Lorna Peters

The psychometric properties of the Composite International Diagnostic Interview.

Abstract The Composite International Diagnostic Interview, or CIDI, is a fully structured interview that maps the symptoms elicited during the interview onto DSM-IV and ICD-10 diagnostic criteria and reports whether the diagnostic criteria are satisfied – nothing more, nothing less. The inter-rater reliability has been demonstrated to be excellent, the test-retest reliability good, and the validity has been demonstrated to be good, given the methodological constraints. The CIDI is available in lifetime and 12-month versions, and in both paper-and-pencil and computer-administered forms. The latter version is suitable for self-administration in cooperative subjects. The CIDI is available in many languages. It is supported by ten centres around the world, which conduct regular training programmes for interviewers. The training programmes are standardised and the training materials are comprehensive. The data from the CIDI is entered into standard data entry and scoring programmes that give as output the diagnostic criteria satisfied. The interviews, the training materials, and the scoring programmes are copyright by the World Health Organization (WHO) and are supervised by an advisory committee on behalf of WHO. That committee and the training centres welcome enquiries from researchers and clinicians who are interested in using the CIDI.

Exposure and cognitive restructuring for social phobia: A controlled study *

Forty-three social phobics were assigned to exposure (EXP), cognitive restructuring without exposure (CR-alone), or to an intervention combining these techniques (COMB), in a wait-list controlled (WLC) trial. Treatment integrity assessment showed compliance with instructions consistent with the treatments. Within-group analyses showed that the COMB and CR-alone groups improved significantly on all variables, whereas the EXP group showed changes on phobia but not attitudinal measures. Between-group analyses indicated COMB to be superior to EXP on two phobia measures. CR-alone was inferior to EXP and COMB on behavioral approach after treatment, but showed continued improvement relative to the exposure groups on this and other variables by follow-up. The relative ability of treatment-induced changes in fear of negative evaluation (FNE), locus of control, and irrational beliefs to predict long-term improvement was assessed. Changes in these variables were predictive of improvement. The change in FNE accounted for the majority of the explained variance.

WHO Study on the reliability and validity of the alcohol and drug use disorder instruments: overview of methods and results

The WHO Study on the reliability and validity of the alcohol and drug use disorder instruments in an international study which has taken place in centres in ten countries, aiming to test the reliability and validity of three diagnostic instruments for alcohol and drug use disorders: the Composite International Diagnostic Interview (CIDI), the Schedules for Clinical Assessment in Neuropsychiatry (SCAN) and a special version of the Alcohol Use Disorder and Associated Disabilities Interview schedule-alcohol/drug-revised (AUDADIS-ADR). The purpose of the reliability and validity (R&V) study is to further develop the alcohol and drug sections of these instruments so that a range of substance-related diagnoses can be made in a systematic, consistent, and reliable way. The study focuses on new criteria proposed in the tenth revision of the International Classification of Diseases (ICD-10) and the fourth revision of the diagnostic and statistical manual of mental disorders (DSM-IV) for dependence, harmful use and abuse categories for alcohol and psychoactive substance use disorders. A systematic study including a scientifically rigorous measure of reliability (i.e. 1 week test-retest reliability) and validity (i.e. comparison between clinical and non-clinical measures) has been undertaken. Results have yielded useful information on reliability and validity of these instruments at diagnosis, criteria and question level. Overall the diagnostic concordance coefficients (kappa, kappa) were very good for dependence disorders (0.7-0.9), but were somewhat lower for the abuse and harmful use categories. The comparisons among instruments and independent clinical evaluations and debriefing interviews gave important information about possible sources of unreliability, and provided useful clues on the applicability and consistency of nosological concepts across cultures.

Discriminant validity of the Social Phobia and Anxiety Inventory (SPAI), the Social Phobia Scale (SPS) and the Social Interaction Anxiety Scale (SIAS)

Three measures commonly used in assessment of social phobia, the Social Phobia and Anxiety Inventory (SPAI [Turner, S. M., Beidel, D. C. & Dancu, C. V. (1996). Social phobia and anxiety inventory: manual. Toronto, Ont.: Multi-Health Systems Inc.), the Social Phobia Scale (SPS [Mattick, R. P. & Clarke, J. C. (1998). Development and validation of measures of social phobia scrutiny fear and social interaction anxiety. Behaviour Research and Therapy, 36, 455-470] and the Social Interaction Anxiety Scale (SIAS [Mattick, R. P. & Clarke, J. C. (1998). Development and validation of measures of social phobia scrutiny fear and social interaction anxiety. Behaviour Research and Therapy, 36, 455-470], were compared for their ability to discriminate between social phobia and other anxiety disorders (panic disorder with or without agoraphobia). Participants were 117 patients attending a specialized anxiety disorders unit for treatment. While all three measures were able to detect differences between social phobic patients and patients with panic disorder with or without agoraphobia, a logistic regression analysis showed that the SPAI, but not the SPS and SIAS, was a significant predictor of membership of the social phobia group. Receiver operating characteristic (ROC) analysis also showed that the SPAI was the better measure for discriminating between social phobia and panic disorder with and without agoraphobia. Analysis of the sensitivity, specificity and positive and negative predictive power of the measures at the optimum cutoff scores produced by the ROC analysis are presented.

Procedural validity of the computerized version of the Composite International Diagnostic Interview (CIDI-Auto) in the anxiety disorders

The procedural validity of the computerized version of the Composite International Diagnostic Interview (CIDI-Auto) was examined against the consensus diagnoses of two clinicians for six anxiety disorders (agoraphobia, panic disorder (+/- agoraphobia), social phobia, simple phobia, obsessive compulsive disorder (OCD), generalized anxiety disorder (GAD) and major depressive episode (MDE)). Clinicians had available to them all data obtained over a 2- to 10-month period. Subjects were 98 patients accepted for treatment at an Anxiety Disorders Clinic, thus, all subjects had at least one of the diagnoses being examined. While the CIDI-Auto detected 88.2% of the clinician diagnoses, it identified twice as many diagnoses as did the clinicians. The sensitivity of the CIDI-Auto was above 0.85 except for GAD, which had a sensitivity of 0.29. The specificity of the CIDI-Auto was lower (range: 0.47-0.99). The agreement between the CIDI-Auto and the clinician diagnoses, as measured by intraclass kappas, ranged from poor (kappa = 0.02; GAD) to excellent (kappa = 0.81; OCD), with a fair level of agreement overall (kappa = 0.40). Canonical correlation analysis suggested that the discrepancies between the CIDI-Auto and clinicians were not due to different diagnostic distinctions being made. It is suggested that the CIDI-Auto may have a lower threshold for diagnosing anxiety disorders than do experienced clinicians. It is concluded that, in a sample where all subjects have at least one anxiety disorder diagnosis, the CIDI-Auto has acceptable validity.

A comparison of two structured diagnostic interviews: CIDI and SCAN

The relationship between and the inter-rater reliability of the Composite International Diagnostic Interview (CIDI) and the Schedules for Clinical Assessment in Neuropsychiatry (SCAN) for anxiety and depressive disorders were explored. The CIDI and the SCAN were administered by trained interviewers in counterbalanced order. A subsample of interviews was observed to determine the inter-rater reliability of the instruments. Subjects were 101 patients accepted for treatment at an Anxiety Disorders Clinic; 29 of the 101 patients participated in the inter-rater reliability study. Concordance between the instruments as measured by canonical correlation analysis was moderate for current (r=0.69, p=0.05) and for lifetime (r=0.66, p=0.05) diagnoses. Inter-rater reliability of the CIDI was perfect (overall intraclass kappa = 1.00), and of the SCAN was good (overall intraclass kappa = 0.67). It is concluded that although the two instruments made similar diagnostic distinctions, the clinical judgement involved in administering the SCAN resulted in the more moderate levels of agreement between the interviewer and observer than those found for the CIDI.

Are computerized interviews equivalent to human interviewers? CIDI-Auto versus CIDI in anxiety and depressive disorders.

BACKGROUND The equivalency of the Composite International Diagnostic Interview delivered by human interviewers (CIDI) and its computerized version (CIDI-Auto) was examined for anxiety and depressive disorders. METHODS Subjects were 40 patients at an Anxiety Disorders Clinic and 40 general medical practice attenders. The CIDI-Auto and CIDI were administered in counterbalanced order on the same day and measures of computer attitudes and the acceptability of the two interview formats were also taken. RESULTS The CIDI-Auto and the CIDI were found to be equally acceptable to subjects on the dimensions of comfort and preference, while the CIDI-Auto was rated as less embarrassing but too long in comparison with the CIDI. The agreement between the two formats was acceptable with kappa values for ICD-10 diagnoses being above 0.65 and for DSM-III-R diagnoses above 0.5 except for two diagnoses (generalized anxiety disorder and dysthymia). Discrepancies between the two formats were predicted by computer attitudes and not by computer experiences or the tendency to respond in a socially desirable fashion. CONCLUSIONS It is concluded that the CIDI-Auto in its self-administered form is an acceptable substitute for the CIDI for suitable subjects.

Development of a measure of the experience of being bullied in youth

The Personal Experiences Checklist (PECK) was developed to provide a multidimensional assessment of a young persons personal experience of being bullied that covered the full range of bullying behaviors, including covert relational forms of bullying and cyber bullying. A sample of 647 school children were used to develop the scale, and a 2nd sample of 218 children completed the PECK and a battery of measures of bullying (including peer nomination), anxiety, depression, and self-esteem, to provide validity evidence. Test-retest reliability was assessed in a further sample of 78 students. Four factors emerged from a principal axis factoring consistent with the domains of relational-verbal bullying, cyber bullying, physical bullying, and bullying based on culture and were confirmed with confirmatory factor analysis. The data also supported a higher order bullying factor with direct effects on these 4 factors. All PECK scales showed good to excellent internal consistency (Cronbachs α range = .78-.91) and adequate test-retest reliability (range r = .61-.86). Most, but not all, expected relations were found with alternative methods of assessing bullying and measures of psychopathology. Taken together, the PECK provides a promising comprehensive and behaviorally focused dimensional measure of bullying.

Development of a short form Social Interaction Anxiety (SIAS) and Social Phobia Scale (SPS) using nonparametric item response theory: the SIAS-6 and the SPS-6.

Shortened forms of the Social Interaction Anxiety Scale (SIAS) and the Social Phobia Scale (SPS) were developed using nonparametric item response theory methods. Using data from socially phobic participants enrolled in 5 treatment trials (N = 456), 2 six-item scales (the SIAS-6 and the SPS-6) were developed. The validity of the scores on the SIAS-6 and the SPS-6 was then tested using traditional methods for their convergent validity in an independent clinical sample and a student sample, as well as for their sensitivity to change and diagnostic sensitivity in the clinical sample. The scores on the SIAS-6 and the SPS-6 correlated as well as the scores on the original SIAS and SPS, with scores on measures of related constructs, discriminated well between those with and without a diagnosis of social phobia, providing cutoffs for diagnosis and were as sensitive to measuring change associated with treatment as were the SIAS and SPS. Together, the SIAS-6 and the SPS-6 appear to be an efficient method of measuring symptoms of social phobia and provide a brief screening tool.

Integrating cognitive bias modification into a standard cognitive behavioural treatment package for social phobia: a randomized controlled trial

OBJECTIVE The aim of the current study was to integrate recent developments in the retraining of attentional biases towards threat into a standard cognitive behavioural treatment package for social phobia. METHOD 134 participants (M age-32.4: 53% female) meeting DSM-IV criteria for social phobia received a 12-week cognitive behavioural treatment program. They were randomly allocated to receive on a daily basis using home practice, either an additional computerised probe procedure designed to train attentional resource allocation away from threat, or a placebo variant of this procedure. Measures included diagnostic severity, social anxiety symptoms, life interference, and depression as well as state anxiety in response to a laboratory social threat. RESULTS At the end of treatment there were no significant differences between groups in attentional bias towards threat or in treatment response (all ps>0.05). Both groups showed similar and highly significant reductions in diagnostic severity, social anxiety symptoms, depression symptoms, and life interference at post-treatment that was maintained and in most cases increased at 6 month follow-up (uncontrolled effect sizes ranged from d=0.34 to d=1.90). CONCLUSIONS The current results do not indicate that integration of information processing-derived attentional bias modification procedures into standard treatment packages as conducted in this study augments attentional change or enhances treatment efficacy. Further refinement of bias modification techniques, and better methods of integrating them with conventional approaches, may be needed to produce better effects.