PSYD33H3 Chapter Notes - Chapter 0: Major Depressive Disorder, Psychiatric Epidemiology, Neuropsychiatry
A Comparison of Self-report and Clinical Diagnostic Interviews for Depression
Background:
• The field of psychiatric epidemiology continues to employ self-report instruments, but
the low degree of agreement between diagnoses achieved using these instruments vs
that achieved by psychiatrists in the clinical modality threatens the credibility of the
results
Methods:
• In the Baltimore Epidemiologic Catchment Area follow-up, 349 individuals who had a
Diagnostic Interview Schedule (DIS) interview were blindly examined by psychiatrists
using the schedules for clinical assessment in neuropsychiatry (SCAN)
o DIS Interview
▪ Interviews took place in the respondents’ house, using the DIS, version III,
revised
▪ Interviewers were typical survey interviewers
▪ Diagnostic algorithms for DSM-III-R were used
▪ Subjects discussed and signed informed-consent documents both for the
household phase of the research and for the office-visit
o SCAN Interview
▪ Respondents who, on the basis of their baseline and follow-up responses,
seemed to be potential new cases with any of 7 disorders (major
depressive disorder, panic disorder, agoraphobia, social phobia,
obsessive-compulsive disorder, alcohol use disorder, and cognitive
impairment) were invited to a local office for an examination by a
psychiatrist and a series of personality, risk factor, and
neuropsychological tests
• Comparisons were made at the level of diagnosis, syndrome, and DSM-IV symptom
group
• Indexes of agreement were computed, and characteristics of discrepant cases were
identified
Results:
• About 1/5 of the respondents in the office-visit phase of the study received a lifetime
diagnosis of depressive disorder on either the DIS or the SCAN
• Agreement on diagnosis of major depressive disorder was only fair (k = 0.20), with the
DIS missing many cases judged to meet criteria for diagnosis using the SCAN (29%
sensitivity)
• A major source of discrepancy was respondents with false-negative diagnoses who
repeatedly failed to report DIS symptoms attributed to life crises or medical conditions
• Older age, male sex, and lower impairment were associated with under detection by the
DIS, using logistic regression analysis
