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Abstract
Background: Three previous individual participant data meta-analyses (IPDMAs) reported that, compared to the Structured Clinical Interview for DSM (SCID), alternative reference standards, primarily the Composite International Diagnostic Interview (CIDI) and Mini International Neuropsychiatric Interview (MINI), tended to misclassify major depression status, controlling for depression symptom severity. However, there was important imprecision in results.
Objectives: To synthesize results from three previous IPDMAs and compare performance of the most commonly used diagnostic interviews for major depression classification, the SCID, CIDI, and MINI.
Methods: We used databases from published IPDMAs that used the Edinburgh Postnatal Depression Scale (EPDS) and Hospital Anxiety and Depression Scale – Depression subscale (HADS-D) to control for depressive symptoms and an updated Patient Health Questionnaire-9 (PHQ-9) database. We standardized screening tool scores across IPDMA databases. For each IPDMA, separately, we fit binomial generalized linear mixed models to compare adjusted odds ratios (aORs) of (1) major depression classification, controlling for symptom severity and participant characteristics, and (2) the interaction between interview and symptom severity. We synthesized results using DerSimonian-Laird random-effects meta-analysis.
Results: In total, 69,405 participants (7,574 [11%] with major depression) from 212 studies were included (Table 1). As reported in Table 2, controlling for symptom severity and participant characteristics, the MINI (74 studies; 25,749 participants) classified major depression more often than the SCID (108 studies; 21,953 participants; aOR [95% CI] = 1.46 [1.11-1.92]). Classification odds for the CIDI (30 studies; 21,703 participants) and SCID did not differ overall (aOR [95% CI] =1.19 [0.79, 1.75]), but as screening scores increased, aOR increased less for the CIDI than the SCID (interaction aOR [95% CI] = 0.64 [0.52-0.80]). See Figure 1.
Conclusions: Compared to the SCID, the MINI classified major depression more often. Odds of depression classification with the CIDI increased less as symptom levels increased. Interpretation of research that uses diagnostic interviews to classify depression should consider interview characteristics.
Patient or healthcare consumer involvement: Patients and healthcare consumers were not directly involved in the study. However, better understanding differences in performance of different reference standards for major depression classification will lead to better quality evidence syntheses and thus more informed health policies for mental health.
Objectives: To synthesize results from three previous IPDMAs and compare performance of the most commonly used diagnostic interviews for major depression classification, the SCID, CIDI, and MINI.
Methods: We used databases from published IPDMAs that used the Edinburgh Postnatal Depression Scale (EPDS) and Hospital Anxiety and Depression Scale – Depression subscale (HADS-D) to control for depressive symptoms and an updated Patient Health Questionnaire-9 (PHQ-9) database. We standardized screening tool scores across IPDMA databases. For each IPDMA, separately, we fit binomial generalized linear mixed models to compare adjusted odds ratios (aORs) of (1) major depression classification, controlling for symptom severity and participant characteristics, and (2) the interaction between interview and symptom severity. We synthesized results using DerSimonian-Laird random-effects meta-analysis.
Results: In total, 69,405 participants (7,574 [11%] with major depression) from 212 studies were included (Table 1). As reported in Table 2, controlling for symptom severity and participant characteristics, the MINI (74 studies; 25,749 participants) classified major depression more often than the SCID (108 studies; 21,953 participants; aOR [95% CI] = 1.46 [1.11-1.92]). Classification odds for the CIDI (30 studies; 21,703 participants) and SCID did not differ overall (aOR [95% CI] =1.19 [0.79, 1.75]), but as screening scores increased, aOR increased less for the CIDI than the SCID (interaction aOR [95% CI] = 0.64 [0.52-0.80]). See Figure 1.
Conclusions: Compared to the SCID, the MINI classified major depression more often. Odds of depression classification with the CIDI increased less as symptom levels increased. Interpretation of research that uses diagnostic interviews to classify depression should consider interview characteristics.
Patient or healthcare consumer involvement: Patients and healthcare consumers were not directly involved in the study. However, better understanding differences in performance of different reference standards for major depression classification will lead to better quality evidence syntheses and thus more informed health policies for mental health.