Objective-This study investigated the combination of item response theory and computerized adaptive testing (CAT) for psychiatric measurement as a means of reducing the burden of research and clinical assessments.Methods-Data were from 800 participants in outpatient treatment for a mood or anxiety disorder; they completed 616 items of the 626-item Mood and Anxiety Spectrum Scales (MASS) at two times. The first administration was used to design and evaluate a CAT version of the MASS by using post hoc simulation. The second confirmed the functioning of CAT in live testing.Results-Tests of competing models based on item response theory supported the scale's bifactor structure, consisting of a primary dimension and four group factors (mood, panic-agoraphobia, obsessive-compulsive, and social phobia). Both simulated and live CAT showed a 95% average reduction (585 items) in items administered (24 and 30 items, respectively) compared with administration of the full MASS. The correlation between scores on the full MASS and the CAT version was .93. For the mood disorder subscale, differences in scores between two groups of depressed patients-one with bipolar disorder and one without-on the full scale and on the CAT showed effect sizes of .63 (p<.003) and 1.19 (p<.001) standard deviation units, respectively, indicating better discriminant validity for CAT.Conclusions-Instead of using small fixed-length tests, clinicians can create item banks with a large item pool, and a small set of the items most relevant for a given individual can be administered with no loss of information, yielding a dramatic reduction in administration time and patient and clinician burden.Psychiatric measurement has been based primarily on subjective judgment and classical test theory. Typically, impairment level is determined by a total score, which requires that the same items be administered to all respondents. An alternative to administration of a full scale is disclosures The authors report no competing interests. This form of testing has recently emerged in mental health research (3,4). Procedures based on item response theory (5) can be used to obtain estimates for items (for example, difficulty or discrimination) and individuals (for example, severity of depression) to more efficiently identify suitable item subsets for each individual. This approach to testing is referred to as computerized adaptive testing (CAT) and is immediately applicable to psychiatric services (6-10). For example, a depression inventory can be administered adaptively, such that an individual responds only to items that are most appropriate for assessing his or her level of depression. The net result is that a small, optimal number of items is administered to the individual without loss of measurement precision.
NIH Public AccessA complication of applying item response theory to psychiatric measurement problems is that unlike traditional ability testing (for example, mathematics achievement), for which approximately unidimensional scales are used, psychiatric...