Reliability and validity of a Chinese computerized diagnostic instrument

Test-retest reliability of schizoaffective disorder compared with schizophrenia, bipolar disorder, and unipolar depression--a systematic review and meta-analysis

OBJECTIVES

Schizoaffective disorder is a frequent diagnosis, and its reliability is subject to ongoing discussion. We compared the diagnostic reliability of schizoaffective disorder with its main differential diagnoses.

METHODS

We systematically searched Medline, Embase, and PsycInfo for all studies on the test-retest reliability of the diagnosis of schizoaffective disorder as compared with schizophrenia, bipolar disorder, and unipolar depression. We used meta-analytic methods to describe and compare Cohen's kappa as well as positive and negative agreement. In addition, multiple pre-specified and post hoc subgroup and sensitivity analyses were carried out.

RESULTS

Out of 4,415 studies screened, 49 studies were included. Test-retest reliability of schizoaffective disorder was consistently lower than that of schizophrenia (in 39 out of 42 studies), bipolar disorder (27/33), and unipolar depression (29/35). The mean difference in kappa between schizoaffective disorder and the other diagnoses was approximately 0.2, and mean Cohen's kappa for schizoaffective disorder was 0.50 (95% confidence interval: 0.40-0.59). While findings were unequivocal and homogeneous for schizoaffective disorder's diagnostic reliability relative to its three main differential diagnoses (dichotomous: smaller versus larger), heterogeneity was substantial for continuous measures, even after subgroup and sensitivity analyses.

CONCLUSIONS

In clinical practice and research, schizoaffective disorder's comparatively low diagnostic reliability should lead to increased efforts to correctly diagnose the disorder.

The epidemiology of anxiety disorders: a review

Epidemiological studies show that anxiety disorders are highly prevalent and an important cause of functional impairment; they constitute the most frequent menial disorders in the community. Phobias are the most common with the highest rates for simple phobia and agoraphobia. Panic disorder (PD) and obsessive-compulsive disorder (OCD) are less frequent (2% lifetime prevalence), and there are discordant results for social phobia (SP) (2%-16%) and generalized anxiety disorder (GAD) (3%-30%). These studies underline the importance of an accurate definition of disorders using unambiguous diagnostic and assessment criteria. The boundaries between anxiety disorders are often ill defined and cases may vary widely according to the definition applied. Simple phobia, agoraphobia, and GAD are more common in vmrnen, while there is no gender différence for SP, PD, and OCD, Anxiety disorders are more common in separated, divorced, and widowed subjects; their prevalence is highest in subjects aged 25 to 44 years and lowest in subjects aged >65 years. The age of onset of the different types of anxiety disorders varies widely: phobic disorders begin early in life, whereas PD occurs in young adulthood. Clinical - rather than epidemiological - studies have examined risk factors such as life events, childhood experiences, and familial factors. Anxiety disorders have a chronic and persistent course, and are frequently comorbid with other anxiety disorders, depressive disorders, and substance abuse. Anxiety disorders most frequently precede depressive disorders or substance abuse, Comorbid diagnoses may influence risk factors like functional impairment and quality of life. It remains unclear whether certain anxiety disorders (eg, PD) are risk factors for suicide. The comorbidity of anxiety disorders has important implications for assessment and treatment and the risk factors should be explored. The etiology, natural history, and outcome of these disorders need to be further addressed in epidemiological studies.

Assessment of depression and anxiety in East Asia

This article provides a critical review of the literature on research with self-report measures of depression and anxiety in East Asia. Three trends are noteworthy. First, research on depression and anxiety in East Asia has relied heavily on the use of a limited number of translated instruments. Second, available research suggests that the Asian language versions of these instruments are reliable and valid for use with Asian populations. Third, some subpopulations in East Asia have been studied extensively with respect to depression and anxiety, but there are many regions of Asia where little research literature is available outside of those published in native language journals. The review concludes with recommendations for future research.

Screening for major depression in Asian-Americans: a comparison of the Beck and the Chinese Depression Inventory

OBJECTIVE

This study compares the effectiveness of the Chinese version of the Beck Depression Inventory (CBDI) and the Chinese Depression Inventory (CDI) in screening for depression among Chinese Americans.

METHOD

Five hundred and three Chinese-Americans in primary care were administered the CBDI and the CDI for depression screening. The results were compared with standard semistructured interview.

RESULTS

With empirically determined cutoff scores of the CBDI (> or =13) and the CDI (>/=16), both instruments have good sensitivity (0.78) and excellent specificity (0.91 and 0.93, respectively). The correlation between the total scores of the two instruments was high (0.785, P < 0.01). The areas under the Receiver Operating Characteristic (ROC) curve of the CBDI and the CDI were 0.94 and 0.95, respectively, and were not significantly different.

CONCLUSION

When administered by interviewers, the CBDI and the CDI have comparable effectiveness. Low participation among Chinese-Americans with self-report measures limits both scales as efficient depression screening instruments.

Inter-rater reliability of ICD-10 in Chinese patients

In an attempt to assess the universal applicability of the International Classification of Disease (ICD-10), two psychiatrists from different socio-cultural backgrounds and training independently performed a chart review of 238 Chinese patients. Inter-rater reliability figures were comparable to those found in the WHO-coordinated ICD-10 field trials. The results suggest that ICD-10 has good ‘universality’ in routine clinical practice.

Comparative study of diagnostic systems: Chinese Classification of Mental Disorders-Second Edition versus DSM-III-R

We report on the diagnostic comparative study of the Chinese Classification of Mental Disorders-Second Edition (CCMD-2) and the DSM-III-R in a field trial in China. The Adult Diagnostic Interview Schedule-Second Edition (ADIS-2), a modified diagnostic interview schedule that can generate both CCMD-2 and DSM-III-R diagnoses, was used to test 254 psychiatric patients in China. It was found that the reliability and validity of the CCMD-2 and DSM-III-R are compatible in most diagnostic categories such as schizophrenia, delusional disorder, bipolar disorders, and depressive disorders. The discrepancies between Chinese and American diagnostic systems were found mainly in neurasthenia and hysterical neuroses. Such discrepancies may have resulted from frequent changes of the diagnostic terms in the West, such as the phenomenon of neurasthenia, or from creating a new disorder entity in CCMD-2, such as "Eastern gymnastic exercises-induced mental disorder. "Further cross-cultural studies focusing on these discrepant disorders are urgently needed to understand the cultural influences on diagnosis, as well as to improve the professional classification of mental disorders in different diagnostic systems.

The reliability and validity of the Chinese Polarity Inventory

For the simultaneous measurement of manic and depressive symptoms, the Chinese Polarity Inventory (CPI), a 20-item self-report scale, was developed. A total of 329 depressive and 356 manic/hypomanic patients were recruited in this scale developmental study in China. All patients completed the CPI and either the Chinese version of the Hamilton Depression Rating Scale (for depressed subjects) or the Chinese version of the Bech-Rafaelsen Mania Scale (for manic subjects). The CPI was found to have excellent reliability and satisfactory concurrent validity. Construct validity analysis was performed using principal component analysis, which yielded 4 clinically meaningful factors: activity, pleasurability, capability and irritability. The CPI was sensitive in differentiating different severities of depression and mania. However, its ability to differentiate mixed phase from other mood states and its sensitivity to changes during the treatment still need to be studied further.

Diagnostic agreement in psychiatry. A comparative study between ICD-9, ICD-10 and DSM-III-R

A random sample of 100 new patients referred consecutively to the psychiatric hospital was assessed using the Arabic translation of the PSE. An abstract form was designed to include all PSE scores as well as the necessary extra data to make ICD-9, ICD-10, and DSM-III-R diagnoses. Kappa correlation was calculated for inter-rater and intra-rater reliability. Overall reliability and reliability of each major psychiatric diagnosis were compared between the three systems. The use of the PSE helped in achieving good agreement between Arab psychiatrists for all the three systems, but ICD-10 was found to have the highest reliability figures both for three-digit and four-digit psychiatric diagnoses.

Computerized psychiatric diagnoses based on euclidean distances: a Chinese example

Current diagnostic methods in psychiatry use sequential logical decision rules that generate a single diagnosis. Insufficient attention has been paid to parallel methods that can simultaneously determine the relative probability of many diagnoses. This study installed 45 items from various symptom scales on a portable computer and applied a euclidean distance formula to generate immediate diagnoses based on responses to the items. The reliability and validity of the method were assessed using Chinese psychiatric inpatients. Interrater reliability was excellent (kappa = 0.91) and 3-week test-retest reliability was fair (k = 0.50). The concordance of this method with clinicians' diagnoses and with diagnoses based on standardized Chinese diagnostic criteria was excellent (k = 0.73 and 0.76). Concordance with DSM-III-R diagnoses and ICD-10 diagnoses was fair (kappa = 0.55 and 0.65). The clinical utility of such parallel methods of psychiatric diagnosis deserves further evaluation.

Adult psychiatric epidemiology in China in the 80s

This paper presents the prevalence rates of the main adult psychiatric disorders as determined by seven community surveys conducted in China in the 1980s. The prevalence rates are compared with previous findings in China and those from Taiwan and the West.

Comparison of the Chinese Depression Inventory and the Chinese version of the Beck Depression Inventory

Using a sample of 329 currently depressed patients from 24 hospitals across China, the Chinese Depression Inventory (CDI) was developed based on its own culture and verbal expression styles. The reliability and validity of CDI were much better for these patients than the Chinese version of the Beck Depression Inventory (CBDI). This study demonstrated that the CDI is both a culturally sensitive and cross-culturally useful self-report scale for measuring the severity of depression in Chinese. The authors suggest that such a rating scale would eliminate serious cultural biases, control for the severity of illness among different ethnic groups and thereby make cross-cultural studies more valid.

Applicability of the Chinese Beck Depression Inventory

Using a sample of 329 currently depressed patients from 24 hospitals across China, this study assesses the reliability and validity of the Chinese version of Beck Depression Inventory (CBDI). Even though the internal reliability and the concurrent validity were good (Cronbach alpha = 0.846; r = 0.566), the results showed that the item of Loss of Libido was most weakly correlated with the CBDI's total score; the items of Sense of Punishment, Sense of Hate, Self Accusations, Crying Spells, Irritability, and Somatic Preoccupation were poorly associated with the intensity of depression measured by the total score of the Chinese version of Hamilton Depression Rating Scale (CHDS). The CBDI's construct validity was rather poor by principal component analysis: three of six factors were unexplainable in terms of clinical features of depression. The results demonstrated that CBDI, even though it was semantically translated into Chinese language, still could not be effectively applied in clinic and research settings in China. Using the theory and methods of psychometrics to develop China's own culturally sensitive self-report inventory is the correct way to eliminate cultural bias and make cross-cultural research more valid. This is the most rigorous scientific approach to cross-cultural comparisons.

Validity and reliability of the Chinese Hamilton Depression Rating Scale

The reliability and validity of the Chinese version of the 17-item Hamilton Depression Rating Scale (CHDS) was assessed. Interrater reliability was excellent, the item total-score correlations were good, and the internal reliability was satisfactory. The concurrent validity was tested by correlating the CHDS score with the Global Assessment Scale score; the strong negative correlation found indicated that the CHDS reflects the overall level of disability. Five distinct factors were generated by principle-component analysis; these factors account for 52.4% of the total variance. Rigorous evaluation of the numerous translated scales being used in clinical and research settings of non-Western countries is important.