Special research report
Validity of the assessment of bipolar spectrum disorders in the WHO CIDI 3.0

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Abstract

Objective

Although growing interest exists in the bipolar spectrum, fully structured diagnostic interviews might not accurately assess bipolar spectrum disorders. A validity study was carried out for diagnoses of threshold and sub-threshold bipolar disorders (BPD) based on the WHO Composite International Diagnostic Interview (CIDI) in the National Comorbidity Survey Replication (NCS-R). CIDI BPD screening scales were also evaluated.

Method

The NCS-R is a nationally representative US household population survey (n = 9282 using CIDI to assess DSM-IV disorders. CIDI diagnoses were evaluated in blinded clinical reappraisal interviews using the non-patient version of the Structured Clinical Interview for DSM-IV (SCID).

Results

Excellent CIDI-SCID concordance was found for lifetime BP-I (AUC = .99 κ = .88, PPV = .79, NPV = 1.0), either BP-II or sub-threshold BPD (AUC = .96, κ = .88, PPV = .85, NPV = .99), and overall bipolar spectrum disorders (i.e., BP-I/II or sub-threshold BPD; AUC = .99, κ = .94, PPV = .88, NPV = 1.0). Concordance was lower for BP-II (AUC = .83, κ = .50, PPV = .41, NPV = .99) and sub-threshold BPD (AUC = .73, κ = .51, PPV = .58, NPV = .99). The CIDI was unbiased compared to the SCID, yielding a lifetime bipolar spectrum disorders prevalence estimate of 4.4%. Brief CIDI-based screening scales detected 67–96% of true cases with positive predictive value of 31–52%.

Limitation

CIDI prevalence estimates are still probably conservative, though, but might be improved with future CIDI revisions based on new methodological studies with a clinical assessment more sensitive than the SCID to sub-threshold BPD.

Conclusions

Bipolar spectrum disorders are much more prevalent than previously realized. The CIDI is capable of generating conservative diagnoses of both threshold and sub-threshold BPD. Short CIDI-based scales are useful screens for BPD.

Section snippets

The NCS-R survey design

The NCS-R was administered face-to-face to a sample of 9282 adult respondents between February 2001 and April 2003. The sample was based on a multi-stage clustered area probability design described in more detail elsewhere (Kessler et al., 2004b). Informed consent was obtained verbally prior to data collection. Consent was verbal rather than written to maintain consistency with the baseline NCS (Kessler et al., 1994). The response rate was 70.9%. Respondents were given a $50 incentive for

Aggregate concordance

The lifetime prevalence estimates (standard error in parentheses) of DSM-IV BP-I, BP-II, and sub-threshold BPD in the weighted SCID clinical reappraisal sample are 1.0% (0.6), 1.7% (0.7), and 1.4% (0.6), respectively, for a total prevalence estimate in the SCID of 4.0% compared to 4.4% in the CIDI. (Table 1) As noted above, these prevalence estimates are conservative, as they are based on the assumption that all main survey respondents who failed to endorse a CIDI BPD stem question would have

Limitations

The results reported here are limited by the fact that the clinical reappraisal sample was small and included no NCS-R respondents who denied the CIDI diagnostic stem questions for mania–hypomania. The issue of omitted NCS-R respondents who denied the CIDI BPD stem questions is of special importance in that this design feature led us to assume that all SCID cases of BPD were captured in the sub-sample of NCS-R respondents who endorsed one of the two CIDI diagnostic stem questions. There are

Conclusions

Within the context of these limitations, the results reported here suggest that the prevalence of DSM-IV bipolar spectrum disorder is at least 4.0% and, given the limitations noted above, probably higher. The CIDI 3.0 assessment of DSM-IV BPD has good concordance with independent SCID diagnoses both at the aggregate level (i.e., in terms of yielding unbiased estimates of prevalence) and at the individual level (i.e., in terms of classifying individual cases). The results also show that a fairly

Acknowledgements

The National Comorbidity Survey Replication (NCS-R) is supported by the National Institute of Mental Health (NIMH; U01-MH60220) with supplemental support from the National Institute of Drug Abuse, the Substance Abuse and Mental Health Services Administration, the Robert Wood Johnson Foundation (Grant # 044780), and the John W. Alden Trust. Additional support for preparation of this paper was provided by BristolMyersSquibb. Collaborating NCS-R investigators include Ronald C. Kessler (Principal

References (43)

  • H.S. Akiskal et al.

    Optimizing the detection of bipolar II disorder in outpatient private practice: toward a systematization of clinical diagnostic wisdom

    J. Clin. Psychiatry

    (2005)
  • J. Angst

    Bipolar disorder — a seriously underestimated health burden

    Eur. Arch. Psychiatry Clin. Neurosci.

    (2004)
  • M. Bauer et al.

    Epidemiology of bipolar disorders

    Epilepsia

    (2005)
  • M.G. Carta et al.

    The accuracy of the Italian version of the Hypomania Checklist (HCL-32) for the screening of bipolar disorders and comparison with the Mood Disorder Questionnaire (MDQ) in a clinical sample

    Clin. Pract. Epidemol. Ment. Health

    (2006)
  • J. Cohen

    A coefficient of agreement for nominal scales

    Educ. Psychol. Meas.

    (1960)
  • R.J. Cook

    Kappa and its dependence on marginal rates

  • M.B. First et al.

    Structured Clinical Interview for DSM-IV Axis I Disorders, Research Version, Non-patient Edition (SCID-I/NP)

    (2002)
  • M. Gibbon et al.

    Mastering the art of research interviewing. A model training procedure for diagnostic evaluation

    Arch. Gen. Psychiatry

    (1981)
  • J.A. Hanley et al.

    If nothing goes wrong, is everything all right? Interpreting zero numerators

    JAMA

    (1983)
  • J.A. Hanley et al.

    The meaning and use of the area under a receiver operating characteristic (ROC) curve

    Radiology

    (1982)
  • R.M. Hirschfeld et al.

    Development and validation of a screening instrument for bipolar spectrum disorder: the Mood Disorder Questionnaire

    Am. J. Psychiatry

    (2000)
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