Computerized-Adaptive vs. Traditional Ratings of Depression and Suicidal Thoughts: An Assay Sensitivity Pilot Study in a Ketamine Clinical Trial

Abstract

There is a public health need for improved suicide risk assessment tools. This pilot methodology study compared the assay sensitivity of computerized adaptive tests (CAT) of depression and suicidal ideation vs. traditional ratings in a randomized trial subgroup. The last 20 persons to enroll in a published ketamine trial in suicidal depression were studied. This subgroup received traditional and CAT ratings at baseline, 24 h post-infusion and follow-up week 2, 4, and 6: Hamilton Depression Rating Scale, Beck Depression Inventory, and Beck Scale for Suicidal Ideation vs. the CAT-Depression Inventory and CAT-Suicide Scale. Results showed larger effect sizes (ES) for CAT compared with traditional clinician-rated and self-report scales. Coefficients of variation for baseline measurements were lower for CAT compared with traditional scales. This is the first study to show that CAT may have greater assay sensitivity for treatment effects, particularly for suicidal ideation, compared with traditional clinician-rated and non-adaptive self-rated scales in a randomized trial. The findings suggest CAT can enable quick long-term follow-up assessments via cellphone, tablet, or computer while minimizing response bias due to repeated measurement of the same symptom items. Clinical Trial Registration: www.ClinicalTrials.gov, identifier: NCT01700829.

Keywords: assay sensitivity; clinical trial; depression scale; signal to noise; suicide assessment.

Conflict of interest statement

RG was a founder of Adaptive Testing Technologies, which licenses use of the CAT-MH™. The terms of this arrangement have been reviewed and approved by the University of Chicago in accordance with its conflict of interest policies. JM received royalties from the Research Foundation for Mental Hygiene for commercial use of the Columbia Suicide Severity Rating Scale which was not used in this study. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Copyright © 2021 Grunebaum, Mann, Galfalvy and Gibbons.

Figures

Figure 1

Observed and Estimated Time Trend – Beck SSIa. aSSI, Clinician rated Scale for Suicidal Ideation.

Figure 2

Observed and Estimated Time Trend – CAT-SSa. aCAT-SS, Computerized Adaptive Test-Suicide Scale.

Figure 3

Observed and Estimated Time Trend – 17-item HAM-Da. aHAM-D, 17-item Hamilton Depression Rating Scale.

Figure 4

Observed and Estimated Time Trend – CAT-DIa. aCAT-DI, Computerized Adaptive Test-Depression Inventory.