Comparing Computerized Adaptive Testing-Mental Health (CAT-MH) and Behavioral Health Measure-20 (BHM-20) screening measures in college mental health

Objective: Mental health screening tools support the process for connecting individuals to appropriate care. Participants: This study compared two such tools, the BHM-20 and the CAT-MH, among first-year undergraduate and graduate students. Methods: Students completed the CAT-MH and, if referred to the counseling center, also took the BHM-20. We analyzed four domains: suicidal ideation, depression, anxiety, and mania. Concordance between the tools was examined using intraclass correlations (ICCs) overall and across demographic subgroups. Results: Results showed poor agreement in most domains, with mania performing significantly worse than others. Moderate reliability was observed for anxiety overall, though not among Asian students, and a few subgroup ICCs showed moderate reliability. Overall, the CAT-MH and BHM-20 demonstrated limited agreement in college students. Conclusions: The BHM-20 may be better suited for repeated follow-ups, while the longer CAT-MH provides more comprehensive evaluations useful at intake. Providers should be aware that the two measures may not converge to the same symptom severity levels across domains, which could add confusion for treatment planning and evaluation over time. Further research is needed to refine screening across diverse student groups.