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Cited by 339Mental Health Treatment and AccessAnxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesReliability and Agreement in Measurement

A Comparison of Self-report and Clinical Diagnostic Interviews for Depression: Diagnostic Interview Schedule and Schedules for Clinical Assessment in Neuropsychiatry in the Baltimore Epidemiologic Catchment Area Follow-up

Eaton, William W., Neufeld, Karen, Chen, Li-Shiun, Cai, Guojun·2000·Archives of General Psychiatry
DOI 10.1001/archpsyc.57.3.217
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Abstract

BACKGROUND: The field of psychiatric epidemiology continues to employ self-report instruments, but the low degree of agreement between diagnoses achieved using these instruments vs. that achieved by psychiatrists in the clinical modality threatens the credibility of the results. METHODS: In the Baltimore Epidemiologic Catchment Area follow-up, 349 individuals who had a Diagnostic Interview Schedule (DIS) interview were blindly examined by psychiatrists using the Schedules for Clinical Assessment in Neuropsychiatry (SCAN). Comparisons were made at the level of diagnosis, syndrome, and DSM-IV symptom group. Indexes of agreement were computed and characteristics of discrepant cases were identified. RESULTS: Agreement on diagnosis of major depressive disorder was only fair (kappa = 0.20), with the DIS missing many cases judged to meet criteria for diagnosis using the SCAN (29% sensitivity). A major source of discrepancy was respondents with false-negative diagnoses who repeatedly failed to report DIS symptoms attributed to life crises or medical conditions. Older age, male sex, and lower impairment were associated with underdetection by the DIS, using logistic regression analysis. In spite of the diagnostic discrepancy, there was substantial correlation in numbers of symptom groups in the 2 modalities (r = 0.49). Agreement was highest (about 55% sensitivity and 90% specificity) when both the SCAN and DIS thresholds were set at the level of depression syndrome instead of diagnosis. CONCLUSIONS: Weak agreement at the level of diagnosis continues to threaten the credibility of estimates of prevalence of specific disorders. A bias toward underreporting, as well as stronger agreement at the level of the depression syndrome and on ordinal measures of depressive symptoms, suggests that associations with risk factors are conservative.

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  • Patient reported mental health does not accurately reflect clinician assessment.

    “previous research has shown that patient reported mental health does not accurately reflect clinician assessment.”

    From Is it Still Ok to be Ok? Mental Health Labels as a Campus Technology (2023) · cites this paper as Eaton et al. 2000

  • Weak agreement between self-reported instruments and clinician conducted diagnostic interviews threatens the credibility of prevalence estimates for specific disorders.

    “Eaton and colleagues describe the issue of weak agreement between self-reported instruments and clinician conducted diagnostic interviews as threatening to the credibility of prevalence estimates for specific disorders (Eaton et al. 2000).”

    From Is it Still Ok to be Ok? Mental Health Labels as a Campus Technology (2023) · cites this paper as Eaton et al. 2000

  • Individuals had a tendency to underreport symptoms in major depressive disorder, primarily those attributed to life-crises and medical conditions.

    “Their research found that individuals had a tendency to underreport symptoms in major depressive disorder, primarily those attributed to life-crises and medical conditions.”

    From Is it Still Ok to be Ok? Mental Health Labels as a Campus Technology (2023) · cites this paper as Eaton et al. 2000

  • Men have been found to underreport depression more than women do.

    “Indeed, men have been found to under-report their levels of depression to a greater extent than females (Allen-Burge et al. 1994;Eaton et al. 2000)”

    From The effects of paternal depression on child and adolescent outcomes: A systematic review (2016) · cites this paper as Eaton et al. 2000

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Authors
Eaton, W. W., Neufeld, K., Chen, L.-S., & Cai, G.
Affiliations
  • Johns Hopkins University (US)
  • World Health Organization (CH)
ORCID
Venue
Archives of General Psychiatry
Publisher
American Medical Association (AMA)
Published
2000-03-01
Volume
57
Issue
3
Pages
217
ISSN
0003-990X (ISSN-L)
DOI
10.1001/archpsyc.57.3.217
OpenAlex
W2051120571
Cited by
339
References
16
Citations by year
2026: 7 · 2025: 9 · 2024: 4 · 2023: 15 · 2022: 14 · 2021: 16 · 2020: 14 · 2019: 11 · 2018: 8 · 2017: 16 · 2016: 15 · 2015: 13 · 2014: 9 · 2013: 9 · 2012: 14
FWCI
23.68
Type
journal article
Language
en
Open access
closed
Locations
  • Archives of General Psychiatry (publishedVersion)
  • PubMed (publishedVersion)
Funders
National Institute of Mental Health (R01MH047447, MH 47447)
Topics
  • Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
  • Social Sciences › Decision Sciences › Statistics, Probability and Uncertainty › Reliability and Agreement in Measurement
Keywords
depression, major depressive disorder, self-report measures, Diagnostic Interview Schedule, diagnostic agreement, underreporting, sensitivity and specificity, depressive syndrome, psychiatric epidemiology
MeSH terms
Adolescent, Adult, Catchment Area, Health, Depressive Disorder, False Negative Reactions, Female, Follow-Up Studies, Health Surveys, Humans, Male, Middle Aged, Predictive Value of Tests, Psychiatric Status Rating Scales, Regression Analysis, Risk Factors, Baltimore, Reproducibility of Results, Prevalence

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