Department of Health Care Policy, Harvard Medical School, Boston, MA, USA.
Int J Methods Psychiatr Res. 2013 Dec;22(4):303-21. doi: 10.1002/mpr.1398.
A clinical reappraisal study was carried out in conjunction with the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS) All-Army Study (AAS) to evaluate concordance of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) diagnoses based on the Composite International Diagnostic Interview Screening Scales (CIDI-SC) and post-traumatic stress disorder (PTSD) checklist (PCL) with diagnoses based on independent clinical reappraisal interviews (Structured Clinical Interview for DSM-IV [SCID]). Diagnoses included: lifetime mania/hypomania, panic disorder, and intermittent explosive disorder; six-month adult attention-deficit/hyperactivity disorder; and 30-day major depressive episode, generalized anxiety disorder, PTSD, and substance (alcohol or drug) use disorder (abuse or dependence). The sample (n = 460) was weighted for over-sampling CIDI-SC/PCL screened positives. Diagnostic thresholds were set to equalize false positives and false negatives. Good individual-level concordance was found between CIDI-SC/PCL and SCID diagnoses at these thresholds (area under curve [AUC] = 0.69-0.79). AUC was considerably higher for continuous than dichotomous screening scale scores (AUC = 0.80-0.90), arguing for substantive analyses using not only dichotomous case designations but also continuous measures of predicted probabilities of clinical diagnoses.
进行了一项临床再评估研究，该研究与陆军军人风险和适应力评估研究（Army STARRS）全陆军研究（AAS）合作，以评估根据复合国际诊断访谈筛选量表（CIDI-SC）和创伤后应激障碍检查表（PCL）进行的《精神障碍诊断与统计手册》第四版（DSM-IV）诊断与基于独立临床再评估访谈的诊断（DSM-IV 结构临床访谈 [SCID]）的一致性。诊断包括：终生躁狂/轻躁狂、惊恐障碍和间歇性爆发障碍；六个月成人注意力缺陷/多动障碍；以及 30 天重度抑郁发作、广泛性焦虑障碍、创伤后应激障碍和物质（酒精或药物）使用障碍（滥用或依赖）。该样本（n=460）经过加权处理，以对 CIDI-SC/PCL 筛查阳性进行过采样。诊断阈值设定为使假阳性和假阴性相等。在这些阈值下，CIDI-SC/PCL 和 SCID 诊断之间发现了良好的个体水平一致性（曲线下面积 [AUC] = 0.69-0.79）。与二分类筛查量表评分相比，连续评分的 AUC 要高得多（AUC=0.80-0.90），这表明不仅要使用二分类病例设计，还要使用连续的临床诊断预测概率测量值进行实质性分析。
