the health and retirement survey J Gerontol 55B 131–140

    Google Scholar 

  53. K Tambs T Moum (1993) ArticleTitleHow well can a few questionnaire items indicate anxiety and depression? Acta Psychiat Scand 87 364–367 Occurrence Handle8517178 Occurrence Handle1:STN:280:DyaK3s3psleiuw%3D%3D

    PubMed  CAS  Google Scholar 

  54. RE McGrath R Terranova DL Pogge C Kravic (2003) ArticleTitleDevelopment of a short-form for the MMPI-2 based on a scale elevation congruence Assessment 10 13–28 Occurrence Handle10.1177/1073191102250333 Occurrence Handle12675380

    Article  PubMed  Google Scholar 

  55. CS Gass C Gonzalez (2003) ArticleTitleMMPI-2 short form proposal: caution Arch Clin Neuropsych 18 521–527

    Google Scholar 

  56. RA Childs (2002) ArticleTitleItem response theory in personality assessment: a demonstration using the MMPI-2 depression scale Psychol Assessment 7 IssueID1 37–54

    Google Scholar 

  57. Cooke DJ, Michie C. An item response theory analysis of the hare psychopathy checklist – revised. Psychol Assessment 1997; 3–14.

  58. DA Santor JC Coyne (2001) ArticleTitleExamining symptom expression as a function of symptom severity: Item performance on the Hamilton Rating Scale for Depression Psychol Assessment 13 IssueID1 127–139 Occurrence Handle1:STN:280:DC%2BD3MzjvFKktA%3D%3D

    CAS  Google Scholar 

  59. RK Hambleton H Swaminathan HJ Rogers (1991) Fundamentals of Item Response Theory Sage Publications, Inc. Newbury Park, California

    Google Scholar 

  60. WJ Linden RK Hambleton (1996) Handbook of Modern Item Response Theory Springer Berlin

    Google Scholar 

  61. RP McDonald (1989) ArticleTitleFuture directions for item response theory Int J Educ Res 13 IssueID2 205–222

    Google Scholar 

  62. LF Hornke (1999) ArticleTitleBenefits form computerized adaptive testing as seen in simulation studies Eur J Psychol Assess 15 IssueID2 91–98

    Google Scholar 

  63. RR Meijer ML Nering (1999) ArticleTitleComputerized adaptive testing. Overview and introduction Appl Psychol Meas 23 187–194

    Google Scholar 

  64. RW Handel YS Ben Porath M Watt (1999) ArticleTitleComputerized adaptive assessment with the MMPI-2 in a clinical setting Psychol Assessment 11 IssueID3 369–380

    Google Scholar 

  65. Cohen Y, Ben-Simon A, Tractinsky N. Computerized Adaptive Test of English Proficiency. Jerusalem, Israel: 1989.

Download references

Author information

Authors and Affiliations

  1. Clinic for Internal Medicine, Department of Psychosomatic Medicine and Psychotherapy, Charité University Medicine Berlin, Lusenstrasse 13a, D-10117, Berlin, Germany

    Herbert Fliege, Janine Becker, Otto B. Walter, Burghard F. Klapp & Matthias Rose

  2. National Institute of Occupational Health, Copenhagen, Denmark

    Jakob B. Bjorner

  3. QualityMetric, Lincoln, RI, USA

    Janine Becker, Jakob B. Bjorner & Matthias Rose

Authors
  1. Herbert Fliege
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Janine Becker
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Otto B. Walter
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jakob B. Bjorner
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Burghard F. Klapp
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Matthias Rose
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Herbert Fliege.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Fliege, H., Becker, J., Walter, O.B. et al. Development of a Computer-adaptive Test for Depression (D-CAT). Qual Life Res 14, 2277–2291 (2005). https://doi.org/10.1007/s11136-005-6651-9

Download citation

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11136-005-6651-9

Keywords

Search

Navigation