Cross‐cultural factorial validation of the Clinical Interview Schedule – Revised (CIS‐R); findings from a nationally representative survey (EMPIRIC)

Jayati Das‐Munshi,Martin Prince,Erico Castro‐Costa,James Nazroo,Michael E Dewey

doi:10.1002/mpr.1428

Abstract

The Clinical Interview Schedule – Revised (CIS‐R) has been widely adopted across cultures to assess common mental disorders. We assessed the factorial validity of the CIS‐R across ethnic minority groups, using data from a nationally representative survey conducted in England in 2000. The sample comprised White British (n = 837), Irish (n = 733), Black Caribbean (n = 694), Bangladeshi (n = 650), Indian (n = 643) and Pakistani (n = 724) respondents. Ordered logistic regression determined the reporting of CIS‐R symptoms. Principal components analysis (PCA) determined the underlying construct of the CIS‐R in White British participants. These factor solutions were then assessed for “best fit” using confirmatory factor analyses (CFAs) across all ethnic groups.In ordered logistic regression analyses, there was heterogeneity in the reporting of worries, phobias, panic and somatic symptoms across ethnic minority groups relative to the White British group. “Best” fit solutions confirmed through CFA were models where all symptoms were allowed to vary across ethnic groups, or models where an underlying “depression‐anxiety” construct was held invariant while “somatic symptoms” were permitted to vary across groups, although differences between models assessed were slight.In conclusion, there may be benefits in assessing the functioning of certain CIS‐R items within specific cultural contexts to ensure adequate face validity of the CIS‐R. Copyright © 2014 John Wiley & Sons, Ltd.

Highlights

Informed presentations of mental distress continue to provide challenges to psychiatric diagnoses (Dimsdale et al, 2007)
The main objectives of this study are to assess: (1) if the reporting of the 14 symptoms on the Clinical Interview Schedule – Revised (CIS-R) varies across ethnic minority groups; (2) if the underlying factor structure of the common mental disorders as assessed by the CIS-R is similar across ethnic groups; (3) if the “fit” of the CIS-R across ethnic groups improves when “somatic symptoms” are allowed to vary whilst “depression-anxiety” symptoms are held invariant, assessing the hypothesis that there is a universal underlying “depression”/”anxiety” construct to the common mental disorders, somatic symptom expression may vary according to cultural context (Weich et al, 2004)
Of the sample 54% was female, and 33% of the sample were in social class 4 and 5, with the ethnic minority groups tending to be of a lower social class than the White British group

Summary

Introduction

Informed presentations of mental distress continue to provide challenges to psychiatric diagnoses (Dimsdale et al, 2007). Epidemiological studies have suggested that the common mental disorders are universal phenomena both in international and transcultural settings (Simon et al, 1999; Simon et al, 2002; Weich et al, 2004), it is widely held that the expression and Factor structure of common mental disorders and ethnicity. The Clinical Interview Schedule – Revised (CIS-R) is a structured validated instrument which has been used to assess the prevalence of common mental disorders (Lewis et al, 1992) It has been used in a number of contexts to examine the prevalence of common mental disorders across ethnic minority groups (Sproston and Nazroo, 2002) or even to act as a “gold standard” against which other instruments are assessed (Patel et al, 2008), there have been very few studies which have directly assessed its psychometric properties within a cross-cultural context. One previous study examined the factor structure of the CIS-R using samples derived from primary care across four different international settings, smaller sample sizes resulted in low prevalence symptoms being discarded from this analysis (Jacob et al, 1998)

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