Previously submitted to: JMIR Mental Health (no longer under consideration since Apr 10, 2023)
Date Submitted: Apr 9, 2023
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
aptihealth Online Multi-Dimensional Behavioral Health Screening Tool (A5): Validation Study
ABSTRACT
Background:
1 in 5 adults in the United States experience some form of mental illness, however, most care settings use screening instruments designed for single disorders. To address this clinical gap, aptihealth has developed an online, multi-dimensional behavioral health screening tool that can accurately and reliably screen for a wide range of psychiatric disorders.
Objective:
To validate a multi-dimensional screening tool for 11 common psychiatric disorders.
Methods:
A study of reliability, content validity, and diagnostic accuracy of the aptihealth A5 was conducted. A total of 7,727 aptihealth patients who completed the A5 online between July 1st 2020, and August 31st 2022 were included. Patients complete the online screener before scheduling a diagnostic interview. At the start of care, patients receive a diagnosis from a licensed behavioral health provider, and most patients complete a Patient Health Questionnaire (PHQ-9) and Generalized Anxiety Disorder Scale (GAD-7). The diagnosis, PHQ-9, and GAD-7 scores are used as reference standards.
Results:
Of the 7,727 participants, the majority were under the age of 45 (71.8%), white (65.3%), and female (50.1%). In an expert review, the A5 items were found to have scale content validities of 87% for clarity, 98% for coherence, 96% for relevance, and 87% for sufficiency. In an alternate form reliability analysis, all A5 items demonstrated at least moderate agreement (Intraclass Correlation Coefficient of 0.40 or higher) when screeners were taken within one week of each other. The A5’s ability to accurately assess the need for treatment for depressive and anxiety disorders was demonstrated through moderate correlations with PHQ-9 (rho = 0.55, 95% CI 0.47-0.52) and GAD-7 (rho = 0.52, 95% CI 0.50-0.55) scores, respectively. Additionally, half of the disorders with a diagnosis prevalence of at least 4% had acceptable sensitivity values greater than 0.70. Finally, factor analysis reiterated the presence of 11 disorders, which were grouped into 13 symptom factors, where sleep and obsessive-compulsive disorders were comprised of two factors of symptoms.
Conclusions:
These findings support the reliability and validity of the A5 screening tool to guide a diagnostic interview and provide more precise patient care.
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