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Case identification in psychiatric epidemiology: a review
William W Eaton1, Alyson L F Hall, Ryan Macdonald
1Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA. weaton@jhsph.edu
International Review of Psychiatry (Abingdon, England)
|September 27, 2007
Summary
Psychiatric survey instruments show variable accuracy in diagnosing mental disorders. While common conditions like depression are better identified, the overall validity of case ascertainment in psychiatric epidemiology remains uncertain.
Area of Science:
- Psychiatry
- Epidemiology
- Psychometrics
Background:
- Psychiatric epidemiology relies on survey diagnostic instruments for case ascertainment.
- These instruments use structured interviews conducted by non-clinicians.
- Numerous validation studies have been performed on these instruments.
Purpose of the Study:
- To review the validation success of survey diagnostic instruments.
- Focus on eight diagnostic categories.
- Utilize psychiatrist examination as the gold standard for validation.
Main Methods:
- Systematic search of public databases for relevant publications.
- Analysis of over 1000 located publications.
- Data extraction included sensitivity, specificity, Kappa, sample characteristics, and validation methods.
Main Results:
- Validation studies varied from 8 (schizophrenia) to 29 (major depressive disorder).
- Reported sensitivities ranged from 0% to 100%.
- Reported specificities ranged from 22% to 100%.
Conclusions:
- Diagnostic accuracy is better for common disorders (e.g., major depressive disorder, alcohol use disorder) than for others (e.g., schizophrenia, bipolar disorder).
- The reliability of case ascertainment in psychiatric epidemiology is questionable.
- Further research is needed to improve diagnostic instrument validity.
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