Original Articles

Composite International Diagnostic Interview screening scales for DSM-IV anxiety and mood disorders

R. C. Kessler^a1 c1, J. R. Calabrese^a2, P. A. Farley^a3, M. J. Gruber^a1, M. A. Jewell^a3, W. Katon^a4, P. E. Keck Jr.^a5, A. A. Nierenberg^a6, N. A. Sampson^a1, M. K. Shear^a7, A. C. Shillington^a3, M. B. Stein^a8, M. E. Thase^a9 and H.-U. Wittchen^a10

^a1 Department of Health Care Policy, Harvard Medical School, Boston, MA, USA

^a2 Department of Psychiatry, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, OH, USA

^a3 Clinical Services, EPI-Q, Inc., Oakbrook Terrace, IL, USA

^a4 School of Medicine, University of Washington, Seattle, WA, USA

^a5 Lindner Center of HOPE and Department of Psychiatry, University of Cincinnati College of Medicine, Cincinnati, OH, USA

^a6 Depression Clinical and Research Program and the Bipolar Clinic and Research Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA

^a7 Columbia University School of Social Work, New York, NY, USA

^a8 Department of Psychiatry, University of California San Diego, San Diego, CA, USA

^a9 Departments of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia Veterans Affairs Medical Center, and the University of Pittsburgh Medical Center, Philadelphia and Pittsburgh, PA, USA

^a10 Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany

Abstract

Lack of coordination between screening studies for common mental disorders in primary care and community epidemiological samples impedes progress in clinical epidemiology. Short screening scales based on the World Health Organization (WHO) Composite International Diagnostic Interview (CIDI), the diagnostic interview used in community epidemiological surveys throughout the world, were developed to address this problem.

Expert reviews and cognitive interviews generated CIDI screening scale (CIDI-SC) item pools for 30-day DSM-IV-TR major depressive episode (MDE), generalized anxiety disorder (GAD), panic disorder (PD) and bipolar disorder (BPD). These items were administered to 3058 unselected patients in 29 US primary care offices. Blinded SCID clinical reinterviews were administered to 206 of these patients, oversampling screened positives.

Stepwise regression selected optimal screening items to predict clinical diagnoses. Excellent concordance [area under the receiver operating characteristic curve (AUC)] was found between continuous CIDI-SC and DSM-IV/SCID diagnoses of 30-day MDE (0.93), GAD (0.88), PD (0.90) and BPD (0.97), with only 9–38 questions needed to administer all scales. CIDI-SC versus SCID prevalence differences are insignificant at the optimal CIDI-SC diagnostic thresholds (χ² ₁ = 0.0–2.9, p = 0.09–0.94). Individual-level diagnostic concordance at these thresholds is substantial (AUC 0.81–0.86, sensitivity 68.0–80.2%, specificity 90.1–98.8%). Likelihood ratio positive (LR+) exceeds 10 and LR− is 0.1 or less at informative thresholds for all diagnoses.

CIDI-SC operating characteristics are equivalent (MDE, GAD) or superior (PD, BPD) to those of the best alternative screening scales. CIDI-SC results can be compared directly to general population CIDI survey results or used to target and streamline second-stage CIDIs.

(Received June 21 2012)

(Accepted September 05 2012)

Key words

• Bipolar disorder;
• Composite International Diagnostic Interview (CIDI);
• generalized anxiety disorder;
• major depression;
• panic disorder;
• screening scales;
• validity

Correspondence:

^c1 Address for correspondence: R. C. Kessler, Ph.D., Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA 02115, USA. (Email: Kessler@hcp.med.harvard.edu)