AbstractThis paper introduces the Composite International Diagnostic – Screener (CID–S) for mental disorders, a 12‐item self‐report questionnaire that is based on core diagnostic questions from the Composite International Diagnostic Interview for the assessment of DSM‐IV and ICD‐10 disorders (CIDI) for use in two‐stage epidemiological designs. Data are reported relating to the performance of the CID–S in a two‐stage study of a random sample of 1095 respondents, using a wide range of DSM‐IV/CIDI diagnoses (somatoform, anxiety, depressive, other affective, and substance‐use disorders). In the first stage, all subjects filled out the screening instrument. Seven to 30 days later trained clinical interviewers administered the computer‐assisted full CIDI. The CID–S had an overall sensitivity of 85.3% (range for specific diagnoses 74.7% for alcohol use disorders to 100% for panic disorders) and negative predictive value (NPV) of 92.0% (range 91.0%–100%) for any current (12‐month) diagnosis and similar values for lifetime disorders (80.7%, NPV: 85.1%). Likelihood for a DSM‐IV diagnosis increased steadily from 10.5% among screen negatives, to 24.9% among those endorsing one screening item to 100% among those endorsing more than eight of the screening items. The performance of the individual CID–S items overall was good, except for three disorders: agoraphobia, somatoform disorders and substance use disorders. Overall, the CID–S was found to be a time‐efficient diagnostic screening tool for most mental disorders (except for some somatoform and substance use disorders), when used in a two‐stage design with a two to 12 week interval between investigations. Copyright © 1999 Whurr Publishers, Ltd.

The paper examines the influence of attitudes and behaviors (illness behavior) in a community sample of depressed cases on the probability of professional recognition and treatment. Particular emphasis is laid upon the identification of a pattern of atypical depression and associated symptoms, believed to be particular frequent among young. This pattern has been labeled >> Sisi-syndrome << referring to medical history research, that suspect that >>Kaiserin Elisabeth< (>$$) over bar>Sisi<<, 1837-1898) had suffered from an unrecognized depressive: illness, characterized besides others by:increased activities and the denial of depressed mood. By using an epidemiological data set of 5131 subjects from general population surveys in Germany the paper examines to what degree such atypical presentations are frequent manifestations and. whether they-explain poor recognition and treatment rates. After controlling for potential confounding variables (severity, course, comorbidity; age, etc) findings,reveal that atypical symptoms, behaviors, and attitudes described in the >>Sisi-construct<< are indeed associated significantly with low treatment rates. Using clusteranalytic methods, a stable and homogenous, almost prototypical >>Sisi-cluster<< of predominantly young. women with major depression, and another less stable cluster of older women was identified, both characterized by very low treatment rates. For males a less stable and less homogenous,>>Sisi-cluster<< was found. Overall about one third of all depressed in the community were assigned to one of these >>Sisi clusters<<. It is concluded,that patient variables and more generally the illness behavior are. important variables in explaining the mechanisms involved in underrecognition of depressive disorders. The >>Sisi-variables<< identified might be useful as simple targets for programs aiming at improvement of poor recognition,in primary care and might facilitate the design of mere sensitive questionnaires.

This paper compares diagnoses of the DSM‐IV algorithms of the computer‐assisted version of the Munich‐Composite International Diagnostic Interview (M‐CIDI) with clinical diagnoses made by treating physicians using the standard LEAD procedure. A random sample of 68 patients being treated in three psychiatric and one neurological ward of the Max Planck Institute of Psychiatry were first examined with the CIDI, using the M‐CIDI/DSM‐IV algorithms. Diagnostic findings were then compared with lifetime and cross‐sectional diagnoses assigned by the treating physician, who was blind to the CIDI findings, taking into account all available symptom and diagnostic information from current and previous charts as well as his own assessments. Clinicians were encouraged to use the DSM‐IV manual to assign multiple lifetime diagnoses and not to focus exclusively on primary diagnoses. To explore agreements and disagreements further, all discrepant cases were subsequently discussed with the treating physicians. There was generally good concordance between clinicians and interview DSM‐IV diagnoses, with the exception of psychotic disorders (kappa: 0.21), dysthymia (0.54) and somatoform disorders (0.50), with kappa values for the remaining categories ranging from 0.63 (any panic disorder) to 0.96 (any depressive episode). It is concluded that the M‐CIDI, in clinical cases, provides valid diagnoses for almost all non‐psychotic disorders and is sensitive for all disorders but might have reduced specificity and predictive value in some anxiety and somatoform disorders. Copyright © 1998 Whurr Publishers Ltd.