Skip to main content
    • Aa
    • Aa

Composite International Diagnostic Interview screening scales for DSM-IV anxiety and mood disorders

  • R. C. Kessler (a1), J. R. Calabrese (a2), P. A. Farley (a3), M. J. Gruber (a1), M. A. Jewell (a3), W. Katon (a4), P. E. Keck (a5), A. A. Nierenberg (a6), N. A. Sampson (a1), M. K. Shear (a7), A. C. Shillington (a3), M. B. Stein (a8), M. E. Thase (a9) and H.-U. Wittchen (a10)...

Lack of coordination between screening studies for common mental disorders in primary care and community epidemiological samples impedes progress in clinical epidemiology. Short screening scales based on the World Health Organization (WHO) Composite International Diagnostic Interview (CIDI), the diagnostic interview used in community epidemiological surveys throughout the world, were developed to address this problem.


Expert reviews and cognitive interviews generated CIDI screening scale (CIDI-SC) item pools for 30-day DSM-IV-TR major depressive episode (MDE), generalized anxiety disorder (GAD), panic disorder (PD) and bipolar disorder (BPD). These items were administered to 3058 unselected patients in 29 US primary care offices. Blinded SCID clinical reinterviews were administered to 206 of these patients, oversampling screened positives.


Stepwise regression selected optimal screening items to predict clinical diagnoses. Excellent concordance [area under the receiver operating characteristic curve (AUC)] was found between continuous CIDI-SC and DSM-IV/SCID diagnoses of 30-day MDE (0.93), GAD (0.88), PD (0.90) and BPD (0.97), with only 9–38 questions needed to administer all scales. CIDI-SC versus SCID prevalence differences are insignificant at the optimal CIDI-SC diagnostic thresholds (χ21 = 0.0–2.9, p = 0.09–0.94). Individual-level diagnostic concordance at these thresholds is substantial (AUC 0.81–0.86, sensitivity 68.0–80.2%, specificity 90.1–98.8%). Likelihood ratio positive (LR+) exceeds 10 and LR− is 0.1 or less at informative thresholds for all diagnoses.


CIDI-SC operating characteristics are equivalent (MDE, GAD) or superior (PD, BPD) to those of the best alternative screening scales. CIDI-SC results can be compared directly to general population CIDI survey results or used to target and streamline second-stage CIDIs.

Corresponding author
*Address for correspondence: R. C. Kessler, Ph.D., Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA 02115, USA. (Email:
Hide All
DG Altman , JM Bland (1994). Diagnostic tests 2: Predictive values. British Medical Journal 309, 102.

G Andrews , MJ Hobbs , TD Borkovec , K Beesdo , MG Craske , RG Heimberg , RM Rapee , AM Ruscio , MA Stanley (2010). Generalized worry disorder: a review of DSM-IV generalized anxiety disorder and options for DSM-V. Depression and Anxiety 27, 134147.

K Barkow , W Maier , TB Üstün , M Gansicke , HU Wittchen , R Heun (2003). Risk factors for depression at 12-month follow-up in adult primary health care patients with major depression: an international prospective study. Journal of Affective Disorders 76, 157169.

B Barrett , S Byford , M Knapp (2005). Evidence of cost-effective treatments for depression: a systematic review. Journal of Affective Disorders 84, 113.

AT Beekman , DJ Deeg , J Van Limbeek , AW Braam , MZ De Vries , W Van Tilburg (1997). Criterion validity of the Center for Epidemiologic Studies Depression scale (CES-D): results from a community-based sample of older subjects in The Netherlands. Psychological Medicine 27, 231235.

WE Broadhead , AC Leon , MM Weissman , JE Barrett , RS Blacklow , TT Gilbert , MB Keller , M Olfson , ES Higgins (1995). Development and validation of the SDDS-PC screen for multiple mental disorders in primary care. Archives of Family Medicine 4, 211219.

SE Bruce , KA Yonkers , MW Otto , JL Eisen , RB Weisberg , M Pagano , MT Shea , MB Keller (2005). Influence of psychiatric comorbidity on recovery and recurrence in generalized anxiety disorder, social phobia, and panic disorder: a 12-year prospective study. American Journal of Psychiatry 162, 11791187.

A Bunevicius , J Peceliuniene , N Mickuviene , L Valius , R Bunevicius (2007). Screening for depression and anxiety disorders in primary care patients. Depression and Anxiety 24, 455460.

J Cohen (1960). A coefficient of agreement for nominal scales. Educational and Psychological Measurement 20, 3746.

J Converse , S Presser (1986). Survey Questions: Handcrafting the Standardized Questionnaire. Sage: Thousand Oaks, CA.

S Dodd , LJ Williams , FN Jacka , JA Pasco , O Bjerkeset , M Berk (2009). Reliability of the Mood Disorder Questionnaire: comparison with the Structured Clinical Interview for the DSM-IV-TR in a population sample. Australian and New Zealand Journal of Psychiatry 43, 526530.

T Donker , A van Straten , I Marks , P Cuijpers (2009). A brief Web-based screening questionnaire for common mental disorders: development and validation. Journal of Medical Internet Research 11, e19.

T Donker , A van Straten , I Marks , P Cuijpers (2011). Quick and easy self-rating of Generalized Anxiety Disorder: validity of the Dutch web-based GAD-7, GAD-2 and GAD-SI. Psychiatry Research 188, 5864.

P Farvolden , C McBride , RM Bagby , P Ravitz (2003). A Web-based screening instrument for depression and anxiety disorders in primary care. Journal of Medical Internet Research 5, e23.

BN Gaynes , J DeVeaugh-Geiss , S Weir , H Gu , C MacPherson , HC Schulberg , L Culpepper , DR Rubinow (2010). Feasibility and diagnostic validity of the M-3 checklist: a brief, self-rated screen for depressive, bipolar, anxiety, and post-traumatic stress disorders in primary care. Annals of Family Medicine 8, 160169.

LE Gibbons , BJ Feldman , HM Crane , M Mugavero , JH Willig , D Patrick , J Schumacher , M Saag , MM Kitahata , PK Crane (2011). Migrating from a legacy fixed-format measure to CAT administration: calibrating the PHQ-9 to the PROMIS depression measures. Quality of Life Research 20, 13491357.

S Gilbody , D Richards , S Brealey , C Hewitt (2007). Screening for depression in medical settings with the Patient Health Questionnaire (PHQ): a diagnostic meta-analysis. Journal of General Internal Medicine 22, 15961602.

M Gili , JV Luciano , MJ Serrano , R Jimenez , N Bauza , M Roca (2011). Mental disorders among frequent attenders in primary care: a comparison with routine attenders. Journal of Nervous and Mental Disease 199, 744749.

JG Green , S Avenevoli , M Finkelman , MJ Gruber , RC Kessler , KR Merikangas , NA Sampson , AM Zaslavsky (2011). Validation of the diagnoses of panic disorder and phobic disorders in the US National Comorbidity Survey Replication Adolescent (NCS-A) supplement. International Journal of Methods in Psychiatric Research 20, 105115.

RB Haynes , DL Sackett , GH Guyatt , P Tugwell (2006). Clinical Epidemiology: How to Do Clinical Practice Research, 3rd edn. Lippincott Williams & Wilkins: Philadelphia, PA.

RM Hirschfeld , AR Cass , DC Holt , CA Carlson (2005). Screening for bipolar disorder in patients treated for depression in a family medicine clinic. Journal of the American Board of Family Practice 18, 233239.

RM Hirschfeld , C Holzer , JR Calabrese , M Weissman , M Reed , M Davies , MA Frye , P Keck , S McElroy , L Lewis , J Tierce , KD Wagner , E Hazard (2003). Validity of the Mood Disorder Questionnaire: a general population study. American Journal of Psychiatry 160, 178180.

RM Hirschfeld , JB Williams , RL Spitzer , JR Calabrese , L Flynn , Jr. PE Keck , L Lewis , SL McElroy , RM Post , DJ Rapport , JM Russell , GS Sachs , J Zajecka (2000). Development and validation of a screening instrument for bipolar spectrum disorder: the Mood Disorder Questionnaire. American Journal of Psychiatry 157, 18731875.

JP Houston , K Kroenke , DE Faries , CC Doebbeling , LA Adler , J Ahl , R Swindle , PT Trzepacz (2011). A provisional screening instrument for four common mental disorders in adult primary care patients. Psychosomatics 52, 4855.

EE Hunter , EC Penick , BJ Powell , E Othmer , EJ Nickel , C Desouza (2005). Development of scales to screen for eight common psychiatric disorders. Journal of Nervous and Mental Disease 193, 131135.

MM Katz , SK Secunda , RM Hirschfeld , SH Koslow (1979). NIMH clinical research branch collaborative program on the psychobiology of depression. Archives of General Psychiatry 36, 765771.

RC Kessler , LA Adler , MJ Gruber , CA Sarawate , T Spencer , DL Van Brunt (2007). Validity of the World Health Organization Adult ADHD Self-Report Scale (ASRS) Screener in a representative sample of health plan members. International Journal of Methods in Psychiatric Research 16, 5265.

RC Kessler , HS Akiskal , J Angst , M Guyer , RM Hirschfeld , KR Merikangas , PE Stang (2006). Validity of the assessment of bipolar spectrum disorders in the WHO CIDI 3.0. Journal of Affective Disorders 96, 259269.

RC Kessler , O Demler , RG Frank , M Olfson , HA Pincus , EE Walters , P Wang , KB Wells , AM Zaslavsky (2005). Prevalence and treatment of mental disorders, 1990 to 2003. New England Journal of Medicine 352, 25152523.

RC Kessler , JG Green , MJ Gruber , NA Sampson , E Bromet , M Cuitan , TA Furukawa , O Gureje , H Hinkov , CY Hu , C Lara , S Lee , Z Mneimneh , L Myer , M Oakley-Browne , J Posada-Villa , R Sagar , MC Viana , AM Zaslavsky (2010 b). Screening for serious mental illness in the general population with the K6 screening scale: results from the WHO World Mental Health (WMH) Survey Initiative. International Journal of Methods in Psychiatric Research 19 (Suppl. 1), 422.

RC Kessler , TB Üstün (2004). The World Mental Health (WMH) Survey Initiative Version of the World Health Organization (WHO) Composite International Diagnostic Interview (CIDI). International Journal of Methods in Psychiatric Research 13, 93121.

RC Kessler , H-U Wittchen , JM Abelson , KA McGonagle , N Schwarz , KS Kendler , B Knäuper , S Zhao (1998). Methodological studies of the Composite International Diagnostic Interview (CIDI) in the US National Comorbidity Survey. International Journal of Methods in Psychiatric Research 7, 3355.

S Kisely , A Scott , J Denney , G Simon (2006). Duration of untreated symptoms in common mental disorders: association with outcomes: international study. British Journal of Psychiatry 189, 7980.

S Kisely , G Simon (2005). An international study of the effect of physical ill health on psychiatric recovery in primary care. Psychosomatic Medicine 67, 116122.

MS Klinkman , JC Coyne , S Gallo , TL Schwenk (1997). Can case-finding instruments be used to improve physician detection of depression in primary care? Archives of Family Medicine 6, 567573.

A Konnopka , F Leichsenring , E Leibing , HH Konig (2009). Cost-of-illness studies and cost-effectiveness analyses in anxiety disorders: a systematic review. Journal of Affective Disorders 114, 1431.

K Kroenke , RL Spitzer , JB Williams , B Lowe (2010). The Patient Health Questionnaire Somatic, Anxiety, and Depressive Symptom Scales: a systematic review. General Hospital Psychiatry 32, 345359.

K Kroenke , RL Spitzer , JB Williams , PO Monahan , B Lowe (2007). Anxiety disorders in primary care: prevalence, impairment, comorbidity, and detection. Annals of Internal Medicine 146, 317325.

JR Landis , GG Koch (1977). The measurement of observer agreement for categorical data. Biometrics 33, 159174.

B Lowe , K Grafe , S Zipfel , RL Spitzer , C Herrmann-Lingen , S Witte , W Herzog (2003). Detecting panic disorder in medical and psychosomatic outpatients: comparative validation of the Hospital Anxiety and Depression Scale, the Patient Health Questionnaire, a screening question, and physicians' diagnosis. Journal of Psychosomatic Research 55, 515519.

B Lowe , RL Spitzer , JB Williams , M Mussell , D Schellberg , K Kroenke (2008). Depression, anxiety and somatization in primary care: syndrome overlap and functional impairment. General Hospital Psychiatry 30, 191199.

L Manea , S Gilbody , D McMillan (2012). Optimal cut-off score for diagnosing depression with the Patient Health Questionnaire (PHQ-9): a meta-analysis. Canadian Medical Association Journal 184, E191E196.

DJ Margolis , W Bilker , R Boston , R Localio , JA Berlin (2002). Statistical characteristics of area under the receiver operating characteristic curve for a simple prognostic model using traditional and bootstrapped approaches. Journal of Clinical Epidemiology 55, 518524.

CJ Miller , SL Johnson , TR Kwapil , CS Carver (2011). Three studies on self-report scales to detect bipolar disorder. Journal of Affective Disorders 128, 199210.

CJ Miller , J Klugman , DA Berv , KJ Rosenquist , SN Ghaemi (2004). Sensitivity and specificity of the Mood Disorder Questionnaire for detecting bipolar disorder. Journal of Affective Disorders 81, 167171.

G Parker , K Fletcher , M Barrett , H Synnott , M Breakspear , M Hyett , D Hadzi-Pavlovic (2008). Screening for bipolar disorder: the utility and comparative properties of the MSS and MDQ measures. Journal of Affective Disorders 109, 8389.

G Parker , R Graham , D Hadzi-Pavlovic , K Fletcher , M Hong , S Futeran (2012). Further examination of the utility and comparative properties of the MSQ and MDQ bipolar screening measures. Journal of Affective Disorders 138, 104109.

G Parker , D Hadzi-Pavlovic , L Tully (2006). Distinguishing bipolar and unipolar disorders: an isomer model. Journal of Affective Disorders 96, 6773.

S Presser , J Blair (1994). Survey pretesting: do different methods yield different results? Sociological Methodology 24, 73104.

S Presser , MP Couper , JT Lessler , E Martin , J Martin , JM Rothgeb , E Singer (2004). Methods for testing and evaluating survey questions. Public Opinion Quarterly 68, 109130.

LS Radloff (1977). The CES-D Scale: a self-report depression scale for research in the general population. Applied Psychological Measurement 1, 385401.

LN Robins , J Wing , HU Wittchen , JE Helzer , TF Babor , J Burke , A Farmer , A Jablenski , R Pickens , DA Regier , N Sartorius , L Towle (1988). The Composite International Diagnostic Interview. An epidemiologic instrument suitable for use in conjunction with different diagnostic systems and in different cultures. Archives of General Psychiatry 45, 10691077.

HC Schulberg , M Saul , M McClelland , M Ganguli , W Christy , R Frank (1985). Assessing depression in primary medical and psychiatric practices. Archives of General Psychiatry 42, 11641170.

RL Spitzer , K Kroenke , JB Williams (1999). Validation and utility of a self-report version of PRIME-MD: the PHQ primary care study. Primary Care Evaluation of Mental Disorders. Patient Health Questionnaire. Journal of the American Medical Association 282, 17371744.

MB Stein , PP Roy-Byrne , JR McQuaid , C Laffaye , J Russo , ME McCahill , W Katon , M Craske , A Bystritsky , CD Sherbourne (1999). Development of a brief diagnostic screen for panic disorder in primary care. Psychosomatic Medicine 61, 359364.

E Susser , S Schwartz , A Morabia , EJ Bromet (2006). Psychiatric Epidemiology: Searching for the Causes of Mental Disorders. Oxford Universiy Press: New York, NY.

MT Tsuang , M Tohen , P Jones (eds) (2011). Textbook of Psychiatric Epidemiology. Wiley: New York, NY.

J Twiss , S Jones , I Anderson (2008). Validation of the Mood Disorder Questionnaire for screening for bipolar disorder in a UK sample. Journal of Affective Disorders 110, 180184.

B Weber Rouget , N Gervasoni , V Dubuis , M Gex-Fabry , G Bondolfi , JM Aubry (2005). Screening for bipolar disorders using a French version of the Mood Disorder Questionnaire (MDQ). Journal of Affective Disorders 88, 103108.

GB Willis (2005). Cognitive Interviewing: A Tool for Improving Questionnaire Design. Sage: Thousand Oaks, CA.

HU Wittchen (1994). Reliability and validity studies of the WHO-Composite International Diagnostic Interview (CIDI): a critical review. Journal of Psychiatric Research 28, 5784.

HU Wittchen , RC Kessler , S Zhao , J Abelson (1995). Reliability and clinical validity of UM-CIDI DSM-III-R generalized anxiety disorder. Journal of Psychiatric Research 29, 95110.

KA Wittkampf , L Naeije , AH Schene , J Huyser , HC van Weert (2007). Diagnostic accuracy of the mood module of the Patient Health Questionnaire: a systematic review. General Hospital Psychiatry 29, 388395.

AS Zigmond , RP Snaith (1983). The hospital anxiety and depression scale. Acta Psychiatrica Scandinavica 67, 361370.

M Zimmerman , JN Galione , CJ Ruggero , I Chelminski , JB McGlinchey , K Dalrymple , D Young (2009). Performance of the mood disorders questionnaire in a psychiatric outpatient setting. Bipolar Disorders 11, 759765.

Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Psychological Medicine
  • ISSN: 0033-2917
  • EISSN: 1469-8978
  • URL: /core/journals/psychological-medicine
Please enter your name
Please enter a valid email address
Who would you like to send this to? *



Altmetric attention score

Full text views

Total number of HTML views: 11
Total number of PDF views: 125 *
Loading metrics...

Abstract views

Total abstract views: 559 *
Loading metrics...

* Views captured on Cambridge Core between September 2016 - 17th October 2017. This data will be updated every 24 hours.