Abstract

Background

Multi-dimensional behavioral rating scales like the CBCL and YSR are available for diagnosing psychosocial maladjustment in adolescents, but these are unsuitable for large-scale usage since they are time-consuming and their many sensitive questions often lead to missing data. This research applies multiple imputation to tackle the effects of missing data in order to develop a simple questionnaire-based predictive instrument for psychosocial maladjustment.

Methods

Questionnaires from 2919 Chinese sixth graders in 21 schools were collected, but 86% of the students were missing one or more of the variables for analysis. Fifteen (10 training, 5 validation) samples were imputed using multivariate imputation chain equations. A ten-variable instrument was constructed by applying stepwise variable selection algorithms to the training samples, and its predictive performance was evaluated on the validation samples.

Results

The instrument had an AUC of 0.75 (95% CI: 0.73 to 0.78) and a calibration slope of 0.98 (95% CI: 0.86 to 1.09). The prevalence of psychosocial maladjustment was 18%. If a score of > 1 was used to define a negative test, then 80% of the students would be classified as negative. The resulting test had a diagnostic odds ratio of 5.64 (95% CI: 4.39 to 7.24), with negative and positive predictive values of 88% and 43%, and negative and positive likelihood ratios of 0.61 and 3.41, respectively.

Conclusions

Multiple imputation together with internal validation provided a simple method for deriving a predictive instrument in the presence of missing data. The instrument's high negative predictive value implies that in populations with similar prevalences of psychosocial maladjustment test-negative students can be confidently excluded as being normal, thus saving 80% of the resources for confirmatory psychological testing.

Keywords:

Missing data; Multiple imputation; Psychological maladjustment; Predictive tool