What are the strengths and weaknesses of computer-based and other automated methods of detecting depression? Two promising technologies make use of the Internet and speech recognition. Whatever technology is used, each method needs to be assessed rigorously using the same high standards that have been applied to pencil-and-paper tests. We are in the midst of a technological revolution that inevitably will transform psychiatric clinical practice. A consensus for routine depression screening is building, and at the same time methods by which it could be accomplished are emerging. The hope is that the right technology can provide an easy, inexpensive, valid, and reliable public health approach to depression screening. Computerized assessment is well accepted in diverse fields, and the use of Internet-based survey technology has grown exponentially. Issues regarding the strengths and limitations of computerized assessments are addressed regularly in the literature. For example, such assessments have been shown to improve data quality while at the same time reducing cost as well as the time to score, analyze, and report results. Increasingly, as depressive disorders have been recognized as highly prevalent with significant morbidity, multiple screeners using an array of technological advances have been developed (Table 8.1 lists selected studies). This chapter will review the technologies that are currently available for automated depression screening and will discuss them in terms of criteria that should dictate their adoption. The growing list of technologies can be classified on several dimensions. Perhaps themostimportant of these isadaptivevs.non-adaptive. Inanadaptive technology pioneered by the Educational Testing Service, a computer, using a preprogrammed algorithm, decides which question to ask next given the responses so far. Paper-and-pencil is the classical non-adaptive technology— everyone gets the same paper with the same questions in the same order. Technological modality is a second dimension. Currently available technologies include the phone, the Internet, and hand-held electronic devices. The phone can be split into several groups, including agent: computer-assisted telephone interview (CATI), speech recognition, and touch-tone. Phone can also be classified as inbound (the patient initiates the call to a toll-free number) or outbound (the system initiates the call).
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