Rapid and Accurate Behavioral Health Diagnostic Screening: Initial Validation Study of a Web-Based, Self-Report Tool (the SAGE-SR)

• Published in: Journal of medical Internet research 2018-03, Vol.20 (3), p.e108-e108
• Main Authors: Brodey, Benjamin, Purcell, Susan E, Rhea, Karen, Maier, Philip, First, Michael, Zweede, Lisa, Sinisterra, Manuela, Nunn, M Brad, Austin, Marie-Paule, Brodey, Inger S
• Format: Article
• Language: English
• Subjects: Averages; Clinical assessment; Clinical interviews; Cognitive interviews; Community mental health services; Computerization; Cutoff scores; Diagnostic and Statistical Manual; Endorsements; Evaluation; Health behavior; Health facilities; Internet; Mania; Medical diagnosis; Medical screening; Mental disorders; Mental health; Original Paper; Outpatients; Self report; Severity; Substance abuse; Symptoms; Test-Retest reliability; Tests; Validation studies; Validity
• ISSN: 1438-8871; 1439-4456; 1438-8871
• DOI: 10.2196/jmir.9428

The Structured Clinical Interview for DSM (SCID) is considered the gold standard assessment for accurate, reliable psychiatric diagnoses; however, because of its length, complexity, and training required, the SCID is rarely used outside of research. This paper aims to describe the development and initial validation of a Web-based, self-report screening instrument (the Screening Assessment for Guiding Evaluation-Self-Report, SAGE-SR) based on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) and the SCID-5-Clinician Version (CV) intended to make accurate, broad-based behavioral health diagnostic screening more accessible within clinical care. First, study staff drafted approximately 1200 self-report items representing individual granular symptoms in the diagnostic criteria for the 8 primary SCID-CV modules. An expert panel iteratively reviewed, critiqued, and revised items. The resulting items were iteratively administered and revised through 3 rounds of cognitive interviewing with community mental health center participants. In the first 2 rounds, the SCID was also administered to participants to directly compare their Likert self-report and SCID responses. A second expert panel evaluated the final pool of items from cognitive interviewing and criteria in the DSM-5 to construct the SAGE-SR, a computerized adaptive instrument that uses branching logic from a screener section to administer appropriate follow-up questions to refine the differential diagnoses. The SAGE-SR was administered to healthy controls and outpatient mental health clinic clients to assess test duration and test-retest reliability. Cutoff scores for screening into follow-up diagnostic sections and criteria for inclusion of diagnoses in the differential diagnosis were evaluated. The expert panel reduced the initial 1200 test items to 664 items that panel members agreed collectively represented the SCID items from the 8 targeted modules and DSM criteria for the covered diagnoses. These 664 items were iteratively submitted to 3 rounds of cognitive interviewing with 50 community mental health center participants; the expert panel reviewed session summaries and agreed on a final set of 661 clear and concise self-report items representing the desired criteria in the DSM-5. The SAGE-SR constructed from this item pool took an average of 14 min to complete in a nonclinical sample versus 24 min in a clinical sample. Responses to individual items can be combined to gen