Consistency checks to improve measurement with the Young Mania Rating Scale (YMRS)

Mitigating rating inconsistency can improve measurement fidelity and detection of treatment response. The International Society for CNS Clinical Trials and Methodology convened an expert Working Group that developed logical consistency (LC) checks for ratings of the Young Mania Rating Scale (YMRS),...

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Bibliographic Details
Published in:Journal of affective disorders 2024-01, Vol.345, p.24-31
Main Authors: Rabinowitz, Jonathan, Young, Robert C., Yavorsky, Christian, Williams, Janet B.W., Sedway, Jan, Marino, Patricia, Matteo, Christopher, Mahableshwarkar, Atul, Kott, Alan, Hefting, Nanco, Engler, Jenicka, Brady, Chris
Format: Article
Language:English
Subjects:
Careless ratings
Consistency of measurement
Inconsistent ratings
YMRS
Young Mania Rating Scale
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Summary:Mitigating rating inconsistency can improve measurement fidelity and detection of treatment response. The International Society for CNS Clinical Trials and Methodology convened an expert Working Group that developed logical consistency (LC) checks for ratings of the Young Mania Rating Scale (YMRS), which is widely used in studies of mood and bipolar disorders. LC and statistical outlier-response pattern checks (SC) were applied to 63,228 YMRS administrations from 14 clinical trials evaluating treatments for bipolar disorder. Checks were also applied to Monte Carlo-simulated data as a proxy for their use under conditions of inconsistency. 42 LC flags were developed, and four SC flags were created from the data set (n = 14). Almost 20 % of the rating administrations had at least one LC flag, 6.7 % had two or more, 1.7 % had three or more; 17.3 % percent of the administrations had at least one SC flag and 4.6 % percent had two or more. Overall, 31 % of administrations had at least one flag of any type, 12.1 % had two or more and 5.3 % had three or more. In acute antimanic treatment trials (n = 10) there were more flags of any type compared to relapse prevention trials (n = 4). Flagged ratings may represent less-common presentations assessed correctly. Using established methods, we illustrate development and application of consistency flags for YMRS ratings. Applying flags and mitigation during trials may improve the value of YMRS data, help focus attention on rater training, and improve reliability and validity of trial data. •A set of expert consensus and statistical flags to help identify possible errors in Young Mania Rating Scale (YMRS) ratings•Flags elaborated in paper can be applied.•Flags represent actual patterns of inconsistencies found.•Application of flags to ratings may improve reliability of ratings and validity of trials.
ISSN:0165-0327
1573-2517
DOI:10.1016/j.jad.2023.10.098