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What is the "validity" of the SCID-I?

The validity of a diagnostic assessment technique is generally measured by determining the agreement between the diagnoses made by the assessment technique and some hypothetical "gold standard." Unfortunately, a gold standard for psychiatric diagnoses remains elusive. There is obvious difficulty in using ordinary clinical diagnoses as the standard because structured interviews have been specifically designed to improve on the inherent limitations of an unstructured clinical interview. In fact, a number of studies have used the SCID as the "gold standard" in determining the accuracy of clinical diagnoses (e.g., Shear et al., 2000; Steiner et al. 1995).

Perhaps the most accepted (albeit flawed) standard used in psychiatric diagnostic studies is known as a "best estimate diagnosis." Spitzer has proposed an operationalization of this best estimate diagnosis which he termed the "LEAD" standard. This standard involves conducting a longitudinal assessment (L) (i.e., relying in data collected over time), done by expert diagnosticians (E), using all data (AD) that are available about the subjects, such as family informants, review of medical records, and observations of clinical staff. Although conceptually the LEAD standard is appealing, the difficulty in implementing it accounts for its limited use. Several studies (Basco et al., 2000, Fenning et al., 1994; Fenning et al., 1996; Kranzler, et al., 1995; Kranzler et al., 1996) used approximations of the LEAD procedure. Both demonstrated superior validity of the SCID over standard clinical interviews at intake episode.


Basco, MR, Bostic, JQ, Davies, D, et al.: Methods to improve diagnostic accuracy in a community mental health setting. Am J Psychiatry 157:1599-1605, 2000

Fennig S, Craig T, Lavelle J, Kovasznay B, Bromet EJ: Best-Estimate Versus Structured Interview-Based Diagnosis in First-Admission Psychosis. Comprehensive Psychiatry 1994 Sep-Oct; 35(5):341-8.

Fennig S, Naisberg-Fennig S, Craig TJ, et al. Comparison of clinical and research diagnoses of substance use disorders in a first-admission psychotic sample. Am J Addiction 5: (1) 40-48 Winter 1996

Kranzler r, Kadden R, Burleson J, et al. Validity of psychiatric diagnoses in patients with substance use disorders - is the interview more important than the interviewer. Compr Psychiat 36: (4) 278-288 Jul-Aug 1995

Kranzler HR, Kadden RM, Babor TF, et al. Validity of the SCID in substance abuse patients. Addiction 91: (6) 859-868 June 1996

Shear, MK, Greeno, C, Kang, J, et al.: Diagnosis of nonpsychotic patients in community clinics. Am J Psychiatry 157:581-587, 2000

Steiner Jl, Tebes Jk, Sledge Wh, et al. A comparison of the structured clinical interview for DSM-III-R and clinical diagnoses. J Nerv Ment Dis 183: (6) 365-369 June 1995