Concordance between symptom screening and diagnostic procedure: the Hopkins Symptom Checklist-25 and the Composite International Diagnostic Interview I |
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| Authors: | I Sandanger T Moum G Ingebrigtsen O S Dalgard T Sørensen D Bruusgaard |
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| Institution: | (1) Institute of General Practice and Community Medicine, Department of Social Insurance Medicine, University of Oslo, P.O. Box 1130 Blindern, N-0317 Oslo, Norway, NO;(2) Department of Behavioural Sciences in Medicine, University of Oslo, Oslo, Norway, NO;(3) Psychiatric Centre, Lofoten Hospital, Lofoten Islands, Nordland, Norway, NO;(4) National Institute of Public Health, Oslo, Norway, NO;(5) Psychiatric Institute, University of Oslo, Oslo, Norway, NO |
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| Abstract: | The definition of case is a core issue in psychiatric epidemiology. Psychiatric symptom screening scales have been extensively
used in population studies for many decades. Structured diagnostic interviews have become available during recent years to
give exact diagnoses through carefully undertaken procedures. The aim of this article was to assess how well the Hopkins Symptom
Checklist-25 (HSCL-25) predicted cases by the Composite International Diagnostic Interview (CIDI), and find the optimal cut-offs
on the HSCL-25 for each diagnosis and gender. Characteristics of concordant and discordant cases were explored. In a Norwegian
two-stage survey mental health problems were measured by the HSCL-25 and the CIDI. Only 46% of the present CIDI diagnoses
were predicted by the HSCL-25. Comorbidity between CIDI diagnoses was found more than four times as often in the concordant
cases (cases agreed upon by both instruments) than in the discordant CIDI cases. Concordant cases had more depression and
panic/generalized anxiety disorders. Neither the anxiety nor the depression subscales improved the prediction of anxiety or
depression. The receiver operating characteristic (ROC) curves confirmed that the HSCL-25 gave best information about depression.
Except for phobia it predicted best for men. Optimal HSCL-25 cut-off was 1.67 for men and 1.75 for women. Of the discordant
HSCL-25 cases, one -third reported no symptoms in the CIDI, one-third reported symptoms in the CIDI anxiety module, and the
rest had symptoms spread across the modules. With the exception of depression, the HSCL-25 was insufficient to select individuals
for further investigation of diagnosis. The two instruments to a large extent identified different cases. Either the HSCL-25
is a very imperfect indicator of the chosen CIDI diagnoses, or the dimensions of mental illness measured by each of the instruments
are different and clearly only partly overlapping.
Accepted: 11 November 1997 |
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