Probability of major depression diagnostic classification using semi-structured versus fully structured diagnostic interviews
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Background: Different diagnostic interviews are used as reference standards for major depression classification in research. Semi-structured interviews involve clinical judgement, whereas fully structured interviews are completely scripted. The Mini International Neuropsychiatric Interview (MINI), a brief fully structured interview, is also sometimes used. It is not known whether interview method is associated with probability of major depression classification. Aims: To evaluate the association between interview method and odds of major depression classification, controlling for depressive symptom scores and participant characteristics. Method: Data collected for an individual participant data meta-analysis of Patient Health Questionnaire-9 (PHQ-9) diagnostic accuracy were analysed and binomial generalised linear mixed models were fit. Results: A total of 17 158 participants (2287 with major depression) from 57 primary studies were analysed. Among fully structured interviews, odds of major depression were higher for the MINI compared with the Composite International Diagnostic Interview (CIDI) (odds ratio (OR) = 2.10; 95% CI = 1.15–3.87). Compared with semi-structured interviews, fully structured interviews (MINI excluded) were non-significantly more likely to classify participants with low-level depressive symptoms (PHQ-9 scores ≤6) as having major depression (OR = 3.13; 95% CI = 0.98–10.00), similarly likely for moderate-level symptoms (PHQ-9 scores 7–15) (OR = 0.96; 95% CI = 0.56–1.66) and significantly less likely for high-level symptoms (PHQ-9 scores ≥16) (OR = 0.50; 95% CI = 0.26–0.97). Conclusions: The MINI may identify more people as depressed than the CIDI, and semi-structured and fully structured interviews may not be interchangeable methods, but these results should be replicated. Declaration of interest: Drs Jetté and Patten declare that they received a grant, outside the submitted work, from the Hotchkiss Brain Institute, which was jointly funded by the Institute and Pfizer. Pfizer was the original sponsor of the development of the PHQ-9, which is now in the public domain. Dr Chan is a steering committee member or consultant of Astra Zeneca, Bayer, Lilly, MSD and Pfizer. She has received sponsorships and honorarium for giving lectures and providing consultancy and her affiliated institution has received research grants from these companies. Dr Hegerl declares that within the past 3 years, he was an advisory board member for Lundbeck, Servier and Otsuka Pharma; a consultant for Bayer Pharma; and a speaker for Medice Arzneimittel, Novartis, and Roche Pharma, all outside the submitted work. Dr Inagaki declares that he has received grants from Novartis Pharma, lecture fees from Pfizer, Mochida, Shionogi, Sumitomo Dainippon Pharma, Daiichi-Sankyo, Meiji Seika and Takeda, and royalties from Nippon Hyoron Sha, Nanzando, Seiwa Shoten, Igaku-shoin and Technomics, all outside of the submitted work. Dr Yamada reports personal fees from Meiji Seika Pharma Co., Ltd., MSD K.K., Asahi Kasei Pharma Corporation, Seishin Shobo, Seiwa Shoten Co., Ltd., Igaku-shoin Ltd., Chugai Igakusha and Sentan Igakusha, all outside the submitted work. All other authors declare no competing interests. No funder had any role in the design and conduct of the study; collection, management, analysis and interpretation of the data; preparation, review or approval of the manuscript; and decision to submit the manuscript for publication.
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Controlling for depressive symptom levels, the CIDI might classify more participants with low level symptoms as having depression but fewer with high level symptoms.
“We analysed studies that used different types of reference standards separately because we previously found that, controlling for depressive symptom levels, the MINI might classify depression more than other diagnostic interviews, and the CIDI might classify more participants with low level symptoms as having depression but fewer with high level symptoms.16 17 18”
Controlling for depressive symptom levels, the MINI might classify depression more than other diagnostic interviews.
“We analysed studies that used different types of reference standards separately because we previously found that, controlling for depressive symptom levels, the MINI might classify depression more than other diagnostic interviews, and the CIDI might classify more participants with low level symptoms as having depression but fewer with high level symptoms.16 17 18”
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Self-citation
- Authors
- Levis, B., Benedetti, A., Riehm, K. E., Saadat, N., Levis, A. W., Azar, M., Rice, D. B., Chiovitti, M. J., Sanchez, T. A., Cuijpers, P., Gilbody, S., Ioannidis, J. P. A., Kloda, L. A., McMillan, D., Patten, S. B., Shrier, I., Steele, R. J., Ziegelstein, R. C., Akena, D. H., Arroll, B., Ayalon, L., Baradaran, H. R., Baron, M., Beraldi, A., Bombardier, C. H., Butterworth, P., Carter, G., Chagas, M. H., Chan, J. C. N., Cholera, R., Chowdhary, N., Clover, K., Conwell, Y., de Man-van Ginkel, J. M., Delgadillo, J., Fann, J. R., Fischer, F. H., Fischler, B., Fung, D., Gelaye, B., Goodyear-Smith, F., Greeno, C. G., Hall, B. J., Hambridge, J., Harrison, P. A., Hegerl, U., Hides, L., Hobfoll, S. E., Hudson, M., Hyphantis, T., Inagaki, M., Ismail, K., Jetté, N., Khamseh, M. E., Kiely, K. M., Lamers, F., Liu, S.-I., Lotrakul, M., Loureiro, S. R., Löwe, B., Marsh, L., McGuire, A., Mohd Sidik, S., Munhoz, T. N., Muramatsu, K., Osório, F. L., Patel, V., Pence, B. W., Persoons, P., Picardi, A., Rooney, A. G., Santos, I. S., Shaaban, J., Sidebottom, A., Simning, A., Stafford, L., Sung, S., Tan, P. L. L., Turner, A., van der Feltz-Cornelis, C. M., van Weert, H. C., Vöhringer, P. A., White, J., Whooley, M. A., Winkley, K., Yamada, M., Zhang, Y., & Thombs, B. D.
- Affiliations
- Jewish General Hospital (CA)
- McGill University Health Centre (CA)
- Amsterdam Public Health (NL)
- University of York (GB)
- Stanford Medicine (US)
- Concordia University (CA)
- University of Calgary (CA)
- Johns Hopkins University (US)
- Makerere University (UG)
- University of Auckland (NZ)
- Bar-Ilan University (IL)
- Iran University of Medical Sciences (IR)
- Garmisch-Partenkirchen Medical Center (DE)
- University of Washington (US)
- Australian National University (AU)
- University of Newcastle Australia (AU)
- Universidade de São Paulo (BR)
- Chinese University of Hong Kong (HK)
- University of North Carolina at Chapel Hill (US)
- Calvary Mater Newcastle Hospital (AU)
- University of Rochester Medicine (US)
- University of Sheffield (GB)
- Charité – Universitätsmedizin Berlin (DE)
- National University of Singapore (SG)
- Harvard University (US)
- University of Pittsburgh (US)
- John Hunter Hospital (AU)
- University Hospital Leipzig (DE)
- The University of Queensland (AU)
- Rush University Medical Center (US)
- University of Ioannina (GR)
- Okayama University Hospital (JP)
- King's College London (GB)
- Mackay Memorial Hospital (TW)
- Mahidol University (TH)
- Schön Klinik Hamburg Eilbek (DE)
- Michael E. DeBakey VA Medical Center (US)
- Saint Joseph's College of Maine (US)
- Universidade Federal de Pelotas (BR)
- Niigata Seiryo University (JP)
- KU Leuven (BE)
- Istituto Superiore di Sanità (IT)
- Royal Edinburgh Hospital (GB)
- Universiti Sains Malaysia (MY)
- Allina Health (US)
- Royal Women's Hospital (AU)
- Tan Tock Seng Hospital (SG)
- Deakin University (AU)
- Tufts University (US)
- Monash University (AU)
- San Francisco VA Medical Center (US)
- National Center of Neurology and Psychiatry (JP)
- Corresponding author
- Thombs, Brett D.
- ORCID
- Levis, Brooke
- Benedetti, Andrea
- Riehm, Kira E.
- Rice, Danielle B.
- Sanchez, Tatiana A.
- Cuijpers, Pim
- Gilbody, Simon
- Ioannidis, John P. A.
- Kloda, Lorie A.
- McMillan, Dean
- Patten, Scott B.
- Shrier, Ian
- Steele, Russell J.
- Ziegelstein, Roy C.
- Akena, Dickens H.
- Arroll, Bruce
- Ayalon, Liat
- Baradaran, Hamid R.
- Baron, Murray
- Bombardier, Charles H.
- Butterworth, Peter
- Carter, Gregory
- Chagas, Marcos H.
- Chan, Juliana C. N.
- Cholera, Rushina
- Chowdhary, Neerja
- Clover, Kerrie
- Conwell, Yeates
- Delgadillo, Jaime
- Fann, Jesse R.
- Fischer, Felix H.
- Fung, Daniel
- Gelaye, Bizu
- Greeno, Catherine G.
- Hall, Brian J.
- Harrison, Patricia A.
- Hegerl, Ulrich
- Hides, Leanne
- Hobfoll, Stevan E.
- Hudson, Marie
- Hyphantis, Thomas
- Inagaki, Masatoshi
- Ismail, Khalida
- Jetté, Nathalie
- Khamseh, Mohammad E.
- Kiely, Kim M.
- Lamers, Femke
- Lotrakul, Manote
- Löwe, Bernd
- Marsh, Laura
- McGuire, Anthony
- Munhoz, Tiago N.
- Patel, Vikram
- Pence, Brian W.
- Persoons, Philippe
- Picardi, Angelo
- Rooney, Alasdair G.
- Santos, Iná S.
- Sidebottom, Abbey
- Simning, Adam
- Stafford, Lesley
- Sung, Sharon
- Tan, Pei Lin Lynnette
- Turner, Alyna
- Vöhringer, Paul A.
- White, Jennifer
- Whooley, Mary A.
- Winkley, Kirsty
- Yamada, Mitsuhiko
- Thombs, Brett D.
- Venue
- The British Journal of Psychiatry
- Publisher
- Royal College of Psychiatrists
- Published
- 2018-05-02
- Volume
- 212
- Issue
- 6
- Pages
- 377-385
- ISSN
- 0007-1250 (ISSN-L)
- 1472-1465
- PMC
- PMC6415695
- OpenAlex
- W2792666127
- Cited by
- 69
- References
- 34
- Citations by year
- 2026: 4 · 2025: 9 · 2024: 7 · 2023: 9 · 2022: 4 · 2021: 11 · 2020: 12 · 2019: 11 · 2018: 2
- FWCI
- 11.73
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- public-domain
- www.cambridge.org/core/terms (unspecified)
- Locations
- The British Journal of Psychiatry (publishedVersion, public-domain)
- Research portal (Tilburg University) (publishedVersion)
- PubMed (publishedVersion)
- Pure Amsterdam UMC (publishedVersion, cc-by)
- Amsterdam UMC (VU Amsterdam) - Institutional Repository (publishedVersion, other-oa)
- Universiti Putra Malaysia Institutional Repository (Universiti Putra Malaysia) (acceptedVersion)
- White Rose Research Online (University of Leeds, The University of Sheffield, University of York) (acceptedVersion)
- PubMed Central (acceptedVersion)
- LSHTM Research Online (London School of Hygiene and Tropical Medicine) (acceptedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion, public-domain)
- DR-NTU (Nanyang Technological University) (submittedVersion)
- Own your potential (DEAKIN) (submittedVersion)
- Utrecht University Repository (Utrecht University) (submittedVersion, other-oa)
- eScholarship@McGill (McGill) (submittedVersion, cc-by-nc-nd)
- Figshare (submittedVersion)
- Research Portal (King's College London) (submittedVersion, other-oa)
- ANU Open Research (Australian National University) (submittedVersion)
- VU Research Portal (submittedVersion, public-domain)
- ResearchSpace (University of Auckland) (submittedVersion, public-domain)
- Utrecht University Repository (Utrecht University) (submittedVersion)
- NOVA (University of Newcastle Australia) (submittedVersion, public-domain)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- Funders
- U.S. Department of Health and Human Services (T32 GM07356)
- U.S. Department of Veterans Affairs (R01 HL079235)
- Robert Wood Johnson Foundation (R01 HL079235)
- American Federation for Aging Research (R01 HL079235)
- Eli Lilly and Company
- Pfizer
- World Health Organization
- Ohio Board of Regents
- Ischemia Research and Education Foundation (R01 HL079235)
- Health Services Research and Development
- Alberta Health Services
- University of Washington (H133N060032, H133N060003, H133N060033)
- Johns Hopkins University
- University of Pittsburgh
- University of Rochester
- University of Calgary
- McGill University
- Rush University
- Banco Santander
- Iran University of Medical Sciences
- Calvary Mater Newcastle
- Duke-NUS Medical School
- Arthritis Society
- National Institute for Health and Care Research (RP-PG-0606-1142, FP7/2007–2013)
- University of Cambridge
- King's College London
- European Commission (2007–2013, FP7 2007-2013, FP7/2007, 334065)
- Australian National University
- Hunter Medical Research Institute
- National University of Singapore
- Nanyang Technological University
- University of Auckland
- Universität Heidelberg
- University of Melbourne
- ZonMw
- Vrije Universiteit Amsterdam (FP7/2007-2013)
- Bundesministerium für Bildung und Forschung (01GY1150)
- Bar-Ilan University
- Ministero della Salute
- Ministry of Health, Labour and Welfare
- Conselho Nacional de Desenvolvimento Científico e Tecnológico
- Mahidol University
- Fundação de Amparo à Pesquisa do Estado do Rio Grande do Sul
- Tehran University of Medical Sciences and Health Services
- Universiti Putra Malaysia
- Universiti Sains Malaysia
- Universidade de Macau (MYRG2015-00109, MYRG2015-00109-FSS)
- Jewish General Hospital
- National Health Research Institutes
- Chinese University of Hong Kong
- Shionogi
- Universidade de São Paulo
- Safe Work Australia
- Innovatiefonds Zorgverzekeraars
- Servier
- Chinese Diabetes Society
- H. Lundbeck A/S
- Scleroderma Society of Ontario
- University of Ioannina
- National Institutes of Health (R36 HS018246, 5f30mh096664-03, FP7/2007-2013, H133N060033, DK-50456)
- Centers for Disease Control and Prevention (R49CE002093)
- Health Resources and Services Administration
- Agency for Healthcare Research and Quality (T32 GM07356, R24 MH071604, R36HS018246, TL1 RR024135)
- University of North Carolina at Chapel Hill
- Johns Hopkins Bloomberg School of Public Health
- Novartis Pharma
- Medical Center, University of Rochester
- O'Brien Institute for Public Health, University of Calgary
- Canadian Institutes of Health Research (FRN83518, (KRS‐134297), RO1 HD39415, 83518)
- Fonds de Recherche du Québec - Santé
- Medical Research Council (FP7/20072013, MR/J000914/1)
- Australian Research Council (FT130101444)
- National Health and Medical Research Council (1088313, FRN 83518, 1002160)
- Health Research Council of New Zealand (2007-2013)
- Programme Grants for Applied Research (RP‐PG‐0606‐1142)
- Lee Kong Chian School of Medicine, Nanyang Technological University
- Lady Davis Institute for Medical Research
- National Institute on Disability and Rehabilitation Research (H133N060032, H133N060003, H133N060033)
- National Heart, Lung, and Blood Institute (R01HL079235)
- National Institute of Mental Health (F30 MH096664, K02MH065919, R49 CE002093, R01MH069666, R24 MH-56858, MH071604, R34MH084673, 5F30MH096664, R24MH071604, MH65919, R01MH073687, R36 HS018246, R34MH072925)
- National Institute of General Medical Sciences (T32GM007356)
- Fogarty International Center (IS130005, R25TW009340)
- National Institute of Diabetes and Digestive and Kidney Diseases (P30DK050456)
- National Center for Research Resources (R36 HS018246, DK50456, RR024135, TL1RR024135, 00109)
- National Institute on Minority Health and Health Disparities (T37MD001449)
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (R01HD039415)
- School of Medicine, University of North Carolina at Chapel Hill
- Canadian Arthritis Network
- National Center for Medical Rehabilitation Research (RO1 HD39415)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
- Keywords
- major depressive disorder, diagnostic classification, structured diagnostic interview, semi-structured interviews, Mini International Neuropsychiatric Interview, Composite International Diagnostic Interview, PHQ-9, diagnostic accuracy, depression severity, individual patient data meta-analysis
- MeSH terms
- Adult, Depression, Major Depressive Disorder, Female, Humans, Interview, Psychological, Male, Probability, Psychiatric Status Rating Scales, Meta-Analysis as Topic
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