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Computer-administered clinical rating scales

A review

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Abstract

While clinician-administered symptom rating scales are the most commonly used outcome measures in pharmaceutical research, error variance due to poor inter-rater reliability increases the risk of type II errors in multi-center clinical trials. Such error variance could obscure true differences between active drug and placebo, or between two comparator compounds. Computer-administered versions of symptom rating scales originally designed to be administered by trained clinicians offer a solution to this problem. This paper reviews the empirical data on the reliability, validity and equivalence of computer-administered rating scales. Computer-administered versions of clinician-administered scales are now available for the assessment of depression, anxiety, obsessive-compulsive disorder, and social phobia. Validation studies support the reliability, validity and equivalence of these scales. Patient reaction has been positive, with patients generally more honest with and often preferring the computer for assessing sensitive areas such as suicide, alcohol or drug abuse, sexual behavior, or HIV related symptoms. Applications using Interactive Voice Response (IVR) technology facilitate longitudinal monitoring of patients without requiring office visits to collect data, increase the accessibility of information to the clinician, and the quality of patient care through more informed decision making. When used in accordance with established ethical guidelines, computers offer a reliable, inexpensive, accessible, and time-efficient means of assessing psychiatric symptoms.

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References

  • American Educational Research Association (1985) Standards for educational and psychological testing. American Psychological Association. Washington, DC

    Google Scholar 

  • Ancill RJ, Rogers D, Carr AC (1985) Comparison of computerised self-rating scales for depression with conventional observer ratings. Acta Psychiatr Scand 71:315–317

    Article  PubMed  CAS  Google Scholar 

  • Ancil R, Hilton S, Carr T, Tooley M, McKenzie A (1986) Screening for antenatal and postnatal depressive symptoms in general practice using a microcomputer-delivered questionnaire. J R Coll Gen Pract 36:276–279

    Google Scholar 

  • Baer L, Minichiello WE, Jenike MA (1987) Use of a portable-computer program in behavioral treatment of obsessive-compulsive disorder. Am J Psychiatry 144:1101

    PubMed  CAS  Google Scholar 

  • Baer L, Brown-Beasley MW, Sorce J, Henriques AI, (1993) Computer-assisted telephone administration of a structured interview for obsessive-compulsive disorder. Am J Psychiatry 150: 1737–1738

    PubMed  CAS  Google Scholar 

  • Baer L, Jacobs DG, Cukor P, O’Laughlen J, Coyle JT, Magruder KM (1995) Automated telephone screening survey for depression. JAMA 273:1943–1944

    Article  PubMed  CAS  Google Scholar 

  • Bartko JJ (1966) The intraclass correlation coefficient as a measure of reliability. Psychol Rep 19:3–11

    PubMed  CAS  Google Scholar 

  • Bech P, Bolwig P, Kramp P, Rafaelsen OJ (1979) The Bech-Rafaelsen Mania Scale and the Hamilton Depression Scale. Acta Psychiatr Scand 59:420–430

    Article  PubMed  CAS  Google Scholar 

  • Bech P, Kastrup M, Rafaelsen OJ (1986) Minicompedium of rating scales for anxiety, depression, mania, schizophrenia with corresponding DSM-III syndromes. Acta Psychiatr Scand 73 [suppl. 326]:23–38

    Google Scholar 

  • Beneke M (1987)_Methodological investigations of the Hamilton Anxiety Scale. Pharmacopsychiatry 20:249–255

    PubMed  CAS  Google Scholar 

  • Bresolin MJ (1984) A comparative study of computer administration of the Minnesota Multiphasic Personality Inventory in an inpatient psychiatric setting. Unpublished doctoral dissertation, Loyola University, Chicago

    Google Scholar 

  • Brown EJ, Heimberg RG, Juster HR (1996) Social phobia subtype and avoidant personality disorder: effect on severity of social phobia, impairment, and outcome of cognitive-behavioral treatment. Behav Ther (in press)

  • Butcher JN (1994) Psychological assessment by computer: potential gains and problems to avoid. Psychiatric Ann 24:20–24

    Google Scholar 

  • Carr AC, Ancill RJ, Ghosh A, Margo A (1981) Direct assessment of depression by microcomputer. Acta Psychiatr Scand 64: 415–422

    Article  PubMed  CAS  Google Scholar 

  • Carr AC, Ghosh A, Ancill RJ (1983) Can a computer take a psychiatric history? Psychol Med 13:151–158

    PubMed  CAS  Google Scholar 

  • Davidson JRT, Potts NLS, Richichi EA, Krishnan RR, Ford SM, Smith RD, Wilson W (1993) The treatment of social phobia with clonazepam and placebo. J Clin Psychopharmacol 13: 423–428

    Article  PubMed  CAS  Google Scholar 

  • Erdman H, Klein MH, Greist JH (1983) The reliability of a computer interview for drug use/abuse information. Behav Res Methods Instrum 15:66–68

    Google Scholar 

  • Erdman H, Klein MH, Greist JH (1985) Direct patient computer interviewing. J Consult Clin Psychol 53:760–763

    Article  PubMed  CAS  Google Scholar 

  • Erdman HP, Klein MH, Greist JH, Skare SS, Husted J, Robins L.N., Helzer JE, Goldring E, Hamburger M, Miller JP (1992) A comparison of two computer-adminstered versions of the NIMH Diagnostic Interview Schedule. J Psychiatr Res 26: 85–95

    Article  PubMed  CAS  Google Scholar 

  • Fairbairn AS, Wood CH, Fletcher CM (1959) Variability in answers to a questionnaire on respiratory symptoms. Br J Prev Soc Med 13:175–193

    PubMed  CAS  Google Scholar 

  • Ghosh A, Marks IM, Carr AC (1988) Therapist contact and outcome of self-exposure treatment of phobias. A controlled study. Br J Psychiatry 152:234–238

    PubMed  CAS  Google Scholar 

  • Gjerris A, Bech P, Bojholm S, Bolwing TG, Kramp P, Clemmesen L, Andersen J, Jensen E, Rafaelson OJ (1983) The Hamilton Anxiety Scale: Evaluation of homogeneity and inter-observer reliability in patients with depressive disorders. J Affect Disord 5:163–170

    Article  PubMed  CAS  Google Scholar 

  • Goldberg DP, Cooper B, Eastwood MR, Keddward HB, Shepherd M (1970) A standardised psychiatric interview for use in community surveys. Br J Prevent Soc Med 24:18–23

    CAS  Google Scholar 

  • Goodman WK, Price LH, Rasmussen SA et al. (1989) The Yale-Brown Obsessive Compulsive Scale, I: development, use, and reliability. II. Validity. Arch Gen Psychiatry 46:1006–1011, 1012–1016

    PubMed  CAS  Google Scholar 

  • Greist JH, Gustafson DH, Stauss FF, Rowse GL, Laughren TP, Chiles JA (1973) A computer interview for suicide-risk prediction. Am J Psychiatry 130:1327–1332

    PubMed  CAS  Google Scholar 

  • Greist JH, Klein MH (1980) Computer programs for patients, clinicians, and researcher in psychiatry. In: Sidowski JB, Johnson JH, Williams TA (eds) Technology in mental health care delivery systems. Norwood, NJ, Ablex, pp 161–182

    Google Scholar 

  • Greist JH, Jefferson JW, Kobak KA, Katzelnick DJ, Serlin RC (1995) Efficacy and tolerability of serotonin transport inhibitors in obsessive compulsive disorder: a meta-analysis. Arch Gen Psychiatry 52:53–60

    PubMed  CAS  Google Scholar 

  • Greist JH, Jefferson JW, Wenzel K, Kobak KA, Ross TM, Katzelnick (1996) Telephone Assessment Program: Efficient Patient Monitoring and Clinician Feedback. Paper presented at the 36th Annual Meeting of the NIMH New Clinical Drug Evaluation Unit, Boca Raton, Fla.

  • Hamilton M (1959) The assessment of anxiety states by rating. Br J Med Psychol 32:50–55

    PubMed  CAS  Google Scholar 

  • Hamilton M (1960) A rating scale for depression. J Neurol Neurosurg Psychiatry 23:56–62

    PubMed  CAS  Google Scholar 

  • Hamilton M (1967) Diagnosis and rating of anxiety. Br J Psychiatry 3:76–79

    Google Scholar 

  • Hamilton M (1974) General problems of psychiatric rating scales (especially for depression). In: Pichot P (ed) Psychological measurements in psychopharmacology (Modern Problems in Pharmacopsychiatry series, vol. 7). Karger, Basel, Paris, pp 125–138

    Google Scholar 

  • Helzer JE, Robins LN, Croughan JL, Ratcliff KS (1981) National Institute of Mental Health Diagnostic Interview Schedule: its history, characteristics and validity. Arch Gen Psychiatry 38: 381–389

    PubMed  Google Scholar 

  • Hofer PJ, Green BF (1985) The challenge of competence and creativity in computerized psychological testing. J Consult Clin Psychol 53:826–838

    Article  PubMed  CAS  Google Scholar 

  • Holt CS, Heimberg RG, Hope DA (1992a) Avoidant personality disorder and the generalized subtype of social phobia. J Abnorm Psychol 101:318–325

    Article  PubMed  CAS  Google Scholar 

  • Holt CS, Heimberg RG, Hope DA, Liebowitz MR (1992b) Situational domains of social phobia. J Anx Disord 6:63–77

    Article  Google Scholar 

  • Honaker LM (1988) The equivalency of computerized and conventional MMPI administration: a critical review. Clin Psychol Rev 8:561–577

    Article  Google Scholar 

  • Hooijer C, Zitman EG, Griez E, van Trilburg W, Willemse A, Dinkgreve MAHM (1991) The Hamilton Depression Rating Scale (HDRS): changes in scores as a function of training and version used. J Affect Disord 22:21–29

    Article  PubMed  CAS  Google Scholar 

  • Katzelnick DJ, Kobak KA, Greist JH, Jefferson JW (1995a) Depression among high utilization primary care patients: effect of identification and treatment on service utilization, disability, and quality of life. Paper presented at National Institute of Mental Health International Conference on Mental Health Services Research, Bethesda, Md

  • Katzelnick DJ, Kobak KA, Greist JH, Jefferson JW (1995b) Sertraline in social phobia: a double-blind, placebo-controlled crossover study. Am J Psychiatry 152:1368–1371

    PubMed  CAS  Google Scholar 

  • Kobak KA, Reynolds WM, Rosenfeld R, Greist JH (1990) Development and validation of a computer-administered version of the Hamilton Depression Rating Scale. Psychol Assess. J Consult Clin Psychol 2:56–63

    Google Scholar 

  • Kobak KA, Reynolds WM, Greist JH (1994) Devepment and validation of a computer-administered version of the Hamilton Anxiety Scale. Psychol Assess 5:487–492

    Article  Google Scholar 

  • Kobak KA, Reynolds WM, Greist JH (1994) Computerized and clinician assessment of depression and anxiety: respondent evaluation and satisfaction. J Person Assess 63: 173–180

    Article  CAS  Google Scholar 

  • Kobak KA, Schaettle S, Katzelnick DJ, Simon G (1995) Guidelines for the Hamilton Depression Rating Scale: modified for the Depression in Primary Care Study. Dean Foundation, Madison, Wise.

    Google Scholar 

  • Kobak KA, Greist JH, Jefferson JW, Katzelnick DJ, Schaettle SC (1996) Computerized Assessment in Clinical Drug Trials. National Institute of Mental Health, New Clinical Drug Evaluation Unit, 36th Annual Meeting, Boca Raton, Fla.

  • Levine S, Ancil RJ, Roberts AP (1989) Assessment of suicide risk by computer-delivered self-rating questionnaire: preliminary findings. Acta Psychiatr Scand 80:216–220

    Article  PubMed  CAS  Google Scholar 

  • Lewis G, Pelosi AJ, Glove E, Wilkinson G, Stansfeld SA, Williams P, Shepherd M (1988) The development of a computerized assessment for minor psychiatric disorder. Psychol Med 18: 737–745

    PubMed  CAS  Google Scholar 

  • Liebowitz MR (1987) Social phobia. Mod Probl Pharmacopsychiatry 22:141–173

    PubMed  CAS  Google Scholar 

  • Liebowitz MR, Schneier F, Campeas R, Hollander E, Hatterer J, Fyer A, Gorman JM, Papp L, Davies S, Gully R, Klein DF (1992) Phenelzine vs atenolol in social phobia: A placebo controlled comparison. Arch Gen Psychiatry 49:290–300

    PubMed  CAS  Google Scholar 

  • Locke SE, Kowaloff HB, Hoff RG, Safran C, Popovsky MA, Cotton DJ, Finkelstein DM, Page PL, Slack WV (1992) Computer-based interview for screening blood donors for risk of HIV transmission. JAMA 268:1301–1305

    Article  PubMed  CAS  Google Scholar 

  • Lucas RW, Mullins PJ, Luna CB, McInroy DC (1977) Psychiatrists and a computer as interrogators of patients with alcohol-related illnesses. a comparison. Br J Psychiatry 131:160–167

    PubMed  CAS  Google Scholar 

  • Maier W, Buller R, Philipp M, Heuser I (1988) The Hamilton Anxiety Scale: reliability, validity, and sensitivity to change in anxiety and depressive disorders. J Affect Disord 14:61–68

    Article  PubMed  CAS  Google Scholar 

  • Margo A, Johnson C, Ancill R, Carr T (1983) Assessment of depression by microcomputer. Acta Psychiatr Scand 67:434–435

    Article  PubMed  CAS  Google Scholar 

  • Meehl PE (1954) Clinical versus statistical prediction: a theoretical analysis and a review of the evidence. University of Minnesota Press, Minneapolis

    Google Scholar 

  • Miller IW, Bishop S, Norman WH, Maddever H (1985) The modified Hamilton Depression Rating Scale for Depression: reliability and validity. Psychiatry Res 14:131–142

    Article  PubMed  CAS  Google Scholar 

  • Montgomery SA, Asberg M (1979) A new depression scale designed to be sensitive to change. Br J Psychiatry 134:382–389

    PubMed  CAS  Google Scholar 

  • Moore NC, Summer KR, Bloor RN (1984) Do patients like psychometric testing by computer? J Clin Psychol 40[3]: 875–877

    Article  PubMed  CAS  Google Scholar 

  • Munjack DJ, Bruns J, Baltazar PL, Brown R, Leonard M, Nagy R, Kock R, Crocker B, Schafer S (1991) A pilot study of buspirone in the treatment of social phobia. J Anx Disord 5:87–98

    Article  Google Scholar 

  • Petrie K, Abell W (1994) Responses of parasuicides to a computerized interview. Comput Hum Behav 10:415–418

    Article  Google Scholar 

  • Reich J, Yates W (1988) A pilot study of the treatment of social phobia with alprazolam. Am J Psychiatry 145:590–594

    PubMed  CAS  Google Scholar 

  • Riskind JH, Beck AT, Brown G, Steer RA (1987) Taking the measure of anxiety and depression: validity of the reconstructed Hamilton scales. J Nerv Ment Dis 175:474–479

    Article  PubMed  CAS  Google Scholar 

  • Rosenfeld R, Dar R, Anderson D, Kobak KA, Greist JH (1992) A computer administered version of the Yale-Brown Obessive Compulsive Scale. Psychol Assess 4:329–332

    Article  Google Scholar 

  • Rozensky RH, Honor LF, Rasinski K, Tovian SM, Herz GI (1986) Paper-and-pencil versus, computer-administered MMPIs: a comparison of patients attitudes. Comput Hum Behav 2: 111–116

    Article  Google Scholar 

  • Russell CKC, Peace KA, Mellsop GW (1986) The reliability of a micro-computer administration of the MMPI. J Clin Psychol, 42:120–122

    Article  PubMed  CAS  Google Scholar 

  • Selmi PM, Klein MH, Greist JH, Sorrell SP, Erdman HP (1990). Computer-administrered cognitive-behavioral therapy for depression. Am J Psychiatry 147:51–56

    PubMed  CAS  Google Scholar 

  • Shepherd M, Clare AC (1981) Addendum to Shepherd M, Cooper B, Brown AC, Kalton G. Psychiatric Illness in General Practice (2nd edn). Oxford University Press, Oxford.

    Google Scholar 

  • Simmons EM, Miller OW (1971) Automated patient history-taking. Hospitals 45:56–59

    PubMed  Google Scholar 

  • Skinner HA, Allen BA (1983) Does the computer make a difference? Computerized versus face to face versus self-report assessment of alcohol, drug and tobacco use. J Consult Clin Psychol 51: 267–275

    Article  PubMed  CAS  Google Scholar 

  • Slack WV (1971) Computer based interviewing system dealing with nonverbal behavior as well as keyboard responses. Science 171: 84–87

    Article  PubMed  CAS  Google Scholar 

  • Slack WV, Hicks GP, Reed CE, Van Cura LJ (1966) A computer-based medical history system. N Engl J Med 274:194–198

    Article  PubMed  CAS  Google Scholar 

  • Slack WV, Safran C, Kowaloff HB, Pearce J, Delbanco TI (1995) A computer-administered health screening interview for hospital personnel. MD Computing 12:25–30

    PubMed  CAS  Google Scholar 

  • Snaith RP, Ahmed SN, Mehta S, Hamilton M (1971) Assessment of the severity of primary depressive illness: Wakefield self-assessment depression inventory. Psychol Med 1:143–149

    Article  PubMed  CAS  Google Scholar 

  • Spitzer RL, Endicott J, Robins E (1978) Research diagnostic criteria: rationale and reliability. Arch Gen Psychiatry 35:773–782

    PubMed  CAS  Google Scholar 

  • Weizenbaum J (1966) ELIZA-A computer program for the study of natural language communication between man and machine. Commun Assoc Comp Machinery 9:36–45

    Google Scholar 

  • Wenzel K, Greist JH, Jeffereson JW, Kobak KA (1994) Parameter driven interview driver. Computer software program. Dean Foundation. Madison, Wise.

    Google Scholar 

  • White DM, Clements CB, Fowler RD (1985) A comparison of computer administration with standard administration of the MMPI. Comput Hum Behav 1:143–162

    Article  Google Scholar 

  • Wiggins JS (1973) Personality and prediction: principles of personality assessment. Addison-Wesley, Reading, Mass.

    Google Scholar 

  • Williams JBW (1988) A structured interview guide for the Hamilton Depression Rating Scale. Arch Gen Psychiatry 45:742–747

    PubMed  CAS  Google Scholar 

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  1. Dean Foundation for Health, Research and Education, 8000 Excelsior Drive, 53717, Madison, WI, USA

    Kenneth A. Kobak, John H. Greist, James W. Jefferson & David J. Katzelnick

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  1. Kenneth A. Kobak
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  2. John H. Greist
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  3. James W. Jefferson
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  4. David J. Katzelnick
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Kobak, K.A., Greist, J.H., Jefferson, J.W. et al. Computer-administered clinical rating scales. Psychopharmacology 127, 291–301 (1996). https://doi.org/10.1007/BF02806006

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