Academic journal article Hong Kong Journal of Psychiatry

The Chinese-Bilingual SCID-I/P Project: Stage 1-Reliability for Mood Disorders and Schizophrenia

Academic journal article Hong Kong Journal of Psychiatry

The Chinese-Bilingual SCID-I/P Project: Stage 1-Reliability for Mood Disorders and Schizophrenia

Article excerpt

Abstract

Objective: To report on the reliability of the Chinese-bilingual Structured Clinical Interview for DSM-IV (Axis I, Patient version) Project (CB-SCID-I/P), stage 1: 'Mood disorders' and 'Schizophrenia and other psychotic disorders'.

Patients and Methods: The CB-SCID-I/P project is a multi-staged translation-validation study of the SCID-I/P (patient research version 2.0, 8/98 revision). Inpatients from the Prince of Wales Hospital were consecutively recruited. Two DSM-IV diagnostic groups were chosen for reliability study for this stage: 'mood disorders' and 'schizophrenia and other psychotic disorders'. Test-retest and joint assessment methods were used to assess inter-rater reliability and clinicians' best-estimate diagnosis was used to assess rater-clinician reliability. Kappa value was used to represent the level of reliability.

Results: 144 inpatients were recruited during a 4-month period. The overall kappa for interrater reliability was 0.84, with percentage agreement at 89.6%. Rater-clinician reliability had a kappa of 0.84 for bipolar affective disorder, 0.76 for mood disorder, and 0.75 for schizophrenia. The overall kappa value was 0.77.

Conclusion: A good degree of agreement was achieved between the SCID raters as well as between the rater and clinician diagnoses. The Chinese-bilingual SCID-I/P is therefore a reliable instrument in generating DSM-IV schizophrenia and mood disorders diagnoses for inpatients.

Key words: Chinese, Diagnosis, Inpatients, Mental status schedule, Mood disorders, Schizophrenia

Introduction

A structured psychiatric interview is a procedure for making psychiatric diagnoses via an interviewing process. The term 'structured' implies the use of specific wording of questions that are being asked, a predetermined order of questions to go through, and systematically, a range of diagnoses to be covered. Theoretically, a structured interview gives the advantage of having a standardised assessment procedure, allows wide coverage, and reduces 'premature closure' to information access and verification, therefore leading to improved reliability, and hopefully improved validity of the diagnoses. There can be varying degrees of structure in a structured interview, ranging from fully structured, to semi-structured, to free form clinical interview, the latter essentially a diagnostic interview carried out by the clinician without any diagnostic aids.

The Structured Clinical Interview for DSM-IV (SCID) is a semi-structured face-to-face psychiatric research instrument for obtaining reliable DSM-IV diagnoses, developed by the Biometrics Research, New York State Psychiatric Institute, NY. (1) Since its inception 20 years ago, the SCID has undergone several revisions, from DSM-III, to DSM-III-R, to the present DSM-IV-based diagnostic instrument that incorporates SCID-I for Axis I disorders and the SCID-II for Axis II disorders. Various versions of the SCID-I have been produced to serve different patient groups and specific purposes. (2-7)

In addition to its original research designation, it has also been employed in clinical settings for complementing the diagnostic and the documentation process, as well as assisting in interview training. Versions of SCID (for DSMIV) currently include the standard Patient (SCID-I/P) and the Non-patient (SCID-I/NP) research editions, a shorter Clinician Version (these are for Axis I disorders), and an SCID-II for Axis II disorders. In addition, there is a KIDSCID for children, plus a few specifically modified versions adopted by individual users. These SCID instruments are at present among the most widely used research tools internationally. The SCID has been translated into more than 10 other languages throughout the world, with the patient research version (SCID-I/P) being the most popular. Its utility, reliability and transportability has been well established and reported. The inter-rater reliability of the original SCID-I (DSM-III-R-based), with 592 subjects from 6 sites using test-retest design, gave kappa values above 0. …

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