Background
Past studies have used markedly different inclusion and exclusion criteria to form
samples used to evaluate diagnostic tests, making it difficult to compare results
across studies. The present investigation compared eight screening algorithms in the
same sample but under two different design strategies.
Methods
The DSM-IV diagnoses were based on a semi-structured diagnostic interview (KSADS)
with the parent and youth sequentially. Raters were blind to index test scores. Participants
were 216 youths with bipolar spectrum diagnoses and 284 youths with other Axis I diagnoses
or no diagnosis. T-tests evaluated whether areas under the curve (AUC) from receiver operating characteristic
analyses differed under the two design conditions.
Results
All of the instruments discriminated bipolar cases better when inclusion and exclusion
criteria duplicated those used in phenomenological research studies selecting narrow
phenotypic cases (AUCs ranging from .90 to .81). The measures performed less well
when more heterogeneous clinical presentations were included [AUCs ranging from .86
to .69, t(8) = 4.99, p = 001].
Conclusions
Results indicate that checklists perform less well discriminating pediatric bipolar
disorder under conditions that more closely resemble clinical practice. Test users
must consider whether the sampling strategies and participant characteristics used
to evaluate tests match the characteristics of their own patients.
Key Words
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Article info
Publication history
Accepted:
June 14,
2006
Received in revised form:
June 12,
2006
Received:
October 13,
2005
Identification
Copyright
© 2006 Society of Biological Psychiatry. Published by Elsevier Inc. All rights reserved.
