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. 2025 May;34(5):1265-1275.
doi: 10.1007/s11136-025-03898-y. Epub 2025 Jan 30.

Psychometric properties and post-hoc CAT analysis of the pediatric PROMIS® item banks anxiety and depressive symptoms in a combined Swedish Child and Adolescent Psychiatry and School sample

Ida Blomqvist  1 , John Eric Chaplin  2 , Eva Henje  3 , Inga Dennhag  3
Affiliations

Psychometric properties and post-hoc CAT analysis of the pediatric PROMIS® item banks anxiety and depressive symptoms in a combined Swedish Child and Adolescent Psychiatry and School sample

Ida Blomqvist et al. Qual Life Res. 2025 May.

Abstract

Purpose: The objective of this study is to assess the psychometric properties and reliability of the Swedish Patient-Reported Outcomes Measurement Information System (PROMIS) item banks for anxiety and depressive symptoms with item response theory analysis and post-hoc computerized adaptive testing in a combined Swedish Child and Adolescent Psychiatry (CAP) and school sample.

Methods: Participants (n = 928, age 12-20) were recruited from junior and high schools and Child and Adolescent Psychiatry Clinics in the region of Västerbotten. Unidimensionality, local independence, and monotonicity was tested. We fitted a graded response model to the data and tested differential item functioning (DIF) for sex, age group, sample type, and language (Swedish vs. U.S.). Moreover, a post-hoc computer adaptive testing (CAT) simulation was performed. All analysis were made in R.

Results: Unidimensionality, local independence, and monotonicity were acceptable. The graded response model yielded acceptable item fit, discriminative, and threshold values for all items in both item banks. DIF for language (Swedish vs. U.S.) was found for two items from the anxiety and one item from the depressive symptoms item banks. A Stocking-lord transformation was used for the items displaying language DIF, and post-hoc CAT simulations were performed. The post-hoc CAT simulation showed reliability around 0.9 for both Swedish and official U.S. item parameters T-scores calibration from within normal limits to severe anxiety and depressive symptoms.

Conclusion: The Swedish pediatric PROMIS item banks of anxiety and depressive symptoms are appropriate to assess mild to severe symptoms of anxiety and depressive symptoms in Swedish school- and CAP samples.

Keywords: Child- and adolescent psychiatry; Computer adaptive testing; Depressive symptoms; Differential item functioning; Graded response model; Item response theory.

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Conflict of interest statement

Declarations. Competing Interests: Dr. J. Chaplin is on the Board of Directors, the PROMIS Health Organization. Dr. I. Dennhag is a member of the PROMIS Health Organization. None of the authors have any financial or non-financial conflicts of interest. Consent to participate: Informed oral and written consent was obtained from all respondents and additional parental consent for respondents 15 years or younger. Consent to publish: Not applicable. Ethical approval: This study was approved by the Swedish Regional Ethical Review Board in Sweden (Number 2018/59-31).

Figures

Fig. 1
Fig. 1
Reliability of the Swedish pediatric PROMIS Anxiety item bank comparing CAT simulation with Swedish parameters on the validation sample, CAT simulation with US parameters on the validations sample with full length item bank on the validation and evaluation samples
Fig. 2
Fig. 2
Reliability of the Swedish pediatric PROMIS Depressive symptoms item bank comparing CAT simulation with Swedish parameters on the validation sample, CAT simulation with US parameters on the validations sample with full length item bank on the validation and evaluation samples
See this image and copyright information in PMC

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