Test–retest reliability of schizoaffective disorder compared with schizophrenia, bipolar disorder, and unipolar depression—a systematic review and meta‐analysis
Abstract
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.
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Reliability problems have long been noted in the DSM diagnosis of Schizoaffective Disorder.
“Indeed, reliability problems have long been noted in the DSM diagnosis of Schizoaffective Disorder 42 .”
From An organization‐ and category‐level comparison of diagnostic requirements for mental disorders in <scp>ICD</scp> ‐11 and <scp>DSM</scp> ‐5 (2021) · cites this paper as [42]
Schizoaffective disorder is not uncommon in clinical populations, and its reliability remains debated.
“Schizoaffective disorder is not a rare diagnosis in clinical populations, and its reliability is subject to ongoing discussion 46 .”
The DSM has historically and currently used a longitudinal approach, and most earlier studies were based on it.
“This is different from the longitudinal approach historically and currently taken by the DSM, on which most previous studies have been based 46,47 .”
A meta-analysis by Santelmann and colleagues found an average kappa difference of about 0.2 between schizoaffective disorder and diagnoses such as schizophrenia, bipolar disorder, and unipolar depression.
“In a meta-analysis of studies on sequential reliability (test-retest) of schizoaffective disorders, Santelmann et al 46 documented a mean difference of approximately 0.2 for kappa between schizoaffective disorder and other diagnoses such as schizophrenia, bipolar disorder and unipolar depression.”
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- Authors
- Santelmann, H., Franklin, J., Bußhoff, J., & Baethge, C.
- Affiliations
- University of Cologne (DE)
- Corresponding author
- Baethge, Christopher
- Venue
- Bipolar Disorders
- Publisher
- Wiley
- Published
- 2015-10-26
- Volume
- 17
- Issue
- 7
- Pages
- 753-768
- ISSN
- 1398-5647 (ISSN-L)
- 1399-5618
- OpenAlex
- W1867708229
- Cited by
- 53
- References
- 90
- Citations by year
- 2026: 3 · 2025: 2 · 2024: 3 · 2023: 1 · 2022: 1 · 2021: 5 · 2020: 13 · 2019: 9 · 2018: 4 · 2017: 4 · 2016: 6 · 2015: 2
- FWCI
- 0.73
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Bipolar Disorders (publishedVersion)
- PubMed (publishedVersion)
- Kölner Universitäts PublikationsServer (Universität zu Köln) (publishedVersion)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Bipolar Disorder and Treatment
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Social Sciences › Decision Sciences › Statistics, Probability and Uncertainty › Reliability and Agreement in Measurement
- Keywords
- schizoaffective disorder, test-retest reliability, diagnostic reliability, schizophrenia, bipolar disorder, major depressive disorder, differential diagnosis, diagnostic agreement, kappa statistic
- MeSH terms
- Bipolar Disorder, Major Depressive Disorder, Diagnosis, Differential, Humans, Psychotic Disorders, Schizophrenia, Reproducibility of Results
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