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Int J Methods Psychiatr Res. 2007;16(4):219-29. doi: 10.1002/mpr.230.

Using decision theory to derive optimal cut-off scores of screening instruments: an illustration explicating costs and benefits of mental health screening.

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Department of Clinical Psychology, Vrije Universiteit, Amsterdam, The Netherlands.


This paper shows how decision theory can be used to determine optimal cut-off scores on mental health screeners. The procedure uses (a) the costs and benefits of correct and erroneous decisions, and (b) the rates of correct and erroneous decisions as a function of the cut-off score. Using this information, for each cut-off point expected costs are calculated. The cut-off point with the lowest expected costs is the optimal cut-off score. An illustration is given in which the General Health Questionnaire is employed as a major depression screener. Optimal cut-off points are determined for four different contexts: patients, health service providers, society, and mental health researchers. As in these four situations different costs are encountered, different optimal cut-off points were found.

[Indexed for MEDLINE]

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