David Nguyen*, BPsyC eTherapy Unit, Swinburne University of Technology, Australia, Melbourne, Australia Britt Klein, BPsyC eTherapy Unit, Swinburne University of Technology, Australia, Melbourne, Australia Denny Meyer, BPsyC eTherapy Unit, Swinburne University of Technology, Melbourne, Australia David Austin, BPsyC eTherapy Unit, Swinburne University of Technology, Melbourne, Australia Track: Research Presentation Topic: other Presentation Type: Oral presentation Submission Type: Single Presentation Building: Joseph B. Martin Conference Center at Harvard Medical School Room: C-Rotunda Room Date: 2012-09-16 02:00 PM – 02:45 PM Last modified: 2012-09-12

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Background: Clinical assessment is critical for the effective treatment of mental illness. The recent proliferation of online mental health resources has seen the emergence of brief clinical assessment tools such as diagnostic screeners. These offer various benefits over traditional face-to-face or paper-and-pencil assessment means, such as added accessibility and enhanced data management. Importantly, certain online screeners have shown an acceptable level of diagnostic accuracy in comparison to “gold standard” assessment means. The Online Psychological Assessment (e-PASS) program is a new self-report diagnostic tool at www.anxietyonline.org.au which provides feedback and referral recommendations. Unlike existing online screening programs, the e-PASS assesses a wide range of disorders (i.e. 21 DSM-IV disorders), and aims to measures severity and distinguish primary/secondary diagnoses. The e-PASS has face validity and evidence of agreement with external sources. However, further evaluation of the e-PASS is needed to clarify its diagnostic accuracy and usability.

Objective: To examine the potential value of online assessment tools, this study investigated the validity and user experience of the e-PASS. Of particular interest was whether the e-PASS could adequately achieve its purpose of diagnosing disorders, detecting severity, and distinguishing primary from secondary diagnoses. A secondary objective was to explore people’s experience of the e-PASS in comparison with other assessment methods such as phone clinical interview, in order to identify the e-PASS’s strengths and areas requiring improvement.

Methods: Participants were 620 adults in Australia, recruited voluntarily from www.anxietyonline.org.au. Participants initially completed sociodemographic questions and the e-PASS. A subset of participants (156) then completed a semi-structured clinical interview (the “gold standard” validity criteria) over the phone using the MINI and ADIS-IV interview schedules, whilst 173 participants also completed several self-report questionnaires (e.g. CES-D, GAD-7, PDSS-SR, Y-BOCS) online. Finally, 97 participants undertook an online survey or semi-structured phone interview of their e-PASS experience.

Results: The e-PASS demonstrated acceptable sensitivity (>0.70) and specificity (>0.65) for several disorders, including MDD, panic disorder, GAD, and insomnia. While generally showing high specificity (>0.90), the following disorders displayed below acceptable sensitivity (<0.70): OCD, body dysmorphic disorder, PTSD, and bulimia nervosa. A positive e-PASS diagnosis resulted in significantly higher scores on corresponding self-report questionnaires. Logistic regression analysis suggested that diagnostic accuracy of e-PASS (AUC = 0.81-0.89) is comparable to that of corresponding questionnaires (0.81-0.86) and that the e-PASS diagnostic accuracy for panic disorder, GAD, and social phobia could be improved by reducing the e-PASS severity threshold for a clinical diagnosis. Preliminary analyses of experiential factors suggest several positive themes (e.g. self-control, comprehensiveness, convenience, and anonymity) and negative themes (e.g. restrictiveness, technical difficulties, impersonal) associated with e-PASS use. Final results will also outline e-PASS’s accuracy in distinguishing primary/secondary diagnoses.

Conclusions: The e-PASS has the potential to not only screen for mental disorders, but also identify severity and distinguish primary/secondary diagnoses. Preliminary results indicate the e-PASS is diagnostically accurate, particularly for certain disorders. Furthermore, e-PASS experience seems to be associated with several unique attributes, such as offering greater anonymity and convenience compared with traditional assessment means. Overall, these results highlight the value of online assessment programs such as the e-PASS, and support their potential use as a primary rather than adjunctive diagnostic tool.