It is possible that some of the people reading these lines have visited a mental health professional’s office, either at a public or private level. As far as the public sector is concerned, both patients and professionals are faced with a major problem: long waiting lists for relatively short, widely spaced sessions, with little room for many of the existing therapies to be applied and for appropriate follow-up in each case.
One of the main problems in public health systems lies in the very high load of patients with mental health problems, the lack of professionals and the scarce time available to correctly evaluate and detect this type of problem, for example, in the context of Primary Care. This article aims to focus on a fundamental issue in addressing these problems, psychological assessment and the contributions that new technologies can offer to improve it.
In the field of mental health assessment and diagnosis, different assessment formats are often used. Among them, in addition to the usual tests, we can often find other options such as structured or semi-structured diagnostic interviews(i.e. interviews totally or partially scripted and aimed at the diagnosis of mental disorder) and screening tests(instruments that seek to screen for the existence of specific symptoms, usually to determine whether a more comprehensive examination is needed to detect and diagnose a disorder)
There are a number of notable structured diagnostic interviews (e.g., Structured Clinical Interview – SCID, First, 1997; Schedule for affective disorders and schizophrenia- SADS, Puig-Antich, & Chambers, 1978), which have a wide range of possible applications in psychiatry, clinical psychology, research or prevalence studies on mental disorders (Ezpaleta, 1995). Diagnostic interviews have a number of advantages over unstructured interviews by the professional, for example, they have less diagnostic variability, i.e. greater reliability and validity. They also better detect possible comorbidities of the disorder, facilitate communication between professionals and their format allows comparison between different clinical centres (Sheehan et al., 1998).
However, structured diagnostic interviews also have a number of important limitations. For example:
They require more time to administer.. In general, their application requires an excessive amount of time, which can be between 45 and 120 minutes, depending on the test.
Difficulty of application and interpretation of results:Some of these interviews contain very detailed and exhaustive information on psychopathological disorders and subtypes of these disorders, differential diagnoses, present or lifelong symptoms, etc. This implies that these types of interviews may be inefficient for use in clinical care settings with high patient loads (e.g. primary care, adult or child mental health centers, emergency services).
Need for well-trained professionals:In addition, many of the diagnostic interviews (e.g. SCID, SADS, etc.) require previously trained mental health professionals due to their complexity of application and interpretation of results.
Due to these limitations, new assessment instruments have been designed to be easier to adapt and more commonly used in the clinical setting, for example, the PRIME-MD (Spitzer et al., 1994), and the Mini-International Neuropsychiatric Interview (MINI; Sheehan et al., 1998). These types of evaluations have a faster, simpler format and require less preparation of the mental health professionals conducting them, compared to other diagnostic interviews. Finally, a large number of screening tests, much simpler to apply, are also used in clinical practice to detect possible psychopathological risk in the population.
Despite the advantages cited above, these instruments may also have some limitations. For example, in the case of the MINI, it is sometimes considered that some questions may be imprecise, and may need interpretation by therapists or patients, which consequently may affect important results (Pettersson et al., 2018). Also, the assessment has been considered as limited in some questionnaires (e.g. PRIME-MD), limiting itself to cover the most common psychopathological disorders, and excluding other important disorders (Pettersson et al., 2018). Finally, in the case of screening questionnaires, this type of test may be inaccurate and reliable in detecting certain mental health problems, with a high percentage of false positives and false negatives (Lavigne, Feldman, & Meyers, 2016).
What can new technologies contribute to psychological assessment?
Nowadays, many psychological tests have been adapted to an online version, and it is increasingly common to use digital assessment instruments in clinical practice. These instruments have a number of advantages over more traditional psychological assessment, in pencil and paper format. For example, they allow a large amount of data to be collected easily and quickly and results to be available immediately (Carlbring et al., 2007). In addition, some of the main advantages and strengths of this psychological assessment format compared to other traditional formats would be the following:
More flexible evaluation.. The flexibility in online evaluation allows the barriers of time and space, which are characteristic of traditional evaluation, to be overcome, making it possible to answer questions in the consultation, but also in other places (e.g. at home, at work, etc.). The role of applications and webapps can be crucial in this area (Barak & Grohol, 2011). Another important advantage is that the person taking the assessment can choose at what time he or she prefers to take the test (e.g. when he or she feels more rested, or more relaxed), avoiding the influence of other factors such as anxiety when being assessed and/or tiredness, social desirability (Buchanan et al., 2002) and, consequently, providing more reliable results on the psychological construct being assessed (Suler, 2001). Finally, this type of assessment allows for the incorporation of a wide variety of formats (e.g., text, audio, video, dynamic items), which allows for the adaptation or even improvement of traditional assessment procedures (Parshall, Harmes, Davey, & Pashley, 2009).
Faster and more efficient interpretation of results, the value of immediacy. One of the main advantages of online evaluation is the speed in answering the questions, and especially the quick interpretation of the results obtained, through internal algorithms that can last a few seconds. This converts this type of evaluation into a very efficient system for reducing the time of test administration, and notably simplifies the interpretation of the results, especially of those tests whose results may be more complex to interpret.
Safer evaluations. Reduction of scoring bias and interpretation of results and data protection. Another of the main advantages of this type of evaluation is that it allows for safer and more accurate results. Online evaluation allows for a substantial reduction in hand-made scoring and interpretation errors, which are one of the main sources of error during psychological assessment, and allows for a significant increase in the reliability of the tests.
Accessibility of results. The results obtained can be saved (e.g. in a clinical history of the application itself, or in databases) and easily retrieved for future evaluations. Therefore, the use of online tests can be ideal for follow-up actions in both clinical and research settings. Similarly, these data can be easily exported to other formats and external databases (e.g., Excel or SPSS), allowing for easy statistical analysis of large volumes of data.
However, there are also imitations of the new technologies applied to psychological assessment. For example, due to the large and rapid growth that this field has experienced in recent years, numerous websites or other digital platforms have appeared that offer online psychological assessment content, without control measures and/or studies that guarantee their validity and reliability.. Among this content, websites or applications with tests for self-diagnosis or evaluation of psychopathological risk, which can lead many patients to misdiagnose themselves, stand out especially. In addition, on other occasions these websites or applications offer invalid, partial or unscientific information, even offering potentially harmful information for the patient.
Therefore, it is necessary to develop online assessment instruments in mental health, with greater empirical support and greater control measures in their use and distribution (Parshal et al., 2009). In addition, standardized procedures should be followed for their validation, and at the same time, the possible influence of other factors or sources of error on the results should be controlled (e.g. digital competence of patients).
From PSICONEXIA, we want to develop an evaluation instrument in mental health called Psiconexia Predict, which will allow us to improve the limitations posed by both classic diagnostic interviews and screening tests that are commonly used in clinical practice, and specifically, in primary care, through the use of new technologies. In other words, to develop a more efficient psychological evaluation that can help mental health centers or clinics with a high demand for patients. On the other hand, this evaluation must be equally comprehensive, reliable and valid to be able to correctly detect mental health problems and classify their level of psychopathological risk.
- Barak, A., & Grohol, J. M. (2011). Current and future trends in internet-supported mental health interventions. Journal of Technology in Human Services, 29(3), 155-196.
- Buchanan, T. (2002). Online assessment: Desirable or dangerous?. Professional psychology: Research and practice, 33(2), 148.
- Carlbring, P., Brunt, S., Bohman, S., Austin, D., Richards, J., Öst, L. G., & Andersson, G. (2007). Internet vs. paper and pencil administration of questionnaires commonly used in panic/agoraphobia research. Computers in Human Behavior, 23(3), 1421-1434.
- Ezpeleta L, Osa N de la, Júdez J, Doménech JM, Navarro JB, Losilla JM. Fiabilidad test-retest de la adaptación española de la Diagnostic Interview Children and Adolescent- DICA-R . Psichothema 1997;9(3):529-39.
- First, M. B. (1997). Structured clinical interview for DSM-IV Axis I disorders SCID-I: Clinician version, scoresheet. American Psychiatric Press.
- Lavigne, J. V., Feldman, M., & Meyers, K. M. (2016). Screening for mental health problems: addressing the base rate fallacy for a sustainable screening program in integrated primary care. Journal of pediatric psychology, 41(10), 1081-1090.
- Parshall, C. G., Harmes, J. C., Davey, T., & Pashley, P. J. (2009). Innovative items for computerized testing. In Elements of adaptive testing (pp. 215-230). Springer, New York, NY.
- Pettersson, A., Modin, S., Wahlström, R., af Winklerfelt Hammarberg, S., & Krakau, I. (2018). The Mini-International Neuropsychiatric Interview is useful and well accepted as part of the clinical assessment for depression and anxiety in primary care: a mixed-methods study. BMC family practice, 19(1), 19.
- Puig-Antich, J., & Chambers, W. (1978). The schedule for affective disorders and schizophrenia for school-age children (Kiddie-SADS). New York: New York State Psychiatric Institute.
- Sheehan, D. V., Lecrubier, Y., Sheehan, K. H., Amorim, P., Janavs, J., Weiller, E., … & Dunbar, G. C. (1998). The Mini-International Neuropsychiatric Interview (MINI): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. The Journal of clinical psychiatry.
- Spitzer, R. L., Williams, J. B., Kroenke, K., Linzer, M., deGruy, F. V., Hahn, S. R., … & Johnson, J. G. (1994). Utility of a new procedure for diagnosing mental disorders in primary care: the PRIME-MD 1000 study. Jama, 272(22), 1749-1756.
- Suler, J. (2001). Assessing a person’s suitability for online therapy: The ISMHO clinical case study group. CyberPsychology & Behavior, 4(6), 675-679.
Leave a Reply
You must be logged in to post a comment.