A comparison of the Composite International Diagnostic Interview (CIDI-Auto) with clinical assessment in diagnosing mood and anxiety disorders.
OBJECTIVE
Increasingly, epidemiological studies are employing computerized and highly standardized interviews, such as the Composite International Diagnostic Interview (CIDI-Auto), to assess the prevalence of psychiatric illness. Recent studies conducted in specialist units have reported poor agreement between experienced clinicians' and CIDI-Auto diagnoses. In this study we investigated the concordance rate between clinicians and the CIDI-Auto for the diagnosis of six anxiety disorders and two mood disorders, whereby the CIDI-Auto was treated as the 'gold standard'.


METHODS
Subjects were 262 patients who were assessed by a clinical psychologist or psychiatrist and completed the CIDI-Auto at a tertiary referral unit for anxiety and mood disorders. Agreement between the clinicians' diagnoses and the diagnoses generated by the CIDI-Auto according to both DSM-IV and ICD-10 codes, were examined by kappa statistics. Sensitivity and specificity values were also calculated.


RESULTS
Agreement between clinicians and the CIDI-Auto (DSM-IV) ranged from poor for social phobia and posttraumatic stress disorder (kappa < 0.30) to moderate for obsessive- compulsive disorder (OCD; kappa = 0.52). Agreement between clinicians and the CIDI-Auto (ICD-10) ranged from poor for major depressive episode (kappa = 0.25) to moderate for OCD (kappa = 0.57). With the CIDI diagnosis treated as the gold standard, clinicians' diagnoses showed low sensitivity (kappa < 0.70) for all the disorders except for OCD (for ICD-10), but high specificity (kappa > 0.70) for all the disorders.


CONCLUSIONS
Poor agreements between experienced clinicians and the CIDI-Auto were reported for anxiety and mood disorders in the current study. A major implication is that if diagnosis alone directed treatment, then patients could receive different treatments, depending on whether the computer, or a clinician, made the diagnosis.
Komiti
A A
AA
University of Melbourne, Department of Psychiatry, Depression and Anxiety Research and Treatment Program, Royal Melbourne Hospital, Parkville, Victoria 3052, Australia. angelaak@unimelb.edu.au
Jackson
H J
HJ
Judd
F K
FK
Cockram
A M
AM
Kyrios
M
M
Yeatman
R
R
Murray
G
G
Hordern
C
C
Wainwright
K
K
Allen
N
N
Singh
B
B
D000328:Adult; D001008:Anxiety Disorders / Q000175:diagnosis*; D003657:Decision Making; D005260:Female; D006801:Humans; D007406:Interview, Psychological; D008297:Male; D019964:Mood Disorders / Q000175:diagnosis*; D011569:Psychiatric Status Rating Scales; D012680:Sensitivity and Specificity