Interpretative guidelines for neuropsychiatric measures with dichotomouslyscored items

Neuropsychiatric measures consisting of dichotomously scored items are comm only used in clinical assessment. After summing these items, clinical guide lines frequently recommend cutoff scores to determine the presence or degre e of a particular attribute, such as depression. However, blind application of such cutoffs neglects whether the total score is significantly differen t from chance. This confounding problem is illustrated using the Geriatric Depression Scale (GDS), and recommendations for interpreting the degree to which a GDS score significantly exceeds chance are presented. Specifically, GDS scores between 11 and 20, inclusive, were found not to differ signific antly from chance (p > 0.05), assuming a random response pattern. The impor tance of supportive clinical evidence of depressive symptomatology is incre ased for scores in this range. These guidelines will be helpful in using su ch measures with patients who may vary with respect to response accuracy, a nd in assessing possible incomplete effort or random responding. (C) 1999 J ohn Wiley & Sons, Ltd.