Validation of the diagnoses of panic disorder and phobic disorders in the US National Comorbidity Survey Replication Adolescent (NCS-A) supplement

Validity of the adolescent version of the World Health Organization Composite International Diagnostic Interview (CIDI) Version 3.0, a fully‐structured research diagnostic interview designed to be used by trained lay interviewers, is assessed in comparison to independent clinical diagnoses based on the Schedule for Affective Disorders and Schizophrenia for School‐age Children (K‐SADS). This assessment is carried out in the clinical reappraisal sub‐sample (n = 347) of the US National Comorbidity Survey Adolescent (NCS‐A) supplement, a large (n = 10,148) community epidemiological survey of the prevalence and correlates of adolescent mental disorders in the United States. The diagnoses considered are panic disorder and phobic disorders (social phobia, specific phobia, agoraphobia). CIDI diagnoses are found to have good concordance with K‐SADS diagnoses [area under the receiver operating characteristic curve (AUC) = 0.81–0.94], although the CIDI diagnoses are consistency somewhat higher than the K‐SADS diagnoses. Data are also presented on criterion‐level concordance in an effort to pinpoint CIDI question series that might be improved in future modifications of the instrument. Finally, data are presented on the factor structure of the fears associated with social phobia, the only disorder in this series where substantial controversy exists about disorder subtypes. Copyright © 2011 John Wiley & Sons, Ltd.     

The Reliability and Validity of Kiddie‐Schedule for Affective Disorders and Schizophrenia ‐ Present and Life‐time Version ‐ Persian Version

Background: The validity and reliability of a Persian version of the Kiddie Schedule for Affective Disorders and Schizophrenia‐Present and Lifetime Version (K‐SADS‐PL‐P) was evaluated. Method: The K‐SADS‐PL‐P was administered to 102 inpatients (mean age = 15.3 yrs, SD = 1.81) in a child and adolescent psychiatric ward. The psychometric properties were evaluated in comparison to the results of clinical diagnosis. Results: The K‐SADS‐PL‐P showed good‐to‐excellent concurrent validity in diagnosing current major disorders. Test‐retest reliabilities of most of the current diagnoses were also good to excellent. Conclusion: The Persian version of the K‐SADS‐PL provides reliable and valid youth psychiatric diagnoses.     

Attention deficit hyperactivity disorder: concordance of the adolescent version of the Composite International Diagnostic Interview Version 3.0 (CIDI) with the K‐SADS in the US National Comorbidity Survey Replication Adolescent (NCS‐A) supplement

This paper evaluates the internal consistency reliability and concurrent validity of the assessment of Diagnostic and Statistical Manual of Mental Disorders (DSM‐IV) attention deficit hyperactivity disorder (ADHD) in the adolescent version of the World Health Organization (WHO) Composite International Diagnostic Interview Version 3.0 (CIDI). The CIDI is a lay‐administered diagnostic interview that was carried out in conjunction with the US National Comorbidity Survey Adolescent Supplement, a US nationally representative survey of 10,148 adolescents and their parents. Internal consistency reliability was evaluated using factor and item response theory analyses. Concurrent validity was evaluated against diagnoses based on blinded clinician‐administered interviews. Inattention and hyperactivity‐impulsivity items loaded on separate but correlated factors, with hyperactivity and impulsivity items forming a single factor in parent reports but separate factors in youth reports. We were able to differentiate hyperactivity and impulsivity factors for parents as well by eliminating a subset who endorsed zero ADHD items from the factor analysis. Although concurrent validity was relatively weak, decomposition showed that this was due to low validity of adolescent reports. A modified CIDI diagnosis based exclusively on parent reports generated a diagnosis that had good concordance with clinical diagnoses [area under the curve (AUC) = 0.78]. Implications for assessing ADHD using the CIDI and the effect of different informants on measurement are discussed. Copyright © 2010 John Wiley & Sons, Ltd.     

An assessment of structured diagnostic interviews for adult anxiety disorders

Structured diagnostic interviews have been developed to aid reliable diagnosis of psychiatric disorders. Five of the available interviews are reviewed with respect to adult anxiety disorders: the Anxiety Disorders Interview Schedule-Revised (ADIS-R), the Composite International Diagnostic Interview (CIDI), the Schedule for Affective Disorders and Schizophrenia (SADS), the Schedules for Clinical Assessment in Neuropsychiatry (SCAN), and the Structured Clinical Interview for DSM-III-R (SCID). Each of these assessment instruments is compared concerning their relative merits, psychometric properties, and usefulness to practicing clinicians and researchers. It is concluded that structured interviews increase diagnostic reliability. Since reliability is a prerequisite for validity, structured diagnostic interviews represent a necessary addition to research clinical assessment.     

The Composite International Diagnostic Interview: feasibility and necessity of editing and interviewer training in general population surveys

Current knowledge of the prevalence of psychiatric disorders in the general population is basically derived from highly standardized and fully structured interviews such as the Diagnostic Interview Schedule (DIS) and the Composite International Diagnostic Interview (CIDI), which were administered by psychiatric lay interviewers. The feasibility of the most recent German version of the CIDI, the Munich‐CIDI (M‐CIDI) was analysed with respect to unit and item non‐response. We also analysed the effects of editing and interviewer training, constituting quality assurance procedures that are inherent with the CIDI. A random sample of 4075 adults in a northern German region were interviewed by 56 psychiatric lay interviewers, using the M‐CIDI, enabling an assessment to be made of the most frequent DSM‐IV diagnoses over the whole lifespan. Editing was carried out by psychologists and was combined with weekly interviewer training and individualized feedback. Results show a negligible rate of interview‐induced unit non‐response (0.1% only partially completed interviews) and item‐non‐response due to refusal, except for illicit drug use (3%). Considerable item non‐response due to ‘don't know’ answers occurred in time‐related questions. Errors detected by editing led to data correction in 37% of all interviews. Alcohol, nicotine, and somatoform disorder sections were mainly affected on the level of items and diagnostic decision. Occurrence of errors decreased with increasing interviewer experience and training in CIDI administration, but was not associated with participants' characteristics such as age and educational level. Complex time‐related questions, allocation of physicians' diagnoses, and calculation of alcohol consumption index were most frequently subject to editing. We conclude that the application of editing may significantly influence the result of psychiatric epidemiological studies for some diagnostic categories. Findings are discussed on the background of future improvements of the CIDI. Copyright © 2000 Whurr Publishers Ltd.     

Parent–child agreement and prevalence estimates of diagnoses in childhood: Direct interview versus family history method

Diagnostic information on children is typically elicited from both children and their parents. The aims of the present paper were to: (1) compare prevalence estimates according to maternal reports, paternal reports and direct interviews of children [major depressive disorder (MDD), anxiety and attention‐deficit and disruptive behavioural disorders]; (2) assess mother–child, father–child and inter‐parental agreement for these disorders; (3) determine the association between several child, parent and familial characteristics and the degree of diagnostic agreement or the likelihood of parental reporting; (4) determine the predictive validity of diagnostic information provided by parents and children. Analyses were based on 235 mother–offspring, 189 father–offspring and 128 mother–father pairs. Diagnostic assessment included the Kiddie‐schedule for Affective Disorders and Schizophrenia (K‐SADS) (offspring) and the Diagnostic Interview for Genetic Studies (DIGS) (parents and offspring at follow‐up) interviews. Parental reports were collected using the Family History – Research Diagnostic Criteria (FH‐RDC). Analyses revealed: (1) prevalence estimates for internalizing disorders were generally lower according to parental information than according to the K‐SADS; (2) mother–child and father–child agreement was poor and within similar ranges; (3) parents with a history of MDD or attention deficit hyperactivity disorder (ADHD) reported these disorders in their children more frequently; (4) in a sub‐sample followed‐up into adulthood, diagnoses of MDD, separation anxiety and conduct disorder at baseline concurred with the corresponding lifetime diagnosis at age 19 according to the child rather than according to the parents. In conclusion, our findings support large discrepancies of diagnostic information provided by parents and children with generally lower reporting of internalizing disorders by parents, and differential reporting of depression and ADHD by parental disease status. Follow‐up data also supports the validity of information provided by adolescent offspring. Copyright © 2009 John Wiley & Sons, Ltd.     

Modifying and validating the Composite International Diagnostic Interview (CIDI) for use in Nepal

Background: Efforts to develop and validate fully‐structured diagnostic interviews of mental disorders in non‐Western countries have been largely unsuccessful. However, the principled methods of translation, harmonization, and calibration that have been developed by cross‐national survey methodologists have never before been used to guide such development efforts. The current report presents the results of a rigorous program of research using these methods designed to modify and validate the Composite International Diagnostic Interview (CIDI) for an epidemiological survey in Nepal. Methods: A five‐step process of translation, harmonization, and calibration was used to modify the instrument. A blinded clinical reappraisal design was used to validate the instrument. Results: Preliminary interviews with local mental health expert led to a focus on major depressive episode, mania/hypomania, panic disorder, post‐traumatic stress disorder, generalized anxiety disorder, and intermittent explosive disorder. After an iterative process of multiple translations‐revisions guided by the principles developed by cross‐national survey methodologists, lifetime DSM‐IV diagnoses based on the final Nepali CIDI had excellent concordance with diagnoses based on blinded Structured Clinical Interview for DSM‐IV (SCID) clinical reappraisal interviews. Conclusions: Valid assessment of mental disorders can be achieved with fully‐structured diagnostic interviews even in low‐income non‐Western settings with rigorous implementation of replicable developmental strategies. Copyright © 2013 John Wiley & Sons, Ltd.     

National Comorbidity Survey Replication Adolescent Supplement (NCS-A): III. Concordance of DSM-IV/CIDI Diagnoses With Clinical Reassessments

ObjectiveTo report results of the clinical reappraisal study of lifetime DSM-IV diagnoses based on the fully structured lay-administered World Health Organization Composite International Diagnostic Interview (CIDI) Version 3.0 in the U.S. National Comorbidity Survey Replication Adolescent Supplement (NCS-A).MethodBlinded clinical reappraisal interviews with a probability subsample of 347 NCS-A respondents were administered using the Schedule for Affective Disorders and Schizophrenia for School-Age Children (K-SADS) as the gold standard. The DSM-IV/CIDI cases were oversampled, and the clinical reappraisal sample was weighted to adjust for this oversampling.ResultsGood aggregate consistency was found between CIDI and K-SADS prevalence estimates, although CIDI estimates were meaningfully higher than K-SADS estimates for specific phobia (51.2%) and oppositional defiant disorder (38.7%). Estimated prevalence of any disorder, in comparison, was only slightly higher in the CIDI than K-SADS (8.3%). Strong individual-level CIDI versus K-SADS concordance was found for most diagnoses. Area under the receiver operating characteristic curve, a measure of classification accuracy not influenced by prevalence, was 0.88 for any anxiety disorder, 0.89 for any mood disorder, 0.84 for any disruptive behavior disorder, 0.94 for any substance disorder, and 0.87 for any disorder. Although area under the receiver operating characteristic curve was unacceptably low for alcohol dependence and bipolar I and II disorders, these problems were resolved by aggregation with alcohol abuse and bipolar I disorder, respectively. Logistic regression analysis documented that consideration of CIDI symptom-level data significantly improved prediction of some K-SADS diagnoses.ConclusionsThese results document that the diagnoses made in the NCS-A based on the CIDI have generally good concordance with blinded clinical diagnoses.     

Predictive gender and education bias in Kessler's psychological distress Scale (k10)

Background Kessler's Psychological Distress Scale (K10) is a ten-item measure of psychological distress that has been used in recent epidemiological research and as a screen for mental disorders. Moderate relationships have been reported between the K10 and measures of related constructs, such as diagnoses of mental disorders and associated disability. However, it is unclear whether the validity of the K10 is consistent across important demographic, cultural, and socio-economic groups such as gender and educational history or whether there is evidence of predictive bias or inconsistency across these groups. Methods Differential validity or predictive bias in the relationship between K10 scores and disability days, SF12 Mental Component Summary (MCS) scores, and 1-month Composite International Diagnostic Interview (CIDI) diagnoses of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) Anxiety and Depressive disorders due to gender and completing secondary school were examined using hierarchical linear and logistic regression analyses in the Australian National Survey of Mental Health and Wellbeing data set. Results Very small slope and/or intercept biases in the relationship between the K10 and disability days, the SF12 MCS, and 1-month CIDI diagnoses of anxiety and depression were found [effect sizes, the ratio of variance explained to unexplained variance (Cohen's f²), varied from 0.0001 to 0.004]. Conclusion Gender and educational predictive biases in the relationship between the K10 and disability days, SF12 MCS, and 1-month diagnoses were found to be very small and are unlikely to have any practical impact. This analysis adds to evidence supporting the use of the K10 in epidemiological research.     

Concordance between Composite International Diagnostic Interview and self‐reports of depressive symptoms: a re‐analysis

Concordance between sum scores of self‐reported depressive symptoms and structured interview diagnoses has been studied extensively, but are these the best attainable self‐report‐based predictions for interview diagnoses? We maximized the cross‐validated concordance between World Health Organization's Composite International Diagnostic Interview (CIDI) diagnosis and Beck's Depression Inventory (BDI), and General Health Questionnaire (GHQ), from the viewpoint of exploratory statistics, re‐analysing Health 2000 general‐population sample of adults over 30 years in mainland Finland (N = 5200–5435). BDI sum‐score prediction of CIDI diagnosis could be superseded by using (1) weighted sums of items, (2) classification trees constructed from items, or (3) a single item. Best solution (2) yielded cross‐validated Youden's Index 0.757 [standard error (SE) = 0.001, sensitivity = 0.907, specificity = 0.851], improving the concordance to 1.07‐fold (1.18‐fold for 12‐month diagnosis). A single‐item solution was best for the GHQ. All positive predictive values remained low (0.09–0.31). Thus, CIDI‐to‐questionnaire concordance can be improved by using all information in the questionnaires instead of just sum scores, but latent‐trait theory for questionnaires is incompatible with interview diagnoses (single item achieved better concordance than summing all). Self‐reports have low predictive value for CIDI diagnoses in the general population, but better in settings with higher major depressive disorder (MDD) base rates. Copyright © 2015 John Wiley & Sons, Ltd.     

Development and feasibility of the computerized Turkish edition of the Composite International Diagnostic Interview [DIA‐X/CIDI version 2.8(TR)]

The Composite International Diagnostic Interview (CIDI), which has been widely applied in epidemiological research, is a standardized, clinically structured interview that enables the diagnosis of mental disorders based on DSM and ICD criteria. The computerized DIA‐X CIDI Version 2.8 investigated in this study is an adaptation of the German DIA‐X/Munich CIDI, which was translated in a multi‐step process into Turkish and used to survey the prevalence of mental disorders in individuals with Turkish migration backgrounds in Germany (N = 662). The bilingual lay interviewers were intensively trained and supervised during the data collection. The survey was accompanied by further quality measures, including editing and documenting. To investigate the instrument's feasibility, quality criteria were used based on the following data sources: (1) socio‐demographic sample characteristics; (2) interviewer assessments and (3) quantitative measures (interview duration, non‐response items, error items). The results indicated that quality differences between the German and Turkish DIA‐X/CIDI are associated with age, educational level and socio‐economic status and not with the CIDI version itself. In short, the Turkish DIA‐X/CIDI Version 2.8 has comparatively good quality and feasibility relative to its German counterpart.     

The assessment of affective disorders in children and adolescents by semistructured interview. Test-retest reliability of the schedule for affective disorders and schizophrenia for school-age children, present episode version

The reliability of assessment of Research Diagnostic Criteria and DSM-III axis I affective disorders in children and adolescents was studied using a semistructured diagnostic interview. The Schedule for Affective Disorders and Schizophrenia (SADS) for School-Age Children (Kiddie SADS) Present Episode Version, an adaptation of the adult SADS for children was used. Fifty-two subjects, aged 6 through 17 years, were interviewed in a test-retest format by one of three pairs of interviewers. Assessment of symptoms and composite scales of the depressive syndrome were determined to have acceptable reliability, as were three depressive diagnoses. Conduct disorder was assessed with high reliability. Four anxiety disorders and their composite symptoms were assessed with unacceptable reliability; only separation anxiety was assessed with acceptable reliability. The results of this study showed generally lower reliability of symptoms, scales, and diagnoses than did two studies of adults using the SADS.     

Lessons learned from the clinical reappraisal study of the Composite International Diagnostic Interview with Latinos

Given recent adaptations of the World Health Organization's World Mental Health Composite International Diagnostic Interview (WMH‐CIDI), new methodological studies are needed to evaluate the concordance of CIDI diagnoses with clinical diagnostic interviews. This paper summarizes lessons learned from a clinical reappraisal study done with US Latinos. We compare CIDI diagnoses with independent clinical diagnosis using the World Mental Health Structured Clinical Interview for DSM‐IV (WMH‐SCID 2000). Three sub‐samples stratified by diagnostic status (CIDI positive, CIDI negative, or CIDI sub‐threshold for a disorder) based on nine disorders were randomly selected for a telephone re‐interview using the SCID. We calculated sensitivity, specificity, and weight‐adjusted Cohen's kappa. Weighted 12 month prevalence estimates of the SCID are slightly higher than those of the CIDI for generalized anxiety disorder, alcohol abuse/dependence, and drug abuse/dependence. For Latinos, CIDI‐SCID concordance at the aggregate disorder level is comparable, albeit lower, to other published reports. The CIDI does very well identifying negative cases and classifying disorders at the aggregate level. Good concordance was also found for major depressive episode and panic disorder. Yet, our data suggests that the CIDI presents problems for assessing post‐traumatic stress disorder (PTSD) and generalized anxiety disorder (GAD). Recommendations on how to improve future versions of the CIDI for Latinos are offered. Copyright © 2009 John Wiley & Sons, Ltd.     

Briquet's syndrome in a man.

A case history is presented of a man who met the diagnostic criteria of Briquet's syndrome after a 7-year history of excessive use of psychiatric and medical health care services. Despite his having been seen by several psychiatrists, the diagnosis was made only following the use of the Schedule for Affective Disorders and Schizophrenia (SADS), a structured psychiatric interview, the results of which were applied to operationalized diagnostic criteria (Research Diagnostic Criteria [RDC]). This case demonstrates: 1) the fact that Briquet's Syndrome, commonly considered a female disorder, can occur in men; 2) the utility of structured interviews and defined diagnostic criteria in arriving at unexpected diagnoses; and 3) the importance of recognizing Briquet's Syndrome in order to avoid needless medical intervention for somatic complaints of psychological origins.     

Usefulness of the PERI demoralization scale to screen for psychiatric disorder in a community sample

The authors gave the PERI Demoralization Scale (PERI-D), a measure of nonspecific psychological distress, to 528 subjects drawn from a larger longitudinal community survey. Respondents also were interviewed using the Schedule for Affective Disorders and Schizophrenia (SADS), a structured clinical interview. Based on the SADS, subjects were given diagnoses based on Research Diagnostic Criteria (RDC). The results corroborate earlier findings of a modest relationship between self-reported symptoms of distress and the diagnosis of clinical psychiatric disorder. There was somewhat better fit between RDC diagnoses of depression, particularly major depression, and PERI-D symptom scores, suggesting the PERI-D items may be slightly more useful for detecting cases of depression in the community than for the broader range of psychiatric disorders. In general, the authors concur with earlier writers who suggest that brief psychiatric symptom scales may be useful as screening tests in community surveys, but such instruments do not in themselves provide good estimates of the prevalence of clinical psychiatric disorder in the community.     

Validation of diagnoses of distress disorders in the US National Comorbidity Survey Replication Adolescent Supplement (NCS-A)

Research diagnostic interviews need to discriminate between closely related disorders in order to allow comorbidity among mental disorders to be studied reliably. Yet conventional studies of diagnostic validity generally focus on single disorders and do not examine discriminant validity. The current study examines the validity of fully-structured diagnoses of closely-related distress disorders (generalized anxiety disorder, post-traumatic stress disorder, major depressive episode, and dysthymic disorder) in the lay-administered Composite International Diagnostic Interview Version 3.0 (CIDI) with independent clinical diagnoses based on the Schedule for Affective Disorders and Schizophrenia for School-Age Children (K-SADS) in the US National Comorbidity Survey Replication Adolescent Supplement (NCS-A). The NCS-A is a national survey of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) among 10,148 adolescents. A probability sub-sample of 347 of these adolescents and their parents were administered blinded follow-up K-SADS interviews. Good concordance [area under the receiver operating characteristic curve (AUC)] was found between diagnoses based on the CIDI and the K-SADS for generalized anxiety disorder (AUC = 0.78), post-traumatic stress disorder (AUC = 0.79), and major depressive episode/dysthymic disorder (AUC = 0.86). Further, the CIDI was able to effectively discriminate among different types of distress disorders in the sub-sample of respondents with any distress disorder.     

The Florence Psychiatric Interview

The Florence Psychiatric Interview (FPI) is an interviewing instrument for evaluating psychopathology in the community. The FPI is designed to be completed by clinical interviewers, and focuses on single episodes of illness where the symptoms are assessed and graded according to their severity on five‐point scales. Psychiatric symptoms are evaluated regardless of their diagnostic collocation, and period and lifetime diagnoses may be generated by combining the episodes and using the appropriate algorithms (the information provided by the FPI covers the requirements of all the present diagnostic systems). Other aspects of psychiatric disorders that are usually ignored in other interviews are investigated (for example, costs of illness, use of health facilities, life events, and personality traits). Data on reliability (inter‐rater agreement and test‐retest reliability) and agreement with other instruments such as the Composite International Diagnostic Interview (CIDI) and the Structured Clinical Interview for the Diagnostic and Statistic Manual of Mental Disorders (SCID) seem encouraging. The FPI's ability to collect lifetime symptoms by combining episodes matches that of an interview (the CIDI) that uses the lifetime approach. Agreement between fully qualified psychiatrists and trained residents was excellent. The ability of the cases to recall symptoms experienced several years before was also acceptable. This instrument is therefore proposed for clinical studies at the epidemiological level. Copyright © 2001 Whurr Publishers Ltd.     

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

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.     

The Composite International Diagnostic Interview. An epidemiologic Instrument suitable for use in conjunction with different diagnostic systems and in different cultures

The Composite International Diagnostic Interview (CIDI), written at the request of the World Health Organization/US Alcohol, Drug Abuse, and Mental Health Administration Task Force on Psychiatric Assessment Instruments, combines questions from the Diagnostic Interview Schedule with questions designed to elicit Present State Examination items. It is fully structured to allow administration by lay interviewers and scoring of diagnoses by computer. A special Substance Abuse Module covers tobacco, alcohol, and other drug abuse in considerable detail, allowing the assessment of the quality and severity of dependence and its course. This article describes the design and development of the CIDI and the current field testing of a slightly reduced "core" version. The field test is being conducted in 19 centers around the world to assess the interviews' reliability and its acceptability to clinicians and the general populace in different cultures and to provide data on which to base revisions that may be found necessary. In addition, questions to assess International Classification of Diseases, ninth revision, and the revised DSM-III diagnoses are being written. If all goes well, the CIDI will allow investigators reliably to assess mental disorders according to the most widely accepted nomenclatures in many different populations and cultures.     

Panic attacks as risk markers for mental disorders*

Abstract Objective This paper extends previous epidemiological findings linking panic attacks with future episodes of depression and examines whether this relationship is independent of the effects of gender and neuroticism. Methods Composite International Diagnostic Interview (CIDI) DSM-IV diagnoses from a stratified multi-stage population survey of 10,641 Australian adults were analysed using logistic regression to examine the relationship between lifetime panic attacks, gender, neuroticism and mental disorders. Results People who experienced full CIDI DSM-IV panic attacks more than 12 months ago were 4 times more likely to meet criteria for current Depressive Disorder than those who reported no attacks. Those with panic attacks in the past 12 months were 13.3 times more likely to report current Depressive Disorders. A similar pattern was also present for non-panic Anxiety Disorders (odds ratio=7.5 for lifetime, but not 12-month panic attacks, and 21.46 for 12-month panic attacks) and for Substance Use Disorders (2.1 and 4.6, respectively) suggesting a broader relationship with psychopathology than previously reported. For each of these groupings of mental disorders, panic attacks accounted for significant variability over and above the effects of gender, neuroticism, and comorbid Anxiety Disorders. Conclusions Panic attacks are associated with current and future Anxiety, Depressive, and Substance Use Disorders, and this relationship is not solely accounted for by differences in gender and neuroticism.* Previous Presentation: An earlier version of this paper was included in an unpublished PhD thesis by Andrew Baillie under the supervision of Prof Ron Rapee.