Publisher:
World Health Organization
www.who.int/msa/cidi/

Initial Material Cost:
Complete Package (includes lifetime and 12-month interviews, plus interviewer’s and trainer’s manual, Probe Flow Chart, and question specifications. Also includes the scoring and data entry programs for both interviews.): $150;
CIDI Auto (The computerized version of the CIDI): $500

Representativeness of Norming Sample:
None described

Languages:
English, Spanish, French, Italian, Dutch, German, and Portuguese 1

Type of Assessment:
Self report

Age Range and Administration Interval:
Adults who can read and write

Personnel, Training, Administration, and Scoring Requirements:
Administration time is 75 minutes for the regular form; 20 minutes for the short form. The instruments can be administered by a trained nonclinican and scored by a clerical individual. Computer scoring takes 20 minutes.

Summary
Initial Material Cost: 2 ($100 to $200)
Reliability: Inter-rater: 3 (kappa .65 and higher), Test-retest: 3 (kappa mostly .65 and higher)
Validity: Concurrent: 3 (mostly .5 and higher)
Norming Sample Characteristics: 1 (none described)
Ease of Administration and Scoring: 3 (administered and scored by a highly trained individual)

Description: The Composite International Diagnostic Interview (CIDI) is a comprehensive, fully-structured psychiatric diagnostic interview designed to be used by trained nonclinician interviewers to diagnose more than 40 mental disorders among adults from different cultures according to the definitions and criteria of both the International Classification of Diseases, 10th edition) (ICD-10) and the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) diagnostic systems for lifetime, last year, last 6 months, last month, and last 2 weeks. The CIDI is available in lifetime and 12-month versions, and in both paper and pencil and computer-administered forms. The latter version is suitable for self-administration by cooperative subjects. During a CIDI interview, respondents are asked closed-ended questions about symptoms of psychiatric disorders. Positive responses to some of the symptom questions are followed by questions from the Probe Flow Chart that determine whether the symptom is a possible psychiatric symptom (that is, it is clinically significant and is not due to medication, drugs or alcohol or to a physical illness or injury). Negative responses to symptom questions will often lead to later questions being skipped. If enough symptoms have been endorsed, and these symptoms occur in a pattern that suggests a diagnosis might be present, respondents are asked about the onset and the recency of the particular cluster of symptoms that they have endorsed. In addition to the CIDI, a shortened form exists, CIDI-SF, used for the period of the past 12 months. Six DSM-IV mental disorders and two DSM-IIIR substance disorders are evaluated with the CIDI-SF: major depression, generalized anxiety, specific phobia, social phobia, agoraphobia, panic attack, alcohol dependence, and drug dependence.

Uses of Information: The CIDI is used to determine whether or not a person is likely to suffer from a mental disorder.

Reliability: (1) Inter-rater reliability: An intr-aclass kappa of 1.00. (2) Test-retest: Test-retest (with a one-month interval) kappa coefficients for substance abuse disorders over the respondents’ lifetime using the Munich CIDI ranged from .55 (drug abuse) to .83 (alcohol abuse). The Brazilian CIDI yielded test-retest (no test interval provided) kappa coefficients ranging from .61 to 1.00 on all psychiatric and substance abuse/dependency disorders, except for alcohol abuse, which had a coefficient of .35. The kappas for simple phobia, social phobia, and agoraphobia over the respondents’ lifetimes were .46, .47, and .63, respectively, and, for generalized anxiety disorder, it was .53.

Validity2: Concurrent validity (referred to as “concordance validity” by authors): A comparison between the CIDI and the Structured Clinical Interview for DMS-III-R (SCID) on simple phobia, social phobia, and agoraphobia disorders yielded kappa coefficients of .45, .62, and .63, respectively, and .35 on the lifetime generalized anxiety disorder. A comparison between the CIDI and the clinical DSM-III-R criteria checklist produced kappa coefficients of .84, .83, and .76 for depressive, psychoactive substance, and anxiety disorders, respectively, and .78 for all disorders. The canonical correlation coefficients between the CIDI and the Schedules for Clinical Assessment in Neuropsychiatry on anxiety and depressive disorders were .66 for lifetime disorders and .69 for current disorders. Two studies, one that compared the CIDI-Auto with those of psychiatrists and the other that compared CIDI-Auto with pairs of clinicians, found that CIDI-Auto tended to identify more disorders than the mental professionals. The CIDI-Auto generated an average of 2.3 diagnoses of general disorders per subject compared to 1.3 diagnoses for psychiatrist and twice as many anxiety diagnoses than the clinicians. A kappa coefficient of .23 was obtained between the diagnoses of the CIDI and the psychiatrists. The CIDI-Auto sensitivity was above .85 for all anxiety disorders, except generalized anxiety disorder, which had a sensitivity of .29.3 Its specificity ranged from .47 to .99.4 The level of agreement between the CIDI-Auto and the clinicians, as measured by intraclass kappa, ranged from .02 to .81, with an overall kappa of .40.

Method of Scoring: Scoring can be done manually or by using the computerized version of the CIDI, known as CIDI-Auto, which is an SPSS-based program. The CIDI-SF is scored manually by summing the number of positive responses to symptoms the respondent reported. The manual for scoring the CIDI-SF is available at the CIDI Website.

Interpretability: No instructions were available for interpreting the CIDI. The CIDI-SF uses a probability-of-caseness score to indicate the likelihood that the respondent would meet the full diagnostic criteria if given the complete CIDI. Tables are used to convert CIDI-SF raw scores for each disorder into probability-of-caseness values that range from 0.0 to 1.0. Alternatively, the examiner can elect not to use the probability values and, instead, consider all probabilities greater than .50 to indicate that the respondent would be a CIDI case for that disorder.

Training Support: Administration of the interview requires training on skip patterns, on the use of the Probe Flow Chart, in assembling lists of the endorsed symptoms for the onset and recency questions, and in the use of the data entry and scoring program. Training in administering this structured interview is conducted at nine WHO endorsed centers around the world. The WHO-CIDI Website URL is www.who.int/msa/cidi/. The cost is $1000.

Adaptations/Special Instructions for Individuals with Disabilities: None

Report Preparation Support: None

References:

Robins, Lee N., John Wing, Hans Ulrich Wittchen, John E. Helzer, Thomas F. Babor, Jay Burke, Anne Farmer, Assen Jablenski, Roy Pickens, Darrel A. Regier, Norman Sartorius, Leland H. Towle. “The Composite International Diagnostic Interview: An Epidemiologic Instrument Suitable for Use in Conjunction With Different Diagnostic Systems and in Different Cultures.” Arch Gen Psychiatry, Vol. 45, Dec. 1988, pp. 1069-1077.

World Health Organization. Composite International Diagnostic Interview (CIDI), Core Version 2.1, Interviewer’s Manual. World Health Organization, January 1997.