Lesage A D, Fournier L, Cyr M, Toupin J, Fabian J, Gaudette G, Vanier C, Bebbington P E, Brewin C R
Centre de recherche Fernand-Seguin, Louis-H. Lafontaine Hospital, Institut Philippe-Pinel, Montreal, Quebec, Canada.
Psychol Med. 1996 Mar;26(2):237-43. doi: 10.1017/s0033291700034632.
One hundred and nine adults were screened in the community using the abridged version of the CIDI (CIDIS). The subjects comprised DSM-III-R current cases (N = 48), lifetime cases (N = 31) and non-cases (N = 30). The interviews with the 109 subjects were conducted by one of two pairs of clinicians and videotaped. Each interviewer-pair included a psychiatrist and a clinical psychologist. They rated the community version of the Needs for Care (NFCAS-C) by consensus. The other pair of judges then viewed the video and rated the NFCAS-C independently. The agreement on overall needs was excellent (kappa = 0.75), and very good for four of the seven specific sections (from kappa = 0.61 to 0.81). One section could not be rated because of low prevalence, and agreement was less good for the remaining two sections. Agreement was good on specific interventions (medication, kappa = 0.60; specific psychotherapy, kappa = 0.55), but poor on non-specific interventions. The majority of disagreements were due to differences in clinical judgement rather than to technical errors. A new instruction manual has been produced and should help training as well as stabilizing reliability. In devising reliable and valid instruments based on clinical judgement, a balance must be achieved between enhancing reliability with more precise rules and constraining clinical judgement so tightly that validity is lost.
在社区中使用CIDI（CIDIS）简版对109名成年人进行了筛查。受试者包括DSM-III-R现患病例（N = 48）、终生病例（N = 31）和非病例（N = 30）。对这109名受试者的访谈由两组临床医生中的一组进行，并进行了录像。每组访谈人员包括一名精神科医生和一名临床心理学家。他们通过共识对社区版护理需求量表（NFCAS-C）进行评分。然后另一组评判人员观看录像并独立对NFCAS-C进行评分。在总体需求方面的一致性非常好（kappa = 0.75），在七个特定部分中的四个部分一致性也很好（kappa值从0.61到0.81）。由于患病率较低，有一个部分无法评分，其余两个部分的一致性较差。在特定干预措施方面（药物治疗，kappa = 0.60；特定心理治疗，kappa = 0.55）一致性良好，但在非特定干预措施方面一致性较差。大多数分歧是由于临床判断的差异而非技术错误。已经编制了一本新的指导手册，这应该有助于培训并稳定信度。在基于临床判断设计可靠且有效的工具时，必须在通过更精确的规则提高信度与过度限制临床判断以至于失去效度之间取得平衡。
