Brugha T S, Bebbington P E, Jenkins R, Meltzer H, Taub N A, Janas M, Vernon J
Department of Psychiatry, Epidemiology and Public Health, School of Medicine, Leicester.
Psychol Med. 1999 Sep;29(5):1029-42. doi: 10.1017/s0033291799008892.
Comparisons of structured diagnostic interviews with clinical assessments in general population samples show marked discrepancies. In order to validate the CIS-R, a fully structured diagnostic interview used for the National Survey of Psychiatric Morbidity in Great Britain, it was compared with SCAN, a standard, semi-structured, clinical assessment.
A random sample of 1882 Leicestershire addresses from the Postcode Address File yielded 1157 eligible adults: of these 860 completed the CIS-R; 387 adults scores > or = 8 on the CIS-R and 205 of these completed a SCAN reference examination. Neurotic symptoms, in the previous week and month only, were enquired about. Concordance was estimated for ICD-10 neurotic and depressive disorders, F32 to F42 and for depression symptom score.
Sociodemographic characteristics closely resembled National Survey and 1991 census profiles. Concordance was poor for any ICD-10 neurotic disorder (kappa = 0.25 (95% CI, 0.1-0.4)) and for depressive disorder (kappa = 0.23 (95% CI, 0-0.46)). Sensitivity to the SCAN reference classification was also poor. Specificity ranged from 0.8 to 0.9. Rank order correlation for total depression symptoms was 0.43 (Kendall's tau b; P < 0.001; N = 205).
High specificity indicates that the CIS-R and SCAN agree that prevalence rates for specific disorders are low compared with estimates in some community surveys. We have revealed substantial discrepancies in case finding. Therefore, published data on service utilization designed to estimate unmet need in populations requires re-interpretation. The value of large-scale CIS-R survey data can be enhanced considerably by the incorporation of concurrent semi-structured clinical assessments.
在普通人群样本中，结构化诊断访谈与临床评估的比较显示出明显差异。为了验证用于英国精神病发病率全国调查的完全结构化诊断访谈CIS - R，将其与标准的半结构化临床评估SCAN进行了比较。
从邮政编码地址文件中随机抽取1882个莱斯特郡地址，得到1157名符合条件的成年人：其中860人完成了CIS - R；387名成年人在CIS - R上的得分≥8分，其中205人完成了SCAN参考检查。仅询问了前一周和前一个月的神经症症状。对国际疾病分类第10版（ICD - 10）的神经症和抑郁症（F32至F42）以及抑郁症状评分进行了一致性估计。
社会人口学特征与全国调查和1991年人口普查概况非常相似。对于任何ICD - 10神经症障碍（kappa = 0.25（95%可信区间，0.1 - 0.4））和抑郁症（kappa = 0.23（95%可信区间，0 - 0.46）），一致性都很差。对SCAN参考分类的敏感性也很差。特异性范围为0.8至0.9。总抑郁症状的等级相关系数为0.43（肯德尔tau b；P < 0.001；N = 205）。
高特异性表明CIS - R和SCAN一致认为，与一些社区调查的估计相比，特定障碍的患病率较低。我们发现了病例发现方面的重大差异。因此，旨在估计人群中未满足需求的服务利用情况的已发表数据需要重新解释。通过纳入同步的半结构化临床评估，可以大大提高大规模CIS - R调查数据的价值。
