The concurrent validity of a Web-based self-report assessment for personality disorders.

Incorporating online tools in clinical practice could help improve routine assessments of personality disorders and their co-occurring clinical disorders. TeleScreen, a Web-based self-report questionnaire for DSM-IV disorders, has not yet been compared with well-validated structured interviews for clinical and personality disorders. Patients with personality disorders (n = 89) were assessed with TeleScreen and independently interviewed with Structured Clinical Interview for DSM-IV Axis-I disorders (SCID-I) and personality disorders (SCID-II). The concurrent validity was examined using sensitivity, specificity, and positive and negative predictive values. Five personality disorders had a prevalence rate higher than 4% and could be examined in the analyses: borderline, obsessive-compulsive, dependent, avoidant and paranoid personality disorders. TeleScreen showed moderate to good validity for borderline personality disorder and obsessive-compulsive personality disorder but suboptimal validity for the dependent, avoidant and paranoid personality disorders. Clinical disorders showed moderate to good values, except for social phobia, dysthymia and eating disorders. These findings provide preliminary evidence for the concurrent validity of TeleScreen for some personality disorders, such as the borderline personality disorder, and pave the way for larger studies to confirm these results. © 2018 John Wiley & Sons, Ltd.

The Perception and Needs of Psychologists Toward Blended Care.

BACKGROUND: Blended care, meaning that online (Internet) components are used in combination with face-to-face contact, in mental health is increasingly encouraged, but research about the needs of psychologists is scarce. METHODS: We assessed the perceptions, design, and barriers toward blended care among members of the Dutch Association of Psychologists through an e-mailed survey. Mean scores (SD) and answer percentages were calculated. Mann-Whitney tests were performed to investigate differences between users and nonusers and primary- and secondary care professionals. RESULTS: Generally, psychologists (63% response rate) had a positive perception toward blended care and they intended to use it in future (M = 3.71, SD = 1.19). Users of blended care and secondary care professionals were more positive toward blended care than nonusers and primary care professionals. Online psychoeducation, diary forms, and exercises for different therapeutic approaches and communication technology configurations were most welcomed. Still, quite some barriers were mentioned before professionals would use blended care. CONCLUSIONS: Psychologists had a positive perception toward blended care, as long as attention is paid to the perceived barriers. Results of this survey could be used in the development of online components that correspond to the needs of professionals. Reviewing the needs of psychologists, e-health components of different therapeutic approaches, apart from cognitive behavioral therapy, are welcomed. Future research is necessary to gain insight in the (cost) effectiveness of blended care for different types of patients (e.g., transdiagnostic interventions) and of different therapeutic approaches.

The concurrent validity of a new eDiagnostic system for mental disorders in primary care.

BACKGROUND: An eDiagnostic system was implemented to classify mental disorders, to support general practitioners. OBJECTIVE: Assessing the validity of the system, compared to the psychologists' judgment. METHODS: Concurrent validity, using routinely collected data of 675 primary care patients with a suspicion of a mental disorder in the Netherlands. Four psychologists classified the patients according to the DSM-IV. Hundred records were randomly selected to investigate the inter-rater reliability among psychologists. To investigate the concurrent validity of the system the sensitivity, specificity, positive predictive values (PPVs), negative predictive values (NPVs) and Cohen's κ-values (κ-values) were calculated. RESULTS: Inter-rater agreement between psychologists were fair to good or excellent. The system could correctly estimate the echelon (sensitivity range: 0.85-0.95, specificity range: 0.88-0.98) and correctly identify most Axis I classifications (sensitivity: 0.46-1.00, specificity: 0.75-0.99), except for Asperger's, sexual and adjustment disorders (sensitivity: 0.10-0.24, specificity: 0.97-0.99). It could determine the absence of a personality disorder (sensitivity: 0.81, specificity: 0.84, PPV: 0.77, NPV: 0.87 and κ-value: 0.65). The sensitivities and specificities for most specific personality disorders were good, but the PPVs for several specific Axis II classifications were low (PPV range: 0.06-0.77). The system was inaccurate in identifying the global assessment of functioning of patients (e.g. κ-values varied from 0.17-0.46). CONCLUSIONS: Generally, the system can be seen as a valid instrument for most DSM-IV classifications in primary care patients. It could assist healthcare professionals in the assessment and classification of mental disorders. Future research should include comparison to an independently administered structured clinical interview.

eDiagnostics: a promising step towards primary mental health care.

INTRODUCTION: There is a growing interest in eHealth applications in daily health care. Considering that a psychological examination, to a large extent, consists of filling out questionnaires, the use of the Internet seems logical. We evaluated an eDiagnostic system for mental health disorders that has recently been introduced in primary care in the Netherlands. METHODS: We monitored the diagnoses produced by the system. Evaluation questionnaires from both GPs/practice nurses (PNs) and patients were collected. In addition, we compared the advice produced by the GPs/PNs and the advice produced by the system. RESULTS: The most prevalent disorders were mood, anxiety and somatoform disorders (n = 353). Patients (n = 242; 74% response rate) were moderately enthusiastic about the eHealth approach, and GPs/PNs (n = 49, 72% response rate per practice) were very enthusiastic. Patients showed no clear preference for a face-to-face consultation with a psychologist over an eDiagnostic system. GPs/PNs felt strengthened in their control function. In most cases, the system gave a different echelon advice (i.e. referral to primary or secondary mental health care) than the GPs/PNs (κ = 0.13, P = 0.003). Nevertheless, GPs/PNs accept the results of the examination and the advice given. CONCLUSIONS: Using the Internet to diagnose mental health problems in primary care seems very promising. This system of using eDiagnostics before referral to a mental health institution may change the management of mental health care. Further research should investigate whether this tool is valid, reliable and (cost) effective.