Development of Diagnostic Variables

1. Development of Diagnostic Variables • Diagnoses have been created for both the DSM-IV and ICD-10 systems • WMH CIDI Advisory Committee instrumental in this process • Instrument Development Phase • During development phase of survey, CIDI questions were designed to assess each criterion necessary for a diagnosis. • Experts in each field were consulted for best way to assess each aspect of the diagnosis • Studied existing CIDI 2.1 as well as all standard research instruments for assessing diagnoses

2. Diagnostic Algorithms • Algorithm Development Phase • Once CIDI 3.0 was finalized, a team of researchers and programmers developed SAS code to operationalize each diagnostic criterion from questions in instrument • Clinical Calibration • Validity studies have been done in: • US, Italy, France, Spain, China, Nigeria, India • Iterative process continues to date • Updates/Improvements to the recent versions of the CIDI 3.0 • Revisions to the diagnostic algorithms are made based on this analysis. • Minor revisions when a particular item does not work or a threshold should be modified to improve concordance (SO) • Major revisions when analysis proves that the cidi was grossly overestimating a particular disorder (bipolar I and bipolar II) • Algorithms released are the most recent as of Feb, 2006. We will not be updating the diagnostic data file available for public release, however, changes will be posted in the diagnostic algorithm section of the ncs website.

3. Diagnostic Variables available through the Public Release dataset • ATTENTION DEFICIT DISORDER • AGORAPHOBIA • ALCOHOL ABUSE with or without dependence • ALCOHOL DEPENDENCE with Abuse • ADULT SEPARATION ANXIETY DISORDER • BIPOLAR I • BIPOLAR II • BIPOLAR SUBTHRESHOLD • CONDUCT DISORDER • DRUG ABUSE with or without dependence • DRUG DEPENDENCE with abuse • DYSTHYMIA • GENERALIZED ANXIETY DISORDER • HYPOMANIA • INTERMITTENT EXPLOSIVE DISORDER • MANIA • MAJOR DEPRESSIVE DISORDER • MAJOR DEPRESSIVE EPISODE • OPPOSITIONAL DEFIANT DISORDER • PANIC ATTACK • PANIC DISORDER • POST-TRAUMATIC STRESS DISORDER • SEPARATION ANXIETY DISORDER • SOCIAL PHOBIA • SPECIFIC PHOBIA • NICOTINE DEPENDENCE

4. Diagnostic Hierarchy Rules • Some DSM-IV diagnoses contain a criterion called a “hierarchy rule”. • E.g. If meet GAD but only during a mood disorder – do not receive gad diagnosis. (SEE DSM-IV GAD criterion F) “The disturbance does not occur exclusively during a Mood Disorder, a Psychotic Disorder, or a Pervasive Developmental Disorder” • In these cases, we create two diagnostic variables: one with hierarchy (narrow definition) and one without hierarchy (broad definition that does not operationalize the hierarchy criterion). • Important for studies of comorbidity. Researchers discretion which version to use – but version must be clearly stated in all reports.

5. Hierarchy Example • Criterion F. • Part 2. The disturbance does not occur exclusively during a Mood Disorder, a Psychotic Disorder, or a Pervasive Developmental Disorder. • Note: Psychotic Disorder and Pervasive Developmental Disorder hierarchies are not operationalized. • (Major Depression = No(5) AND Minor Depression = No(5) AND Dysthymia = No(5) AND Mania = No(5)) OR • ((Major Depression = Yes(1) OR Minor Depression = Yes(1) OR Dysthymia = Yes(1) OR Mania = Yes(1)) AND ( (GAD onset < Mood onset) OR (GAD recency > Mood recency) OR (GAD persistence > Mood persistence))) OR • G10e = No(5)

6. Diagnostic Variables w/Hierarchy DSM-IV Disorder Hierarchical Disorder Alcohol Abuse with hierarchy Alcohol dependence Drug Abuse with hierarchy Drug dependence Dysthymia with hierarchy MDE, Mania, Hypomania GAD with hierarchy MDE, MND, DYS, Mania IED with hierarchy Mania, ALA, ALD, DRA, DRD, MDE, hypomania MDD with hierarchy Mania, hypomania ODD with hierarchy MDE, MND, Mania, CD

7. Organic Exclusion • Many DSM-IV diagnoses contain a criterion called “organic exclusion”. • This criterion has been operationalized using a standard format across CIDI sections. • DXA. Episodes of this sort sometimes occur as the results of physical causes such as physical illness or injury or the use of medication, drugs, or alcohol. Do you think your episodes ever occurred as the result of such physical causes? • DXB. Do you think your episodes were always the result of physical causes? • In any interview schedule where this question (DXB) is “yes” we ask the follow-up question : • DXC. Briefly, what were the physical causes? • All open ended text from the organic exclusion item DXC have been reviewed by a psychiatrist for the NCS-R and a determination has been made as to whether it is a qualifying organic exclusion. • If, it was determined that there is no qualifying organic exclusion, and the respondent meets all other criteria, then the respondent has be hard-coded as meeting the diagnostic criteria for the disorder in the SAS code .

8. Programming Conventions (1) • Diagnostic assignment accomplished by a series of SAS macros • We provide word documents that give detailed descriptions of the sas code but we do not release the code. • Onset and Recency are determined by looking at the Minimum of any onset item and the Maximum of any recency item

9. Programming Conventions (2) • Standard notation: Lifetime Diagnosis dsm_dx icd_dx 12 M Diagnosis d_dx12 i_dx12 30 day Diagnosis d_dx30 i_dx30 Onset Age dx_ond dx_oni Recency Age dx_recd dx_reci Hierarchy example: Dx w/out hierarchy dsm_dx Dx w/ hierarchy dsm_dxh d_dxh12 d_dxh30 icd_dxh i_dxh12 i_dxh30 • Presence/absence of each criterion established first • Allowable values: yes/no/don’t know/refuse • Hierarchy of yes/no/dk/ref for Criteria variables: if not yes: if any no  no, if any dk  dk, if any ref  ref • Standard rules to compile criteria into final diagnosis (yes/no) • Must meet all criteria for yes. If any criterion has value other than ‘YES’, then final diagnosis is “NO” • Do not allow for indeterminacy in final diagnosis (dk/ref not carried through to this point)

10. Imputations of missing data • No imputations of Diagnostic Disorders • Imputation of onset and recency • “hot deck” imputation • Rational imputation • Imputation of demographic/constructed variables. • Regression based, “hot deck” and rational