Clinical reappraisal of the Composite International Diagnostic Interview Version 3.0 in the Saudi National Mental Health Survey

Abstract

Objectives The DSM‐IV diagnoses generated by the fully structured lay‐administered Composite International Diagnostic Interview Version 3.0 (CIDI 3.0) in the Saudi National Mental Health Survey (SNMHS) were compared to diagnoses based on blinded clinical reappraisal interviews. Methods Telephone follow‐up interviews were administered using the clinician‐administered non‐patient edition of the Structured Clinical Interview for DSM‐IV (SCID) in separate sub‐samples of SNMHS respondents who screened positive for four disorders that are of special importance in Arab countries: obsessive–compulsive disorder, separation anxiety disorder, social phobia, and major depressive episode. Results Initial diagnoses based on the CIDI were found to have higher prevalence than those based on the SCID for all four disorders. For reasons having to do with respondent denial of symptoms in the SCID reported in the CIDI, we interpreted these differences as due more to under‐diagnoses in the SCID than over‐diagnoses in the CIDI. Nonetheless, CIDI diagnostic thresholds for three of the four disorders were increased to make sure prevalence estimates based on the CIDI were conservative. The procedures used to implement these recalibrations are described in this paper. Conclusions The CIDI interviews used in the SNMHS generated valid but conservative diagnoses of common mental disorders in the Saudi population.

Lifetime prevalence and treatment of mental disorders in Saudi youth and adolescents

“…The instrument used for the SNMHS was the adapted WHO Composite International Diagnostic Interview (CIDI) 3.0 58 , 59 , a fully structured interview 62 that generated diagnoses based upon the DSM-IV 63 in the SNMHS. These CIDI-related diagnoses showed good concordance with diagnoses based on blinded clinician reappraisal interviews published earlier 64 , 65 . The assessed disorders were grouped into classes such as anxiety disorders (i.e., panic disorder, agoraphobia without panic disorder, social phobia, generalized anxiety disorder, post-traumatic stress disorder, obsessive–compulsive disorder, and separation anxiety disorder), mood disorders (i.e., major depressive disorder, bipolar I and II disorder), eating disorders (i.e., anorexia nervosa, bulimia nervosa, binge-eating disorder), disruptive behavior disorders (i.e., attention deficit hyperactivity disorder (ADHD), conduct disorder, oppositional-defiant disorder, intermittent explosive disorder), and substance use disorders (i.e., alcohol and drug abuse and dependence).…”

The comparative importance of mental and physical disorders for health-related days out of role in the general population of Saudi Arabia

“…If so, our estimates of the relative burden of mental disorders on DOR are likely conservative. Another possibility is that the diagnostic instrument used (CIDI 3.0), which is known to produce conservative estimates more generally, might have been even more conservative in KSA [ 31 ]. It is noteworthy, though, that underreporting of physical disorders might have occurred as well due to the use of self-report physical disorder checklists rather than medical examinations, but we would expect this to be less of a problem than for reports of mental disorders because of the lower stigma associated with physical than mental disorders and evidence from previous research that good correspondence exists between self-reports and clinical records of chronic physical disorders [ 53 , 54 ].…”

“…We focus on 12-month prevalence of five anxiety disorders (panic disorder or agoraphobia, separation anxiety or social phobia, generalized anxiety disorder, post-traumatic stress disorder, obsessive-compulsive disorder), two mood disorders (major depressive disorder, bipolar I-II disorder), two disruptive behavior disorders (attention-deficit/hyperactivity disorder (ADHD), intermittent explosive disorder), and any eating disorder (anorexia nervosa, binge eating disorder, bulimia nervosa). A clinical reappraisal study showed that CIDI diagnoses are valid but conservative compared to diagnoses based on blinded clinical reappraisal interviews with the Structured Clinical Interview for DSM-IV [ 31 ].…”

The prevalence and correlates of bulimia nervosa, binge‐eating disorder, and anorexia nervosa: The Saudi National Mental Health Survey

“…The response rate was 61%. Further details of the survey procedures can be found elsewhere (Aradati et al, 2019; Hyder et al, 2017; Kessler et al, 2020; Shahab et al, 2017).…”