Will a new discipline, clinimetrics, change assessment in clinical psychiatry?

The way researchers currently assess changes in psychological distress may be wrong and lead to misleading and disappointing results. These are the conclusions of a paper published in the third 2004 issue of Psychotherapy and Psychosomatics by three investigators of the University of Bologna (Giovanni A. Fava, Chiara Ruini and Chiara Rafanelli).

Their conclusions are supported by accompanying editorials by Per Bech (Denmark) Carlo Faravelli (Italy) and Andrew Nierenberg (USA)

Psychometric theory is the basis for the development of assessment instruments in psychiatric research. However, the psychometric model appears to be largely inadequate in the clinical setting because of its lack of sensitivity to change and its quest for homogeneous components.

Clinimetrics offers a viable alternative to psychometrics, both from a conceptual and a methodological viewpoint.The term ’clinimetrics’ was introduced by Alvan R. Feinstein in 1982 to indicate a domain concerned with indexes, rating scales and other expressions that are used to describe or measure symptoms, physical signs, and other distinctly clinical phenomena in medicine. The purpose of clinimetric science was to provide an intellectual home for a number of clinical phenomena, which do not find room in the customary clinical taxonomy. Such phenomena include the types, severity and sequence of symptoms; rate of progression of illness, severity of comorbidity; problems of functional capacity; reasons for medical decisions, and many other aspects of daily life, such as well-being and distress.
Clinimetrics has a set of rules which govern the structure of indexes, the choice of component variables, the evaluation of consistency and validity.

Current diagnostic entities (DSM) are based on clinimetric principles, but their use is still influenced by psychometric models. Suggestions for switching gears in assessment research are offered in this article.