Validity of DSM‐III‐R diagnosis by psychological autopsy: a comparison with clinician ante‐mortem diagnosis

Abstract

Psychological autopsies are an important research tool in establishing risk factors associated with suicide. We report the results of a validity study comparing psychological autopsy-generated DSM-III-R diagnoses in suicides and non-suicides with chart diagnoses generated by clinicians who had treated the subjects prior to death. The Structured Clinical Interview for DSM-III-R Disorders (SCID-P) and the Structured Clinical Interview for DSM-III-R Personality Disorders (SCID-II) were used to make independent post-mortem diagnoses. Comparison of research diagnoses with clinician ante-mortem diagnoses generated kappa coefficients of 0.85 for Axis I diagnoses and 0.65 for Axis II conditions. These kappa coefficients compare favourably with direct patient interview reliability studies. This provides evidence for the validity of the psychological autopsy as a method of determining psychiatric diagnosis.

GABAergic Neurons Immunoreactive for Calcium Binding Proteins are Reduced in the Prefrontal Cortex in Major Depression

“…Diagnoses for Axis I disorders were assessed independently by a clinical psychologist and a psychiatrist, and consensus diagnosis was reached in conference, using all available information from the knowledgeable informants, the coroner's office, and previous hospitalizations and doctors' records. Kelly and Mann (1996) have validated the use of the so-called psychiatric autopsy by demonstrating good agreement between informant-based retrospective psychiatric assessments of deceased subjects and chart diagnoses generated by clinicians treating the same subjects before death. Subjects met diagnostic criteria for MDD within the last month of life.…”

Genetic architecture of the human tryptophan hydroxylase 2 Gene: existence of neural isoforms and relevance for major depression

“…Next of kin gave informed consent to the use of brain tissue for research and to undergo a psychological autopsy interview. 18 Clinical axis I and axis II diagnoses, including a major depressive disorder were based on DSM-IV criteria established from structured clinical interviews, SCID-I and SCID-II and when available, from review of medical records with the modified Diagnostic Evaluation After Death. 21 These psychiatric diagnoses (or the absence of any psychiatric diagnosis), based on all available data, were confirmed as meeting published criteria, [22][23][24] at a consensus conference by the authors (JJM, AJD and GR), which also reviewed the medical examiner's determination of suicide or other manner of death.…”

“…[13][14][15][16][17] We investigated the role of TPH2 in major depression and suicidal behavior using a collection of case and control postmortem brain samples. Through psychological autopsies using validated structured clinical interviews with family members 18 we obtained detailed clinical information, including axis I and II psychiatric diagnoses based on DSM-IV diagnostic criteria. Recent studies report associations of TPH2 with major depression and with suicide, involving single nucleotide polymorphisms (SNPs) in intron 5 and exon 11.…”

Neuronal Tryptophan Hydroxylase mRNA Expression in the Human Dorsal and Median Raphe Nuclei: Major Depression and Suicide

“…Subject demographics are presented in Table 1. Control cases died of causes other than suicide and had no Axis I or Axis II psychiatric diagnosis based on a structured clinical interview (SCID I and II; First et al, 1996;Kelly and Mann, 1996;Spitzer et al, 1992;Williams et al, 1992). In all, 10 suicides had an Axis I diagnosis of major depression, one of which had a diagnosis of major depression as part of a schizoaffective disorder.…”