Department of Psychiatry, Yale School of Medicine.
Department of Psychology, Wesleyan University.
J Consult Clin Psychol. 2013 Aug;81(4):650-659. doi: 10.1037/a0032813. Epub 2013 May 6.
Research has demonstrated poor agreement between clinician-assigned personality disorder (PD) diagnoses and those generated by self-report questionnaires and semistructured diagnostic interviews. No research has compared prospectively the predictive validity of these methods. We investigated the convergence of these 3 diagnostic methods and tested their relative and incremental validity in predicting independent, multimethod assessments of psychosocial functioning performed prospectively over 5 years.
Participants were 320 patients in the Collaborative Longitudinal Personality Disorders Study diagnosed with PDs by therapist, self-report, and semistructured interview at baseline. We examined the relative incremental validity of therapists' naturalistic ratings relative to these other diagnostic methods for predicting psychosocial functioning at 5-year follow-up.
Hierarchical linear regression analyses revealed that both the self-report questionnaire and semistructured interview PD diagnoses had significant incremental predictive validity over the PD diagnoses assigned by a treating clinician. Although, in some cases, the clinicians' ratings for individual PDs did have validity for predicting subsequent functioning, they did not generally provide incremental prediction beyond the other methods. These findings remained robust in a series of analyses restricted to a subsample of therapist ratings based on clinical contact of 1 year or greater.
These results from a large clinical sample echo previous research documenting limited agreement between clinicians' naturalistic PD diagnoses and those from self-report and semistructured interview methods. They extend prior work by providing the first evidence about the relative predictive validity of these different methods. Our findings challenge the validity of naturalistic PD diagnoses and suggest the use of structured diagnostic instruments.
研究表明，临床医生诊断的人格障碍 (PD) 与自我报告问卷和半结构化诊断访谈得出的诊断之间存在较差的一致性。没有研究比较过这些方法的预测效度。我们调查了这 3 种诊断方法的一致性，并测试了它们在预测 5 年内前瞻性进行的独立、多方法心理社会功能评估方面的相对和增量有效性。
共有 320 名患者参加了合作纵向人格障碍研究，在基线时由治疗师、自我报告和半结构化访谈进行 PD 诊断。我们考察了治疗师的自然主义评分相对于这些其他诊断方法预测 5 年随访时心理社会功能的相对增量有效性。
分层线性回归分析显示，自我报告问卷和半结构化访谈 PD 诊断对预测后续功能均具有显著的增量预测效度，而临床医生诊断则没有。尽管在某些情况下，个别 PD 的临床医生评分确实具有预测后续功能的有效性，但它们通常不能提供超越其他方法的增量预测。在一系列仅限于治疗师评分的分析中，这些发现仍然稳健，这些评分是基于 1 年或更长时间的临床接触。
这些来自大型临床样本的结果与先前记录的临床医生自然主义 PD 诊断与自我报告和半结构化访谈方法之间存在一致性较差的研究结果相呼应。它们通过提供这些不同方法的相对预测效度的第一个证据扩展了先前的工作。我们的发现对自然主义 PD 诊断的有效性提出了挑战，并建议使用结构化诊断工具。
