Diagnostic Validity of the Composite International Diagnostic Interview (CIDI) Depression Module in an East African Population

Abstract

Objective:

To evaluate the validity and reliability of the structured Composite International Diagnostic Interview (CIDI) in diagnosing current major depressive disorder (MDD) among East African adults.

Methods:

A sample of 926 patients attending a major referral hospital in Ethiopia participated in this diagnostic assessment study. We used a two-stage study design where participants were first interviewed using an Amharic version of the CIDI and a stratified random sample underwent a follow-up semi-structured clinical interview conducted by a psychiatrist, blinded to the screening results, using the Schedules for Clinical Assessment in Neuropsychiatry (SCAN) instrument. We tested construct validity by examining the association of the CIDI and World Health Organization Quality of Life (WHO-QOL) questionnaire. We calculated the psychometric properties of the CIDI using the SCAN diagnostic interview as a gold standard.

Results:

We found that the Amharic version of the CIDI diagnostic interview has good internal reliability (Cronbach's alpha = 0.97) among Ethiopian adults. Compared to the SCAN reference standard, the CIDI had fair specificity (72.2%) but low sensitivity (51.0%). Our study provided evidence for unidimensionality of core depression screening questions on the CIDI interview with good factor loadings on a major core depressive factor.

Conclusion:

The Amharic language version of the CIDI had fair specificity and low sensitivity in detecting MDD compared with psychiatrist administered SCAN diagnosis. Our findings are generally consistent with prior studies. Use of fully structured interviews such as the CIDI for MDD diagnosis in clinical settings might lead to under-detection of DSM-IV MDD.

Get full access to this article

View all access options for this article.

References

Patel

Garrison

de Jesus Mari

Minas

Prince

Saxena

. The Lancet's series on global mental health: 1 year on. Lancet 2008; 372(9646): 1354–1357.

Patel

Prince

. Global mental health: A new global health field comes of age. Journal of the American Medical Association 2010; 303(19): 1976–1977.

Wig

. WHO and mental health—A view from developing countries. Bulletin of the World Health Organization 2000; 78(4): 502–503.

Murray

Vos

Lozano

Naghavi

Flaxman

Michaud

Ezzati

Shibuya

Salomon

Abdalla

. Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990–2010: A systematic analysis for the Global Burden of Disease Study 2010. Lancet 2012; 380(9859): 2197–2223.

Patel

Araya

Chowdhary

King

Kirkwood

Nayak

Simon

Weiss

. Detecting common mental disorders in primary care in India: A comparison of five screening questionnaires. Psychological Medicine 2008; 38(2): 221–228.

Patel

Sartorius

, From science to action: The Lancet Series on Global Mental Health. Current Opinion in Psychiatry 2008; 21(2): 109–113.

Kessler

Abelson

Demler

Escobar

Gibbon

Guyer

Howes

Jin

Vega

Walters

. Clinical calibration of DSM-IV diagnoses in the World Mental Health (WMH) version of the World Health Organization (WHO) Composite International Diagnostic Interview (WMHCIDI). International Journal of Methods in Psychiatric Research 2004; 13(2): 122–139.

Kessler

Angermeyer

Anthony

Graaf

Demyttenaere

Gasquet

Girolamo

Gluzman

Gureje

Haro

Lifetime prevalence and age-of-onset distributions of mental disorders in the World Health Organization's World Mental Health Survey Initiative. World Psychiatry 2007; 6(3): 168–176.

Kessler

Ustun

. The World Mental Health (WMH) Survey Initiative Version of the World Health Organization (WHO) Composite International Diagnostic Interview (CIDI). International Journal of Methods in Psychiatric Research 2004; 13(2): 93–121.

10.

Robins

Wing

Wittchen

Helzer

Babor

Burke

Farmer

Jablenski

Pickens

Regier

. The Composite International Diagnostic Interview. An epidemiologic instrument suitable for use in conjunction with different diagnostic systems and in different cultures. Archives of General Psychiatry 1988; 45(12): 1069–1077.

11.

Haro

Arbabzadeh-Bouchez

Brugha

de Girolamo

Guyer

Jin

Lepine

Mazzi

Reneses

Vilagut

. Concordance of the Composite International Diagnostic Interview Version 3.0 (CIDI 3.0) with standardized clinical assessments in the WHO World Mental Health Surveys. International Journal of Methods in Psychiatric Research 2006; 15(4): 167–180.

12.

Rashid

Kebede

Alem

. Evaluation of an Amharic version of the Composite International Diagnostic Interview (CIDI) in Ethiopia. Ethiopian Journal of Health Development 1996; 10: 69–77.

13.

Kessler

Ustün

, World Health Organization. The WHO World Mental Health Surveys: Global perspectives on the epidemiology of mental disorders. Cambridge/New York/Geneva: Cambridge University Press, published in collaboration with the World Health Organization, 2008.

14.

Kroenke

Spitzer

Williams

. The PHQ-9: Validity of a brief depression severity measure. Journal of General Internal Medicine 2001; 16(9): 606–613.

15.

American Psychiatric Association. Task Force on D-I: In Diagnostic and statistical manual of mental disorders (DSM-IV-TR). Washington, DC: American Psychiatric Association, 2000.

16.

Aboraya

Tien

Stevenson

Crosby

. Schedules for clinical assessment in neuropsychiatry (SCAN): Introduction to WV's mental health community. West Virginia Medical Journal 1998; 94(6): 326–328.

17.

Wing

Babor

Brugha

Burke

Cooper

Giel

Jablenski

Regier

Sartorius

. SCAN. Schedules for Clinical Assessment in Neuropsychiatry. Archives of General Psychiatry 1990; 47(6): 589–593.

18.

Alem

Kebede

Shibre

Negash

Deyassa

. Comparison of computer assisted scan diagnoses and clinical diagnoses of major mental disorders in Butajira, rural Ethiopia. Ethiopian Medical Journal 2004; 42(2): 137–143.

19.

Saxena

Carlson

Billington

, Life WGWHOQO. The WHO quality of life assessment instrument (WHOQOL-Bref): The importance of its items for cross-cultural research. Quality of Life Research 2001; 10(8): 711–721.

20.

Moller-Leimkuhler

: Higher comorbidity of depression and cardiovascular disease in women: A biopsychosocial perspective. The World Journal of Biological Psychiatry 2010; 11(8): 922–933.

21.

Akinyemi

Owoaje

Ige

Popoola

. Comparative study of mental health and quality of life in long-term refugees and host populations in Oru-Ijebu, Southwest Nigeria. BMC Research Notes 2012; 5: 394.

22.

Zhou

McClish

Obuchowski

. Statistical methods in diagnostic medicine (2nd ed.). Oxford, UK: Wiley-Blackwell, 2011.

23.

Begg

Greenes

. Assessment of diagnostic tests when disease verification is subject to selection bias. Biometrics 1983; 39(1): 207–215.

24.

Pepe

. The statistical evaluation of medical tests for classification and prediction. Oxford, UK: Oxford University Press, 2003.

25.

Brugha

Jenkins

Taub

Meltzer

Bebbington

. A general population comparison of the Composite International Diagnostic Interview (CIDI) and the Schedules for Clinical Assessment in Neuropsychiatry (SCAN). Psychological Medicine 2001; 31(6): 1001–1013.

26.

Jordanova

Wickramesinghe

Gerada

Prince

. Validation of two survey diagnostic interviews among primary care attendees: A comparison of CIS-R and CIDI with SCAN ICD-10 diagnostic categories. Psychological Medicine 2004; 34(6): 1013–1024.

27.

Reise

Widaman

Pugh

. Confirmatory factor analysis and item response theory: Two approaches for exploring measurement invariance. Psychological Bulletin 1993; 114(3): 552–566.

28.

Tam

Wong

Lam

Stewart

. The Patient Health Questionnaire-9 for measuring depressive symptoms among the general population in Hong Kong. Comprehensive Psychiatry 2012; 53(1): 95–102.

29.

Kessler

Andrews

Mroczek

Ustun

Wittchen

H-U

. The World Health Organization Composite International Diagnostic Interview short-form (CIDI-SF). International Journal of Methods in Psychiatric Research 1998; 7(4): 171–185.

30.

Ghimire

Chardoul

Kessler

Axinn

Adhikari

. Modifying and validating the Composite International Diagnostic Interview (CIDI) for use in Nepal. International Journal of Methods in Psychiatric Research 2013; 22(1): 71–81.

31.

Tsuang

Tohen

Jones

. Textbook of psychiatric epidemiology. Chichester, West Sussex/Hoboken, NJ: Wiley-Blackwell, 2011.

32.

Patel

Simon

Chowdhary

Kaaya

Araya

. Packages of care for depression in low- and middle-income countries. PLoS Medicine 2009; 6(10): e1000159.

33.

Alem

. Mental health services and epidemiology of mental health problems in Ethiopia. Ethiopian Medical Journal 2001; 39(2): 153–165.

34.

Giel

. The prehistory of psychiatry in Ethiopia. Acta Psychiatrica Scandinavica Supplementum 1999; 397: 2–4.

35.

Araya

Rojas

Fritsch

Gaete

Rojas

Simon

Peters

. Treating depression in primary care in low-income women in Santiago, Chile: A randomised controlled trial. Lancet 2003; 361(9362): 995–1000.

36.

Bolton

Bass

Neugebauer

Verdeli

Clougherty

Wickramaratne

Speelman

Ndogoni

Weissman

. Group interpersonal psychotherapy for depression in rural Uganda: A randomized controlled trial. Journal of the American Medical Association 2003; 289(23): 3117–3124.

37.

Patel

Chisholm

Rabe-Hesketh

Dias-Saxena

Andrew

Mann

. Efficacy and cost-effectiveness of drug and psychological treatments for common mental disorders in general health care in Goa, India: A randomised, controlled trial. Lancet 2003; 361(9351): 33–39.