Background Compared with traditional screening questionnaires, computerised adaptive tests for severity of depression (CAT-DI) and computerised adaptive diagnostic modules for depression (CAD-MDD) show improved precision in screening for major depressive disorder. CAT measures have been tailored to perinatal women but have not been studied in low-income women of colour despite high rates of perinatal depression (PND). Objective This study aimed to examine the concordance between CAT and traditional measures of depression in a sample of primarily low-income black and Latina women. Methods In total, 373 women (49% black; 29% Latina) completed the Patient Health Questionnaire-9 (PHQ-9), CAD-MDD and CAT-DI at 845 visits across pregnancy and postpartum. We examined the concordance between continuous CAT-DI and PHQ-9 scores and between binary measures of PND diagnosis on CAD-MDD and the PHQ-9 (cut-off score >10). We examined cases with a positive PND diagnosis on the CAD-MDD but not on the PHQ-9 (‘missed’ cases) to determine whether clinic notes were consistent with CAD-MDD results. Findings CAT-DI and PHQ-9 scores were significantly associated (concordance correlation coefficient=0.67; 95% CI 0.58 to 0.74). CAD-MDD detected 5% more case of PND compared with PHQ-9 (p<0.001). The average per-visit rate of PND was 14.4% (14.5% in blacks, 14.9% in Latinas) on the CAD-MDD, and 9.5% (9.8% in blacks, 8.8% in Latinas) on the PHQ-9. Clinical notes were available on 60% of ‘missed’ cases and validated CAD-MDD PND diagnosis in 89% of cases. Conclusions CAD-MDD detected 5% more cases of PND in women of colour compared with traditional tests, and the majority of these cases were verified by clinician notes. Clinical implications Use of CAT in routine clinic care may address health disparities in PND screening. Data are available on reasonable request.

中文翻译：

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使用计算机适应性测试来筛查服务不足的有色人种女性的围产期抑郁症

背景 与传统筛查问卷相比，计算机化抑郁症严重程度自适应测试（CAT-DI）和计算机化抑郁症自适应诊断模块（CAD-MDD）在重度抑郁症筛查方面显示出更高的精确度。CAT 措施是针对围产期妇女量身定制的，但尚未在低收入有色人种妇女中进行研究，尽管围产期抑郁症 (PND) 的发病率很高。目的 本研究旨在以低收入黑人和拉丁裔女性为样本，检验 CAT 与传统抑郁症测量方法之间的一致性。方法 总共 373 名女性（49% 黑人；29% 拉丁裔）在怀孕和产后的 845 次就诊中完成了患者健康问卷 9 (PHQ-9)、CAD-MDD 和 CAT-DI。我们检查了连续 CAT-DI 和 PHQ-9 分数之间以及 CAD-MDD 和 PHQ-9 的 PND 诊断二元测量之间的一致性（截止分数 >10）。我们检查了 CAD-MDD 上 PND 诊断为阳性但 PHQ-9 上未诊断为阳性的病例（“漏诊”病例），以确定临床记录是否与 CAD-MDD 结果一致。结果发现 CAT-DI 和 PHQ-9 分数显着相关（一致性相关系数 = 0.67；95% CI 0.58 至 0.74）。与 PHQ-9 相比，CAD-MDD 检测到的 PND 病例多 5% (p<0.001)。CAD-MDD 上的 PND 平均每次访问率为 14.4%（黑人为 14.5%，拉丁裔为 14.9%），PHQ-9 为 9.5%（黑人为 9.8%，拉丁裔为 8.8%）。60% 的“漏诊”病例可获得临床记录，89% 的病例可得到验证的 CAD-MDD PND 诊断。结论 与传统检测相比，CAD-MDD 在有色人种女性中检测到的 PND 病例多了 5%，并且其中大多数病例均得到了临床医生记录的验证。临床意义 在常规临床护理中使用 CAT 可能会解决 PND 筛查中的健康差异问题。可根据合理要求提供数据。