I thank the editors of JMIR Mental Health for the opportunity to respond to the Letter to the Editor [1] critiquing the methodology of the Computerised Online Life events Record (CLEAR) [2] published in this journal. While appreciating the critique, it expands on only one of the validity findings, comparing CLEAR with a life event interview and checklist questionnaire. There are significant points not outlined in the letter [1] and these are addressed here. Without questioning the additional statistical analyses provided by the sensitivity and specificity, the conclusion that this is unacceptable for a “diagnostic tool” is refuted. CLEAR is not a clinical diagnostic tool but owing to its high predictive validity with regard to depression and superiority to the checklist life events test (LTE-Q) [3], it retains value as a method for identifying environmental stressors related to clinical models.

The ambition of the CLEAR measure design needs to be understood. It attempts to capture similar data to those established in the intensive, contextualized, face-to-face, semistructured Life Events and Difficulties Interview (LEDS) [4] by using very detailed, interactive, time-based online self-report material. This is both complex and novel. Such conversion of the interview has never previously been undertaken despite various attempts at further structuring the interview for computerization [5]. The value of CLEAR lies in the large amount of event information and context generated, both quantitative and qualitative, and the preprogramming of data to produce both derived risk factors and partly analyzed data that are easily downloadable for analysis. CLEAR also provides a tailored feedback report for respondents. Besides identifying events, it can specify life event characteristics—not only their usual domain categorizations, but also their severity of threat/unpleasantness; focus of event; and characteristics such as loss, danger, and humiliation. It also identifies positivity of events and related characteristics (eg, relief, goal achievement). This is in addition to the timing of events and those stressors constituting longer-term problems. No checklist can provide such detailed data. Although interviews can provide such data, CLEAR provides very large savings in time and cost, expertise of investigators, and respondent convenience in large-scale data collection. Therefore, the balance of the reported lower sensitivity of the tool to interviews (ie, in missing some life events) needs to be considered in relation to the higher specificity with associated richness of event characteristics and the associated increased prediction of depression [2,4].

Further points in response to this paper are given below:

However, we do take messages from the letter by Rahmani and colleagues [1] and are seeking to increase the validity of CLEAR as compared with the LEDS interview from the observations and qualitative aspects taken from the analyses. This involves providing more structured options on the menu of life events checked. We believe having an online tool such as CLEAR will enable wider investigation of life events and their role in depression for both research and clinical practice.