Diagnosing diagnoses. Receiver operating characteristic methods and psychiatry.

With every issue of theArchives, the reader is inundated with psychiatric research: new treatments, new biological abnormalities, new diagnostic methods, new diagnoses—the list seems endless. It is difficult to conceive of anyone, except, of course, our dedicated Editor, who bothers to read every article in every issue. Indeed, it would be a rare individual who had the time to read every abstract. In the current issue of theArchives, Mossman and Somoza 1 reexamine the dexamethasone suppression test (DST) using a statistical method that is new to psychiatry, namely, receiver operating characteristic (ROC). Using this method, they are able to demonstrate that there is significant variability in the performance of the DST among different psychiatric centers. As with any statistical method, ROC involves more than a little mathematics, and the natural question as one leafs through the See also p 653 .Archivesis "Why should I bother with this?"

[1]  Helena C. Kraemer,et al.  Assessment of 2 × 2 Associations: Generalization of Signal-Detection Methodology , 1988 .

[2]  R. Cadoret,et al.  Cause the bible tells me so. , 1988, Archives of general psychiatry.

[3]  J. Swets,et al.  Assessment of diagnostic technologies. , 1979, Science.

[4]  D Mossman,et al.  Maximizing diagnostic information from the dexamethasone suppression test. An approach to criterion selection using receiver operating characteristic analysis. , 1989, Archives of general psychiatry.

[5]  M C Weinstein,et al.  Performance of screening and diagnostic tests. Application of receiver operating characteristic analysis. , 1987, Archives of general psychiatry.

[6]  E. Keeler,et al.  Primer on certain elements of medical decision making. , 1975, The New England journal of medicine.

[7]  Helena Chmura Kraemer,et al.  The methodological and statistical evaluation of medical tests: The dexamethasone suppression test in psychiatry , 1987, Psychoneuroendocrinology.

[8]  J A Swets,et al.  Measuring the accuracy of diagnostic systems. , 1988, Science.

[9]  B. Carroll,et al.  A specific laboratory test for the diagnosis of melancholia. Standardization, validation, and clinical utility. , 1981, Archives of general psychiatry.

[10]  S. Finklestein,et al.  The predictive power of diagnostic tests and the effect of prevalence of illness. , 1983, Archives of general psychiatry.

[11]  C. Metz Basic principles of ROC analysis. , 1978, Seminars in nuclear medicine.

[12]  J. Hanley,et al.  The meaning and use of the area under a receiver operating characteristic (ROC) curve. , 1982, Radiology.