Measuring psychiatric disorder in the community: a standardized assessment for use by lay interviewers

TLDR

Standardized psychiatric interviews typically rely on expert judgments, but when case definitions are fixed, clinical judgments are often replaced by rule‑based criteria. The authors revised the Clinical Interview Schedule to enhance standardization and enable lay interviewers to assess minor psychiatric disorders across community and clinical settings. They conducted two reliability studies in London and Santiago, Chile, comparing psychiatrically trained interviewers with lay interviewers using the revised CIS‑R. The CIS‑R showed reliability comparable to other standardized interviews, with lay interviewers performing as reliably as psychiatrists and exhibiting no bias, and confirmatory factor analysis suggested that conventional reliability estimates may be inflated.

Abstract

SYNOPSIS Many of the standardized interviews currently used in psychiatry require the interviewer to use expert psychiatric judgements in deciding upon the presence or absence of psychopathology. However, when case definitions are standardized it is customary for clinical judgements to be replaced with rules. The Clinical Interview Schedule was therefore revised, in order to increase standardization, and to make it suitable for use by ‘lay’ interviewers in assessing minor psychiatric disorder in community, general hospital, occupational and primary care research. Two reliability studies of the revised Clinical Interview Schedule (CIS-R) were conducted in primary health care clinics in London and Santiago, Chile. Both studies compared psychiatrically trained interviewer(s) with lay interviewer(s). Estimates of the reliability of the CIS-R compared favourably with the results of studies of other standardized interviews. In addition, the lay interviewers were as reliable as the psychiatrists and did not show any bias in their use of the CIS-R. Confirmatory factor analysis models were also used to estimate the reliabilities of the CIS-R and self-administered questionnaires and indicated that traditional measures of reliability are probably overestimates.