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Composite International Diagnostic Interview screening scales for DSM-IV anxiety and mood disorders

Published online by Cambridge University Press:  18 October 2012

R. C. Kessler ,
J. R. Calabrese ,
P. A. Farley ,
M. J. Gruber ,
M. A. Jewell ,
W. Katon ,
P. E. Keck Jr. ,
A. A. Nierenberg ,
N. A. Sampson  and
M. K. Shear
...Show all authors
R. C. Kessler*
Affiliation:
Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
J. R. Calabrese
Affiliation:
Department of Psychiatry, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, OH, USA
P. A. Farley
Affiliation:
Clinical Services, EPI-Q, Inc., Oakbrook Terrace, IL, USA
M. J. Gruber
Affiliation:
Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
M. A. Jewell
Affiliation:
Clinical Services, EPI-Q, Inc., Oakbrook Terrace, IL, USA
W. Katon
Affiliation:
School of Medicine, University of Washington, Seattle, WA, USA
P. E. Keck Jr.
Affiliation:
Lindner Center of HOPE and Department of Psychiatry, University of Cincinnati College of Medicine, Cincinnati, OH, USA
A. A. Nierenberg
Affiliation:
Depression Clinical and Research Program and the Bipolar Clinic and Research Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
N. A. Sampson
Affiliation:
Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
M. K. Shear
Affiliation:
Columbia University School of Social Work, New York, NY, USA
A. C. Shillington
Affiliation:
Clinical Services, EPI-Q, Inc., Oakbrook Terrace, IL, USA
M. B. Stein
Affiliation:
Department of Psychiatry, University of California San Diego, San Diego, CA, USA
M. E. Thase
Affiliation:
Departments of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia Veterans Affairs Medical Center, and the University of Pittsburgh Medical Center, Philadelphia and Pittsburgh, PA, USA
H.-U. Wittchen
Affiliation:
Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
*
*Address for correspondence: R. C. Kessler, Ph.D., Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA 02115, USA. (Email: Kessler@hcp.med.harvard.edu)
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Abstract

Background

Lack of coordination between screening studies for common mental disorders in primary care and community epidemiological samples impedes progress in clinical epidemiology. Short screening scales based on the World Health Organization (WHO) Composite International Diagnostic Interview (CIDI), the diagnostic interview used in community epidemiological surveys throughout the world, were developed to address this problem.

Method

Expert reviews and cognitive interviews generated CIDI screening scale (CIDI-SC) item pools for 30-day DSM-IV-TR major depressive episode (MDE), generalized anxiety disorder (GAD), panic disorder (PD) and bipolar disorder (BPD). These items were administered to 3058 unselected patients in 29 US primary care offices. Blinded SCID clinical reinterviews were administered to 206 of these patients, oversampling screened positives.

Results

Stepwise regression selected optimal screening items to predict clinical diagnoses. Excellent concordance [area under the receiver operating characteristic curve (AUC)] was found between continuous CIDI-SC and DSM-IV/SCID diagnoses of 30-day MDE (0.93), GAD (0.88), PD (0.90) and BPD (0.97), with only 9–38 questions needed to administer all scales. CIDI-SC versus SCID prevalence differences are insignificant at the optimal CIDI-SC diagnostic thresholds (χ21 = 0.0–2.9, p = 0.09–0.94). Individual-level diagnostic concordance at these thresholds is substantial (AUC 0.81–0.86, sensitivity 68.0–80.2%, specificity 90.1–98.8%). Likelihood ratio positive (LR+) exceeds 10 and LR− is 0.1 or less at informative thresholds for all diagnoses.

Conclusions

CIDI-SC operating characteristics are equivalent (MDE, GAD) or superior (PD, BPD) to those of the best alternative screening scales. CIDI-SC results can be compared directly to general population CIDI survey results or used to target and streamline second-stage CIDIs.

Keywords

Bipolar disorderComposite International Diagnostic Interview (CIDI)generalized anxiety disordermajor depressionpanic disorderscreening scalesvalidity
Type
Original Articles
Information
Psychological Medicine , Volume 43 , Issue 8 , August 2013 , pp. 1625 - 1637
Copyright
Copyright © Cambridge University Press 2012 

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