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June 1987

Performance of Screening and Diagnostic Tests: Application of Receiver Operating Characteristic Analysis

Author Affiliations

From the Mental Health Research Unit, Institute for Health Research, A Joint Program of the Harvard Community Health Plan and Harvard University and the Harvard Program in Psychiatric Epidemiology, Department of Psychiatry, Massachusetts General Hospital, Boston (Drs Murphy, Borus, and Klerman); and the Institute for Health Research, Boston (Drs Berwick, Weinstein, and Budman). Dr Klerman is now with the Department of Psychiatry, Cornell Medical School, New York.

Arch Gen Psychiatry. 1987;44(6):550-555. doi:10.1001/archpsyc.1987.01800180068011

• Evaluation of psychiatric screening and diagnostic tests has benefited from the application of sensitivity, specificity, the k-statistic, and predictive values. These measures derive their meaning from a single criterion threshold. Receiver operating characteristic (ROC) analysis extends assessment of test performance by providing information about all possible pairs of achievable sensitivity and specificity values. The ROC analysis offers a comprehensive means for comparing different tests or different scoring procedures for one test. As a demonstration we used the ROC analysis to evaluate three types of scoring rules for one psychiatric test, the Health Opinion Survey. The demonstration indicated that ROC analysis can profitably take a place among the standard methods for test evaluation in psychiatric research. In addition, ROC analysis can assist clinicians in selecting appropriate test procedures for particular patient populations.