FRIDA: A Four-Factor Adaptive Screening Tool for Demoralization, Anxiety, Irritability, and Depression in Hospital Patients

Belvederi Murri, Martino

First

;Muscettola, Angela

;Specchia, Michele;Montemitro, Chiara;Zerbinati, Luigi;Cruciata, Marco;Toffanin, Tommaso;Sciavicco, Guido;Caruso, Rosangela;Sancassiani, Federica;Carta, Mauro Giovanni;Grassi, Luigi;Nanni, Maria Giulia

2025-01-01

---

Abstract

Background: Demoralization, anxiety, irritability, and depression are common among hospital patients and are associated with poorer outcomes and greater healthcare burden. Early identification is essential, but simultaneous screening across multiple domains is often impractical with questionnaires. Computerized Adaptive Testing (CAT) offers a solution by tailoring item administration, reducing test length while preserving measurement precision. The aim of this study was to develop and validate FRIDA (Four-factor Rapid Interactive Diagnostic Assessment), a freely accessible, web-based CAT for rapid multidimensional screening of psychopathology in hospital patients. Methods: We analysed data from 472 medically ill in-patients at a University Hospital. Item calibration was performed using a four-factor graded response model (demoralization, anxiety, irritability, depression) in the mirt package. CAT simulations were run with 1000 virtual respondents to optimize item selection, exposure control, and stopping rules. The best configuration was applied to the real dataset. Criterion validity for demoralization was evaluated against the Diagnostic Criteria for Psychosomatic Research (DCPR). Results: The four-factor model showed good fit (CFI = 0.947, RMSEA = 0.080). Factor correlations were moderate to high, with the strongest overlap between demoralization and depression (r = 0.93). In simulations, the CAT required, on average, 7.8 items and recovered trait estimates with high accuracy (r = 0.94–0.97). In real patients, mean test length was 11 items, with accuracy of r = 0.95 across domains. FRIDA demonstrated good criterion validity for demoralization (AUC = 0.816; sensitivity 80%, specificity 67.5%). Conclusions: FRIDA is the first freely available, multidimensional CAT for rapid screening of psychopathology in hospital patients. It offers a scalable, efficient, and precise tool for integrating mental health assessment into routine hospital care.