A comparison of the Composite International Diagnostic Interview (CIDI-Auto) with clinical assessment in diagnosing mood and anxiety disorders

Objective: Increasingly, epidemiological studies are employing computerized and highly standardized interviews, such as the Composite International Di agnostic Interview (CIDI-Auto), to assess the prevalence of psychiatric ill ness. Recent studies conducted in specialist units have reported poor agree ment between experienced clinicians' and CIDI-Auto diagnoses. In this study we investigated the concordance rate between clinicians and the CIDI-Auto for the diagnosis of six anxiety disorders and two mood disorders, whereby the CIDI-Auto was treated as the 'gold standard'. Method: Subjects were 262 patients who were assessed by a clinical psycholo gist or psychiatrist and completed the CIDI-Auto at a tertiary referral uni t for anxiety and mood disorders. Agreement between the clinicians diagnose s and the diagnoses generated by the CIDI-Auto according to both DSM-IV and ICD-10 codes, were examined by kappa statistics. Sensitivity and specifici ty values were also calculated. Results: Agreement between clinicians and the CIDI-Auto (DSM-IV) ranged fro m poor for social phobia and posttraumatic stress disorder (kappa < 0.30) t o moderate for obsessive-compulsive disorder (OCD; <kappa> = 0.52). Agreeme nt between clinicians and the CIDI-Auto (ICD-10) ranged from poor for major depressive episode (kappa = 0.25) to moderate for OCD (kappa = 0.57). With the CIDI diagnosis treated as the gold standard, clinicians diagnoses show ed low sensitivity (kappa < 0.70) for all the disorders except for OCD (for ICD-10), but high specificity (<kappa> > 0.70) for all the disorders. Conclusion: Poor agreements between experienced clinicians and the CIDI-Aut o were reported for anxiety and mood disorders in the current study, A majo r implication is that if diagnosis alone directed treatment, then patients could receive different treatments, depending on whether the computer, or a clinician, made the diagnosis.