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.     

The World Mental Health (WMH) Survey Initiative Version of the World Health Organization (WHO) Composite International Diagnostic Interview (CIDI)

This paper presents an overview of the World Mental Health (WMH) Survey Initiative version of the World Health Organization (WHO) Composite International Diagnostic Interview (CIDI) and a discussion of the methodological research on which the development of the instrument was based. The WMH-CIDI includes a screening module and 40 sections that focus on diagnoses (22 sections), functioning (four sections), treatment (two sections), risk factors (four sections), socio-demographic correlates (seven sections), and methodological factors (two sections). Innovations compared to earlier versions of the CIDI include expansion of the diagnostic sections, a focus on 12-month as well as lifetime disorders in the same interview, detailed assessment of clinical severity, and inclusion of information on treatment, risk factors, and consequences. A computer-assisted version of the interview is available along with a direct data entry software system that can be used to keypunch responses to the paper-and-pencil version of the interview. Computer programs that generate diagnoses are also available based on both ICD-10 and DSM-IV criteria. Elaborate CD-ROM-based training materials are available to teach interviewers how to administer the interview as well as to teach supervisors how to monitor the quality of data collection.     

复合性国际诊断访谈表的效度研究

目的 探讨复合性国际诊断访谈表(CIDI)3.1中文版对精神疾病诊断的效度.方法 利用美国精神障碍诊断与统计手册第4版(DSM-Ⅳ)配套的半定式临床问卷(SCID)对400名在精神疾病流行病学调查中接受过CIDI访谈的被试进行检查,根据DSM-Ⅳ作出诊断,比较CIDI和SCID的诊断效度.结果 CIDI 3.1与SCID的诊断一致率由高到低排列:分别为心境障碍、焦虑障碍、精神病性障碍,Kappa值依次为0.53、0.25、0.16;CIDI诊断灵敏度由高到低分别为心境障碍(77.8%)、焦虑障碍(55.8%)、精神病性障碍(40.0%),而对整个精神疾病的诊断灵敏度为93.4%.CIDI诊断特异度由高到低分别为精神病性障碍(96.0%)、心境障碍(76.0%)、焦虑障碍(76.0%),对整个精神疾病的诊断特异度为39.2%.结论 CIDI 3.1对于确定整个精神疾病、心境障碍及焦虑障碍有较高的灵敏度,对于后两者及精神病性障碍有较好的特异度,不失为精神疾病流行病学调查的较好工具.但应注意社区人群中CIDI与SCID对于焦虑障碍和精神病性障碍的诊断一致性相对较差.     

Prevalence of psychiatric disorders in Taiwan defined by the Chinese Diagnostic Interview Schedule

The Taiwan Psychiatric Epidemiological Project, conducted from 1982 to 1986, used the multistage random sampling method with 5005, 3004 and 2995 subjects selected respectively from metropolitan Taipei (MT), 2 small towns (ST) and 6 rural villages (RV). The case identification tool was the Chinese modified Diagnostic Interview Schedule (DIS-CM). This study presents the lifetime and one-year prevalence of 27 and of 17 specific psychiatric disorders respectively. The lifetime prevalence of any disorder defined by the DIS-CM -- excluding tobacco dependence -- was 16.3%, 28.0% and 21.5% in the MT, ST and RV samples respectively. The differences in lifetime prevalence between the sexes and between the 3 sampling areas were significant for 15 and 8 disorders respectively. The ST sample seemed to have the most disorders, with the highest prevalence among 3 sampling areas. The mean ratio of one-year to lifetime prevalence was 0.67. The differences in prevalence rates between the 3 sampling areas and between the international studies are discussed from methodological, social and cultural points of view.     

The Composite International Diagnostic Interview (CIDI-Auto): problems and remedies for diagnosing panic disorder and social phobia

In a recent study of treatment for panic disorder in primary care, the Composite International Diagnostic Interview (CIDI-Auto) was used to provide psychiatric diagnoses. However, during and after data collection, it was discovered that the CIDI appeared to place, or fail to place, a substantial number of people into diagnostic categories in ways that conflicted with the investigators' clinical experience. The wording of questions in the panic module, coupled with a lack of structured follow-up probes, resulted in apparent false negatives for panic disorder. Moreover, patients who would otherwise meet criteria for panic disorder or social phobia did not receive a diagnosis based on rules that may be discordant with clinical practice and, at times, the design of the DSM-IV. For this study, changes were made to the interview, including additional probes for the panic disorder module and modification of the decision rules used to assign or rule out diagnoses of panic disorder and social phobia. The changes resulted in greater inclusion of patients in the panic disorder and social phobia diagnostic categories and we argue that these changes to the CIDI-Auto increase the clinical validity of this instrument. We did not examine the false positive rate for the unmodified or modified CIDI, but this is an important issue that needs to be evaluated in future research.     

Methodological studies of the Composite International Diagnostic Interview (CIDI) in the US national comorbidity survey (NCS)

This paper reports the results of methodological studies carried out in conjunction with the US National Comorbidity Survey (NCS) to evaluate Version 1.0 of the World Health Organization (WHO) Composite International Diagnostic Interview (CIDI). These studies relied on recent survey data collection methodology literature to investigate problems regarding question comprehension, instruction comprehension, respondent motivation to report accurately, and regarding the limits of respondent ability to report accurately. Insights and strategies developed by survey methodologists were used to modify the CIDI in an effort to address these problems. The paper describes these strategies and methodological studies that evaluated their effects, including a clinical reappraisal study and a field experiment that evaluated the impact of question modifications on prevalence estimates. The paper closes with a discussion of remaining methodological problems with the CIDI and potentially useful future studies that might be able to develop solutions to these problems. Copyright © 1998 Whurr Publishers Ltd.     

The World Health Organization Composite International Diagnostic Interview short-form (CIDI-SF)

Data are reported on a series of short-form (SF) screening scales of DSM-III-R psychiatric disorders developed from the World Health Organization's Composite International Diagnostic Interview (CIDI). A multi-step procedure was used to generate CIDI-SF screening scales for each of eight DSM disorders from the US National Comorbidity Survey (NCS). This procedure began with the subsample of respondents who endorsed the CIDI diagnostic stem question for a given disorder and then used a series of stepwise regression analyses to select a subset of screening questions to maximize reproduction of the full CIDI diagnosis. A small number of screening questions, between three and eight for each disorder, was found to account for the significant associations between symptom ratings and CIDI diagnoses. Summary scales made up of these symptom questions correctly classify between 77% and 100% of CIDI cases and between 94% and 99% of CIDI non-cases in the NCS depending on the diagnosis. Overall classification accuracy ranged from a low of 93% for major depressive episode to a high of over 99% for generalized anxiety disorder. Pilot testing in a nationally representative telephone survey found that the full set of CIDI-SF scales can be administered in an average of seven minutes compared to over an hour for the full CIDI. The results are quite encouraging in suggesting that diagnostic classifications made in the full CIDI can be reproduced with excellent accuracy with the CIDI-SF scales. Independent verification of this reproduction accuracy, however, is needed in a data set other than the one in which the CIDI-SF was developed. Copyright © 1998 Whurr Publishers Ltd.     

Comparison of Composite International Diagnostic Interview and clinical DSM-III-R criteria checklist diagnoses.

This article describes a comparison of Composite International Diagnostic Interview (CIDI) diagnostic results and results based on clinicians' observation of CIDI assessments. Psychiatrists scored a DSM-III-R criteria checklist either while observing or after administering 20 CIDI interviews. Overall diagnostic concordance between the checklist and CIDI diagnoses was found to be good (kappa = 0.78). Good diagnostic agreement was also found for 3 groups of DSM-III-R disorders: depressive disorders (kappa = 0.84), psychoactive substance use disorders (kappa = 0.83) and anxiety phobic disorders (kappa = 0.76). These results are consistent with the results from a similar comparison between the CIDI and checklist results for ICD-10 diagnoses.     

To what degree does the Composite International Diagnostic Interview (CIDI) correctly identify DSM-IV disorders? Testing validity issues in a clinical sample

This paper compares diagnoses of the DSM-IV algorithms of the computer-assisted version of the Munich-Composite International Diagnostic Interview (M-CIDI) with clinical diagnoses made by treating physicians using the standard LEAD procedure. A random sample of 68 patients being treated in three psychiatric and one neurological ward of the Max Planck Institute of Psychiatry were first examined with the CIDI, using the M-CIDI/DSM-IV algorithms. Diagnostic findings were then compared with lifetime and cross-sectional diagnoses assigned by the treating physician, who was blind to the CIDI findings, taking into account all available symptom and diagnostic information from current and previous charts as well as his own assessments. Clinicians were encouraged to use the DSM-IV manual to assign multiple lifetime diagnoses and not to focus exclusively on primary diagnoses. To explore agreements and disagreements further, all discrepant cases were subsequently discussed with the treating physicians. There was generally good concordance between clinicians and interview DSM-IV diagnoses, with the exception of psychotic disorders (kappa: 0.21), dysthymia (0.54) and somatoform disorders (0.50), with kappa values for the remaining categories ranging from 0.63 (any panic disorder) to 0.96 (any depressive episode). It is concluded that the M-CIDI, in clinical cases, provides valid diagnoses for almost all non-psychotic disorders and is sensitive for all disorders but might have reduced specificity and predictive value in some anxiety and somatoform disorders. Copyright © 1998 Whurr Publishers Ltd.     

Characteristics of postictal psychosis in a psychiatric center

The clinical characteristics of 12 cases of postictal psychosis treated at Taipei City Psychiatric Center, Taipei, Taiwan, were retrospectively reviewed. Increased seizure frequency, especially with generalized tonic-clonic seizures, was the major risk factor predisposing to postictal psychosis. The psychotic symptoms were variable with delusions and/or hallucinations. These patients showed a much longer history of epilepsy (21.9 +/- 10.7 years) prior to the development of postictal psychosis than has been previously reported. The possible mechanisms in the pathophysiology of psychosis in epileptics were discussed.     

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.     

Bipolar disorder in a national survey using the World Mental Health Version of the Composite International Diagnostic Interview: the impact of differing diagnostic algorithms

Mitchell PB, Johnston AK, Frankland A, Slade T, Green MJ, Roberts G, Wright A, Corry J, Hadzi‐Pavlovic D. Bipolar disorder in a national survey using the World Mental Health Version of the Composite International Diagnostic Interview: the impact of differing diagnostic algorithms. Objective: The World Mental Health Version of the Composite International Diagnostic Interview (WMH‐CIDI) DSM‐IV bipolar disorder diagnostic algorithms were recalibrated in about 2006 following evidence of over‐diagnosis of bipolar I disorder. There have been no reports of the impact of this recalibration on epidemiological findings. Method: Data were taken from the 2007 Australian National Survey of Mental Health and Wellbeing. Findings for cases identified by the recalibrated bipolar disorder definition were contrasted against those identified by the un‐recalibrated definition. Results: The 12‐month prevalence of recalibrated bipolar disorder and un‐recalibrated bipolar disorder were 0.9% and 1.7% respectively. The un‐recalibrated bipolar disorder group was younger and more likely to have never married than the recalibrated bipolar disorder group. They were also more likely to have a comorbid alcohol use disorder, substance use disorder and asthma or arthritis. While they were more likely to have at least severe interference in at least one of the Sheehan Scale domains of functioning, they were less likely to have made a suicide attempt. Similarly, they were less likely to have consulted a psychiatrist. Conclusion: It is not possible to be certain about the nature of these differences. Some may be artifactual (reflecting greater statistical power to detect differences with the larger un‐recalibrated bipolar disorder defined sample), while others may be indicative of the inclusion of a clinically distinct subpopulation with the un‐recalibrated bipolar disorder definition, thereby producing a more heterogeneous sample. These findings indicate the need for clarity in the diagnostic algorithm used in epidemiological reports on bipolar disorder using the World Mental Health Version of the Composite International Diagnostic Interview.     

The psychometric properties of the Composite International Diagnostic Interview

The Composite International Diagnostic Interview, or CIDI, is a fully structured interview that maps the symptoms elicited during the interview onto DSM-IV and ICD-10 diagnostic criteria and reports whether the diagnostic criteria are satisfied – nothing more, nothing less. The inter-rater reliability has been demonstrated to be excellent, the test-retest reliability good, and the validity has been demonstrated to be good, given the methodological constraints. The CIDI is available in lifetime and 12-month versions, and in both paper-and-pencil and computer-administered forms. The latter version is suitable for self-administration in cooperative subjects. The CIDI is available in many languages. It is supported by ten centres around the world, which conduct regular training programmes for interviewers. The training programmes are standardised and the training materials are comprehensive. The data from the CIDI is entered into standard data entry and scoring programmes that give as output the diagnostic criteria satisfied. The interviews, the training materials, and the scoring programmes are copyright by the World Health Organization (WHO) and are supervised by an advisory committee on behalf of WHO. That committee and the training centres welcome enquiries from researchers and clinicians who are interested in using the CIDI. Accepted: 17 February 1997     

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.     

Patients with methamphetamine psychosis admitted to a psychiatric hospital in Japan

To examine the clinical characteristics of methamphetamine (MAP) psychosis in Japan, we evaluated 104 patients with MAP psychosis (80 men and 24 women) admitted to the closed psychiatric units of Tokyo Metropolitan Matsuzawa Hospital between 1988 and 1991. There has recently been a steep increase in the number of admissions for MAP psychosis, reflecting the growth of the epidemic of MAP abuse in Japan. Although more than half of the patients were discharged within one month, 16 patients were hospitalized for more than 3 months. Most of the patients showed paranoid psychotic state similar to schizophrenia, consistent with previous reports. Despite the abstinence from MAP and antipsychotic medication, psychotic symptoms tended to persist in some of the patients. The etiological role of MAP psychosis in the development of long-lasting psychotic state was discussed.     

Development and validation of the Diagnostic Interview Adjustment Disorder (DIAD)

Adjustment disorders (ADs) are under‐researched due to the absence of a reliable and valid diagnostic tool. This paper describes the development and content/construct validation of a fully structured interview for the diagnosis of AD, the Diagnostic Interview Adjustment Disorder (DIAD). We developed the DIAD by partly adjusting and operationalizing DSM‐IV criteria. Eleven experts were consulted on the content of the DIAD. In addition, the DIAD was administered by trained lay interviewers to a representative sample of disability claimants (n = 323). To assess construct validity of the DIAD, we explored the associations between the AD classification by the DIAD and summary scores of the Kessler Psychological Distress 10‐item Scale (K10) and the World Health Organization Disability Assessment Schedule (WHODAS) by linear regression. Expert agreement on content of the DIAD was moderate to good. The prevalence of AD using the DIAD with revised criteria for the diagnosis AD was 7.4%. The associations of AD by the DIAD with average sum scores on the K10 and the WHODAS supported construct validity of the DIAD. The results provide a first indication that the DIAD is a valid instrument to diagnose AD. Further studies on reliability and on other aspects of validity are needed. Copyright © 2014 John Wiley & Sons, Ltd.     

One‐year test–retest reliability of a Japanese web‐based version of the WHO Composite International Diagnostic Interview (CIDI) for major depression in a working population

The purpose of this study was to investigate the one‐year test–retest reliability and the demographic correlates of a self‐administered web‐based depression section of the World Health Organization‐Composite International Diagnostic Interview (WHO‐CIDI) in a working population. Overall, 1060 out of all employees (N = 1279) from a manufacturing company in Japan responded to two web‐based surveys of depression of the WHO‐CIDI within a one‐year interval in 2009 and 2010. The concordance between lifetime diagnoses of major depressive disorder on two occasions was calculated as percent agreement (%), Gwet's AC₁, and Yule's Q indicators were compared by gender, age, education, and marital status. For the total sample, percent agreement was 94%, AC₁ was 0.93, and Yule's Q was 0.82. The concordance rate was low (0.15) among those who were diagnosed at either time or both times. The concordance differed significantly across education and marital status. While the agreement indicators were relatively high, consistent with previous reports based on face‐to‐face interviews conducted within a shorter interval, the low stability of positive cases may challenge the accuracy of lifetime diagnosis of major depressive disorder using a web version of the WHO‐CIDI. Education and marital status might affect the test–retest reliability. Copyright © 2014 John Wiley & Sons, Ltd.