Limitations of a structured psychiatric diagnostic instrument in assessingsomatization among Latino patients in primary care

BACKGROUND. The Composite International Diagnostic Interview (CIDI) has bee n developed as a state-of-the-art, structured diagnostic instrument, design ed to diagnose psychiatric disorders across cultures and languages. Partly because it has been validated in a number of countries and cultural setting s, the CIDI has become widely accepted as a diagnostic instrument in epidem iologic and clinical research. OBJECTIVES. AS part of a larger study of psychiatric disorders in a multi-e thnic, primary care setting, we tried to clarify the limitations of the CID I in diagnosing somatoform symptoms among Latino patients. DESIGN. Relevant sections of the CIDI were administered in English or Spani sh to new patients seeking primary care services at an inner-city, universi ty-affiliated community clinic. Interviews were tape recorded and pertinent passages were transcribed for qualitative analysis. SUBJECTS. One thousand, four hundred and fifty six new patients, comprising 4 ethnic groups: Central American; Mexican; Chicano; and non-Latino White. MEASURES. The CIDI's diagnostic algorithms for somatization were examined i n relation to the transcriptions of inter-views for Latino patients whom th e CIDI diagnosed as somatizers. RESULTS. The CIDI led to the inaccurate identification of somatoform sympto ms resulting from such issues as financial barriers to healthcare access, c ultural syndromes that were not recognized by Western medicine, and languag e differences between patients and physicians. Like other structured instru ments, the CIDI also forced a range of complex experience into a fixed-choi ce interview format. CONCLUSIONS. Despite the advantages of such structured instruments as the C IDI, their capacity to reach accurate psychiatric diagnoses in same cultura l groups and clinical settings requires clarification. These findings also call into question the relatively high rates of somatization among Latino p atients reported in previous studies that have used structured psychiatric diagnostic instruments.