Item Response Modeling of Clinical Instruments With Filter Questions: Disentangling Symptom Presence and Severity

Clinical instruments that use a filter/follow-up response format often produce data with excess zeros, especially when administered to nonclinical samples. When the unidimensional graded response model (GRM) is then fit to these data, parameter estimates and scale scores tend to suggest that the instrument measures individual differences only among individuals with severe levels of the psychopathology. In such scenarios, alternative item response models that explicitly account for excess zeros may be more appropriate. The multivariate hurdle graded response model (MH-GRM), which has been previously proposed for handling zero-inflated questionnaire data, includes two latent variables: susceptibility, which underlies responses to the filter question, and severity, which underlies responses to the follow-up question. Using both simulated and empirical data, the current research shows that compared to unidimensional GRMs, the MH-GRM is better able to capture individual differences across a wider range of psychopathology, and that when unidimensional GRMs are fit to data from questionnaires that include filter questions, individual differences at the lower end of the severity continuum largely go unmeasured. Practical implications are discussed.