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A comparison of psychometric properties between internet and paper versions of two depression instruments (BDI-II and MADRS-S) administered to clinic patients
Örebro University, School of Health and Medical Sciences.ORCID iD: 0000-0001-9500-7763
Dept Clin Neurosci, Sect Internet Psychiat, Karolinska Inst, Stockholm, Sweden; Linköping Univ, Linköping, Sweden.
Örebro University, School of Health and Medical Sciences.
2010 (English)In: Journal of Medical Internet Research, ISSN 1438-8871, E-ISSN 1438-8871, Vol. 12, no 5, article id e49Article in journal (Refereed) Published
Abstract [en]

Background: Self-report measures can guide clinical decisions and are useful when evaluating treatment outcomes. However, many clinicians do not use self-report measures systematically in their clinical practice. Internet-based questionnaires could facilitate administration, but the psychometric properties of the online version of an instrument should be explored before implementation. The recommendation from the International Test Commission is to test the psychometric properties of each questionnaire separately.

Objective: Our objective was to compare the psychometric properties of paper-and-pencil versions and Internet versions of two questionnaires measuring depressive symptoms.

Methods: The 87 participating patients were recruited from primary care and psychiatric care within the public health care system in Sweden. Participants completed the Beck Depression Inventory (BDI-II) and the Montgomery- Åsberg Depression Rating Scale—Self-rated (MADRS-S), both on paper and on the Internet. The order was randomized to control for order effects. Symptom severity in the sample ranged from mild to severe depressive symptoms.

Results: Psychometric properties of the two administration formats were mostly equivalent. The internal consistency was similar for the Internet and paper versions, and significant correlations were found between the formats for both MADRS-S (r= .84) and the BDI-II (r= .89). Differences between paper and Internet total scores were not statistically significant for either questionnaire nor for the MADRS-S question dealing with suicidality (item 9) when analyzed separately. The score on the BDI-II question about suicidality (item 9) was significantly lower when administered via the Internet compared with the paper score, but the difference was small (effect size, Cohen’s [d] = 0.14). There were significant main effects for order of administration on both questionnaires and significant interaction effects between format and order. This should not, however, pose a problem in clinical use as long as the administration format is not changed when repeated measurements are made.

Conclusions: The MADRS-S can be transferred to online use without affecting the psychometric properties in a clinically meaningful way. The full BDI-II also seems to retain its properties when transferred; however, the item measuring suicidality in the Internet version needs further investigation since it was associated with a lower score in this study. The use of online questionnaires offers clinicians a more practical way of measuring depressive symptoms and has the potential to save resources.

Place, publisher, year, edition, pages
Toronto, Canada: Journal of Medical Internet Research , 2010. Vol. 12, no 5, article id e49
Keywords [en]
Questionnaires, psychometrics, Internet, depression
National Category
Medical and Health Sciences Psychiatry
Research subject
Medicine
Identifiers
URN: urn:nbn:se:oru:diva-16410DOI: 10.2196/jmir.1392ISI: 000285714300003PubMedID: 21169165Scopus ID: 2-s2.0-78651312500OAI: oai:DiVA.org:oru-16410DiVA, id: diva2:432091
Available from: 2011-07-29 Created: 2011-07-29 Last updated: 2018-04-23Bibliographically approved
In thesis
1. Managing depression via the Internet: self-report measures, treatment & relapse prevention
Open this publication in new window or tab >>Managing depression via the Internet: self-report measures, treatment & relapse prevention
2011 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Cognitive behaviour therapy (CBT) is an effective treatment for depression but access is limited. One way of increasing access is to offer CBT via the Internet. In Study I, guided Internet-based CBT was found to have a large effect on depressive symptoms compared to taking part in an online discussion group. Approximately two hours were spent on guiding each patient and the large effect found differs from previous studies that showed smaller effects, probably due to lack of guidance. The intervention had no effect on the participants’ quality of life but significantly decreased their level of anxiety.

Internet-based versions of self-report measures can be more practical and efficient than paper versions. However, before implementation, evidence of psychometrical equivalence to the paper versions should be available. This was tested in Studies II and III for the Montgomery-Åsberg Depression Rating Scale – Self-rated (MADRS-S) and the Beck Depression Inventory – Second Edition (BDI-II). When the full scales were investigated, equivalent psychometric properties were found in the two versions of the MADRS-S and BDI-II. However, in the Internet-version of the BDI-II, a lower score was found for the question about suicidality and the difference was statistically significant. Although the difference was small, this indicates that suicidality might be underestimated when using the Internet-based BDI-II.

As the long-term prognosis after treatment for depression is poor, in Study IV we investigated the possibility of delivering CBT-based relapse prevention via the Internet. The results revealed that fewer participants in the intervention group experienced a relapse compared to the control group and that the time spent on guiding each participant was approximately 2.5 hours. A trend towards a higher remission rate was found in the CBT group at the six-month follow-up and a reduction of depressive symptoms was associated with a lowered risk of relapse. CBT-based relapse prevention via the Internet can potentially be made available to large numbers of patients, thus improving their prognosis.

The Internet increases the possibilities for health care providers in the management of depression.

Place, publisher, year, edition, pages
Örebro: Örebro universitet, 2011. p. 88
Series
Örebro Studies in Medicine, ISSN 1652-4063 ; 56
Keywords
Internet, depression, cognitive behaviour therapy, self-report measures, relapse prevention
National Category
Medical and Health Sciences
Research subject
Medicine
Identifiers
urn:nbn:se:oru:diva-15734 (URN)978-91-7668-806-9 (ISBN)
Public defence
2011-09-23, Örebro universitet, Prismahuset, Hörsal P2, Fakultetsgatan 1, Örebro, 09:15 (Swedish)
Opponent
Supervisors
Available from: 2011-05-27 Created: 2011-05-27 Last updated: 2017-10-17Bibliographically approved

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Holländare, FredrikEngström, Ingemar

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