Groundbreaking online test streamlines mental health screening and measurement in healthcare and beyond
August 21, 2019
Personalized medicine has become a byword of modern healthcare. By tailoring interventions to an individual’s specific needs, practitioners and patients are more likely to see improved outcomes.
Robert Gibbons, PhD, Blum-Riese Professor of Biostatistics and Director of the Center for Health Statistics, has developed a highly personalized, effective and efficient electronic screening and measurement tool for quickly identifying and monitoring mental health conditions in the clinical setting and beyond. Known as Computerized Adaptive Testing for Mental Health Disorders, or CAT-MH™, the program can pinpoint a person’s condition, such as depression or anxiety, and measure its severity within a few minutes using just a few questions tailored for that person. Gibbons is a founder of Adaptive Testing Technologies, which distributes the CAT-MH™ suite of computerized adaptive tests.
“Traditional mental health measures use a fixed set of items or symptoms that are the same for every person you test,” Gibbons said. “Adaptive testing, by comparison, gauges the severity of a person’s condition based on their responses to the questions to that point in the test, and then selects the next optimal question from a large bank of potentially hundreds of items.” If a patient takes the test multiple times, different questions are drawn from the item bank, eliminating the potential for response bias.
For example, two elements of the CAT-MH™ are the Computerized Adaptive Diagnostic Screener for Major Depressive Disorder (CAD-MDD) and the CAT-Depression Inventory (CAT-DI), which screen for and measure the severity of depression by drawing symptoms from a bank of nearly 400 questions. On average, it can correctly diagnose a patient using four questions, and measure the severity of depression (if detected) in another eight questions, both within two minutes. The test has the same accuracy as if the patient answered every question in the item bank and had an hour-long, structured clinical interview with a trained diagnostician.
“Adaptive testing maximizes the precision of the measurement while eliminating the clinician burden and minimizing the patient burden,” Gibbons said.
This is the future of mental health measurement, and it is available right now.
That’s critical in the clinical setting, where physicians are pressed to address all of a patient’s questions and needs within their brief appointment time. Neda Laiteerapong, MD, MS, Associate Director for Primary Care-Behavioral Health Integration at UChicago Medicine, has successfully implemented depression screening using the CAD-MDD and CAT-DI in her primary care clinic. Medical assistants administered the screening while taking vitals during the triage, or initial assessment, part of the appointment. A computer reads each question to the patient, which reduces both any literacy issues and discomfort a patient might have felt if the medical assistant posed the questions.
“Often times, depression is not the only reason why the person came to see the doctor, so a positive screening might get lost in the shuffle,” Laiteerapong said. “The results of the CAD-MDD and the CAT-DI are entered as a result in the patient’s electronic health record, just as lab work would be, but immediately in real time so it is really easy for the physician to find. By the time the provider walks in the room, they have a better understanding of that patient’s mood and mental health.”
After implementing CAD-MDD/CAT-DI, the clinic’s rate of positive screening for depression has increased from one percent to eight percent. “We expect it to be around 10 percent, so our results are now much closer to where they should be,” Laiteerapong said. “We are identifying more people with depression.”
Because the CAT-MH™ is accessed through the internet, it can be implemented in any setting using computers or smart devices. Laiteerapong has launched a trial in which patients access the CAD-MDD/CAT-DI through MyChart, an online portal through which patients can communicate with their care team.
“People could be screened in the comfort of their own home and not be influenced by the medical assistant being present,” she said. “If they screen positive for depression, our health care team reaches out and brings them in for care if needed.”
Gibbons also recently ran a trial of the CAT-MH™ in the Cook County Bond Court to evaluate its effectiveness in identifying mental health disorders in a criminal justice population. The results have recently been published in the journal Psychiatric Services.
“The Cook County Jail is the largest provider of mental health services in the country,” Gibbons said. “There are far too many people who end up in jail and prison for their mental health disorders, when in fact these people could lead far more productive lives if they received treatment instead. So. the idea behind our bond court study was to develop and validate that these measures are appropriate for a detainee population.”
And they are; Gibbons found he had to eliminate only nine out of more than 1,000 questions in the item bank in order to maintain an accuracy rate between 96 and 99 percent.
Gibbons is encouraged by the tremendous potential for CAT-MH™ implementation in other settings, ranging from clinical drug trials to child welfare institutions to higher education. For example, UCLA has screened its entire entering class of 6,000 freshmen using the CAT-MH™, with students referred for treatment ranging from online therapy and peer counseling to emergency intervention.
“This is the future of mental health measurement,” Gibbons said, “and it is available right now.”