Concordance of the Composite International Diagnostic Interview Version 3.0 (CIDI 3.0) with standardized clinical assessments in the WHO World Mental Health Surveys

Abstract

The DSM-IV diagnoses generated by the fully structured lay-administered Composite International Diagnostic Interview Version 3.0 (CIDI 3.0) in the WHO World Mental Health (WMH) surveys were compared to diagnoses based on follow-up interviews with the clinician-administered non-patient edition of the Structured Clinical Interview for DSM-IV (SCID) in probability subsamples of the WMH surveys in France, Italy, Spain, and the US. CIDI cases were oversampled. The clinical reappraisal samples were weighted to adjust for this oversampling. Separate samples were assessed for lifetime and 12-month prevalence. Moderate to good individual-level CIDI-SCID concordance was found for lifetime prevalence estimates of most disorders. The area under the ROC curve (AUC, a measure of classification accuracy that is not influenced by disorder prevalence) was 0.76 for the dichotomous classification of having any of the lifetime DSM-IV anxiety, mood and substance disorders assessed in the surveys and in the range 0.62-0.93 for individual disorders, with an inter-quartile range (IQR) of 0.71-0.86. Concordance increased when CIDI symptom-level data were added to predict SCID diagnoses in logistic regression equations. AUC for individual disorders in these equations was in the range 0.74-0.99, with an IQR of 0.87-0.96. CIDI lifetime prevalence estimates were generally conservative relative to SCID estimates. CIDI-SCID concordance for 12-month prevalence estimates could be studied powerfully only for two disorder classes, any anxiety disorder (AUC = 0.88) and any mood disorder (AUC = 0.83). As with lifetime prevalence, 12-month concordance improved when CIDI symptom-level data were added to predict SCID diagnoses. CIDI 12-month prevalence estimates were unbiased relative to SCID estimates. The validity of the CIDI is likely to be under-estimated in these comparisons due to the fact that the reliability of the SCID diagnoses, which is presumably less than perfect, sets a ceiling on maximum CIDI-SCID concordance.

Trauma and PTSD in the WHO World Mental Health Surveys

“…These diagnoses are limited by being based on retrospective reports obtained in a cross-sectional survey using a fully-structured lay-administered diagnostic interview rather than a semi-structured clinician-administered diagnostic interview. The WMH clinical reappraisal study shows that PTSD prevalence is under-estimated in the CIDI compared to blinded semi-structured clinical interviews but that the vast majority of CIDI cases are confirmed in these clinical reappraisal interviews (Haro et al, 2006), suggesting that the WMH prevalence estimates are conservative. WMH results regarding PTSD persistence, in comparison, are anti-conservative because they assess persistence of any symptom rather than of the full PTSD syndrome.…”

“…When DSM-IV/CIDI criteria for PTSD were met, the respondent was asked how long symptoms persisted and if the symptoms were still present at the time of interview. Clinical reappraisal interviews with the SCID (Haro et al, 2006) blinded to CIDI diagnoses of PTSD (but instructed to focus on the same trauma as the one assessed in the CIDI in order to guarantee valid comparison of diagnoses) documented moderate CIDI–SCID concordance (Landis & Koch, 1977) (AUC = .69). Sensitivity and specificity were 38.3% and 99.1%, respectively, resulting in a likelihood ratio positive (Sensitivity/[1-Specificity]) of 42.0 that is well above the 10.0 typically considered definitive for a positive screen (Gardner & Altman, 2000).…”

Impairment in role functioning in mental and chronic medical disorders in the United States: results from the National Comorbidity Survey Replication

“…Generally good concordance has been found between Composite International Diagnostic Interview diagnoses of anxiety and depressive disorders and independent clinical assessment. 35 Composite International Diagnostic Interview diagnoses of impulse-control disorders have not been validated. Treatment of mental disorders was defined as getting any mental health care in the past 12 months, either in the primary care setting or from specialty services.…”

Psychotic experiences and incident suicidal ideation and behaviour: Disentangling the longitudinal associations from connected psychopathology

“…Therefore, the CIDI is essentially a self-report instrument (Eaton et al, 2000). Both the validity (Haro et al, 2006;Reed et al, 1998) and the test-retest reliability have been established, showing that the CIDI provides valid diagnoses for almost all non-psychotic disorders with good to excellent kappa coefficients for most diagnostic sections (Wittchen, 1994) .…”