New Research
National Comorbidity Survey Replication Adolescent Supplement (NCS-A): III. Concordance of DSM-IV/CIDI Diagnoses With Clinical Reassessments

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Abstract

Objective

To report results of the clinical reappraisal study of lifetime DSM-IV diagnoses based on the fully structured lay-administered World Health Organization Composite International Diagnostic Interview (CIDI) Version 3.0 in the U.S. National Comorbidity Survey Replication Adolescent Supplement (NCS-A).

Method

Blinded clinical reappraisal interviews with a probability subsample of 347 NCS-A respondents were administered using the Schedule for Affective Disorders and Schizophrenia for School-Age Children (K-SADS) as the gold standard. The DSM-IV/CIDI cases were oversampled, and the clinical reappraisal sample was weighted to adjust for this oversampling.

Results

Good aggregate consistency was found between CIDI and K-SADS prevalence estimates, although CIDI estimates were meaningfully higher than K-SADS estimates for specific phobia (51.2%) and oppositional defiant disorder (38.7%). Estimated prevalence of any disorder, in comparison, was only slightly higher in the CIDI than K-SADS (8.3%). Strong individual-level CIDI versus K-SADS concordance was found for most diagnoses. Area under the receiver operating characteristic curve, a measure of classification accuracy not influenced by prevalence, was 0.88 for any anxiety disorder, 0.89 for any mood disorder, 0.84 for any disruptive behavior disorder, 0.94 for any substance disorder, and 0.87 for any disorder. Although area under the receiver operating characteristic curve was unacceptably low for alcohol dependence and bipolar I and II disorders, these problems were resolved by aggregation with alcohol abuse and bipolar I disorder, respectively. Logistic regression analysis documented that consideration of CIDI symptom-level data significantly improved prediction of some K-SADS diagnoses.

Conclusions

These results document that the diagnoses made in the NCS-A based on the CIDI have generally good concordance with blinded clinical diagnoses.

Section snippets

NCS-A Sample

The NCS-A is a nationally representative face-to-face survey of 10,148 adolescents (aged 13–17 years) in the continental United States performed between February 2001 and January 2004 in a dual-frame sample that included a household subsample and a school subsample. The household subsample consisted of adolescent residents of the households that participated in the National Comorbidity Survey Replication (NCS-R), a nationally representative household survey of adults.28 This subsample was

Aggregate Concordance

It should be noted that the prevalence estimates presented here are not identical to the NCS-A prevalence estimates. Instead, they represent best estimates in the clinical reappraisal sample based on an attempt to weight the latter sample as best we could to represent the larger sample. There are inevitable limitations to this weighting procedure, however, based on the small size of the clinical reappraisal sample. Within the context of these limitations, the McNemar tests of CIDI versus K-SADS

Discussion

Before turning to substantive interpretation, a number of methodological limitations must be acknowledged. First, K-SADS interviews were performed by telephone, and CIDI interviews were performed face-to-face. Although telephone interviews constitute a valid mode of clinical assessment in both adults29, 30 and adolescents,31, 32 we do not know what would have happened if the same mode of administration had been used in both interviews. Second, the design of the clinical reappraisal study, in

References (66)

  • RC Kessler et al.

    The prevalence and correlates of nonaffective psychosis in the National Comorbidity Survey Replication

    Biol Psychiatry

    (2005)
  • MF Lenzenweger et al.

    DSM-IV personality disorders in the National Comorbidity Survey Replication

    Biol Psychiatry

    (2007)
  • HR Kranzler et al.

    Validity of the longitudinal, expert, all data procedure for psychiatric diagnosis in patients with psychoactive substance use disorders

    Drug Alcohol Depend

    (1997)
  • PJ Ambrosini

    Historical development and present status of the schedule for affective disorders and schizophrenia for school-age children (K-SADS)

    J Am Acad Child Adolesc Psychiatry

    (2000)
  • A Angold et al.

    The Child and Adolescent Psychiatric Assessment (CAPA)

    J Am Acad Child Adolesc Psychiatry

    (2000)
  • BM Booth et al.

    Diagnosing depression in the medically ill: validity of a lay-administered structured diagnostic interview

    J Psychiatr Res

    (1998)
  • RL Spitzer

    Psychiatric diagnosis: are clinicians still necessary?

    Compr Psychiatry

    (1983)
  • CM Lewczyk et al.

    Comparing DISC-IV and clinician diagnoses among youths receiving public mental health services

    J Am Acad Child Adolesc Psychiatry

    (2003)
  • J Jewell et al.

    Comparing the validity of clinician-generated diagnosis of conduct disorder to the diagnostic interview schedule for children

    J Clin Child Adolesc Psychol

    (2004)
  • TS Brugha et al.

    A general population comparison of the Composite International Diagnostic Interview (CIDI) and the Schedules for Clinical Assessment in Neuropsychiatry (SCAN)

    Psychol Med

    (2001)
  • JM Haro et al.

    Concordance of the Composite International Diagnostic Interview Version 3.0 (CIDI 3.0) with standardized clinical assessments in the WHO World Mental Health surveys

    Int J Methods Psychiatr Res

    (2006)
  • WE Narrow et al.

    Revised prevalence estimates of mental disorders in the United States: using a clinical significance criterion to reconcile 2 surveys' estimates

    Arch Gen Psychiatry

    (2002)
  • A Angold et al.

    The Child and Adolescent Psychiatric Assessment (CAPA)

    Psychol Med

    (1995)
  • EJ Costello et al.

    Validity of the NIMH Diagnostic Interview Schedule for Children: a comparison between psychiatric and pediatric referrals

    J Abnorm Child Psychol

    (1985)
  • MH Boyle et al.

    Evaluation of the Diagnostic Interview for Children and Adolescents for use in general population samples

    J Abnorm Child Psychol

    (1993)
  • L Ezpeleta et al.

    Diagnostic agreement between clinicians and the Diagnostic Interview for Children and Adolescents—DICA-R—in an outpatient sample

    J Child Psychol Psychiatry

    (1997)
  • Kessler RC, Avenevoli S, Costello EJ et al. Design and field procedures in the US National Comorbidity Survey...
  • RC Kessler et al.

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

    Int J Methods Psychiatr Res

    (2004)
  • RC Kessler et al.

    Methodological studies of the Composite International Diagnostic Interview (CIDI) in the US National Comorbidity Survey

    Int J Methods Psychiatr Res

    (1998)
  • HU Wittchen et al.

    Reliability and procedural validity of UM-CIDI DSM-III-R phobic disorders

    Psychol Med

    (1996)
  • JK Wing et al.

    SCAN. Schedules for Clinical Assessment in Neuropsychiatry

    Arch Gen Psychiatry

    (1990)
  • G Andrews et al.

    A comparison of two structured diagnostic interviews: CIDI and SCAN

    Aust N Z J Psychiatry

    (1995)
  • V Jordanova et al.

    Validation of two survey diagnostic interviews among primary care attendees: a comparison of CIS-R and CIDI with SCAN ICD-10 diagnostic categories

    Psychol Med

    (2004)
  • Cited by (0)

    The National Comorbidity Survey Replication Adolescent Supplement (NCS-A) is supported by the National Institute of Mental Health (NIMH; Grant U01-MH60220) with supplemental support from the National Institute on Drug Abuse, the Substance Abuse and Mental Health Services Administration, the Robert Wood Johnson Foundation (Grant 044780), and the John W. Alden Trust. The work of Dr. Merikangas and her staff on the NCS-A is additionally supported by the NIMH Intramural Research Program, whereas the work of Dr. Zaslavsky and his staff on the validity of the NCS-A measures is supported by NIMH Grant R01-MH66627. The views and opinions expressed in this article are those of the authors and should not be construed to represent the views of any of the sponsoring organizations, agencies, or U.S. Government. A complete list of NCS-A publications can be found at http://www.hcp.med.harvard.edu/ncs.

    The NCS-A is performed in conjunction with the World Health Organization World Mental Health (WMH) Survey Initiative. The authors thank the staff of the WMH Coordination Centers for assistance with instrumentation, fieldwork, and consultation on data analysis. The WMH Data Coordination Centers have received support from NIMH (Grants R01-MH070884, R13-MH066849, R01-MH069864, and R01-MH077883), National Institute on Drug Abuse (Grant R01-DA016558), the Fogarty International Center of the National Institutes of Health (Grant R03-TW006481), the John D. and Catherine T MacArthur Foundation, the Pfizer Foundation, and the Pan American Health Organization. The WMH Data Coordination Centers have also received unrestricted educational grants from AstraZeneca, Bristol-Myers Squibb, Eli Lilly and Company, GlaxoSmithKline, Ortho-McNeil, Pfizer, Sanofi-Aventis, and Wyeth. A complete list of WMH publications can be found at http://www.hcp.med.harvard.edu/wmh.

    The authors thank Steven Heeringa, Ph.D., and Alan Zaslavsky, Ph.D., as the statistical experts for this article.

    This article is the subject of an editorial by Dr. Peter Szatmari in this issue.

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