2782 – An empirical study: are structured diagnostic interviews valid?

Abstract

Introduction Structured diagnostic interviews performed by non-clinicians are today frequently used for research purposes and are increasingly common in clinical practice. The validity of such interviews is theoretically unexamined and only poorly empirically studied. Aim To assess the validity of structured psychiatric diagnostic interviews using the SCID (Structured Clinical Interview for DSM-IV) as a representative. Methods A sample of 100 diagnostically heterogeneous, first-admitted inpatients were interviewed and diagnosed by a forthe- purpose trained non-clinician rater using the SCID. The DSM-IV diagnoses yield from the SCID interviews were compared with consensus Life-Time Best Estimate DSM-IV diagnoses. These diagnoses were assessed by two experienced research clinicians based on multiple sources of information, which included videotaped comprehensive semi-structured narrative interviews. Results The overall kappa agreement was 0.18. The sensitivity and specificity for the diagnosis of schizophrenia by the SCID were 19% and 100% respectively. Conclusions Structured diagnostic interviews in a first-admission inpatient sample are not a valid way of allocating psychiatric diagnoses and are not recommendable for clinical work. These interviews should only be used in research on the condition of certain prior precautions. It is suggested that a revival of systematic theoretical and practical training in psychopathology is an obvious way forward in order to improve the validity and hence, a therapeutic utility, of the psychiatric diagnosis.