Structured and Semistructured Interviews Chapter 3 Structured and Semistructured Interviews

Structured and Semistructured Interviews Developed to address an important problem in the mental health field: Clinicians and researchers had tremendous difficulty in making consistent and accurate diagnoses of mental disorders with unstructured clinical interviews Questions lacked uniformity or standardization

Basic Issues Unstructured clinical interviews Dependent on the clinician’s unique background, knowledge base, theoretical model, and interpersonal style, and thus are highly flexible Clinicians are entirely responsible for asking whatever questions they decide are necessary to reach a diagnostic conclusion High variability across interviews from one clinician to another

Structured Interviews Important purposes Increases coverage of many mental disorders that otherwise might be overlooked Enhances the diagnostician’s ability to accurately determine whether particular symptoms are present or absent Reduces variability among interviewers, which improves reliability

Structured Interviews cont. Fully structured Questions are asked verbatim to the respondent Wording of probes used to follow up on initial questions is specified Interviewers are trained to not deviate from this rigid format Can be administered by nonclinicians who receive training on the specific instrument

Semistructured Interviews Interviewer has substantial latitude to follow up on responses for questions typically asked verbatim Interviewer can modify or augment the standard inquiries with individualized and contextualized probes to more accurately rate specific symptoms Requires clinically experienced examiners to administer the interview and to make diagnoses

Applications Research Clinical practice Clinical training Interviews used to formally diagnose participants for inclusion into a study so that research topics can be explored for a particular diagnosis or group of diagnoses Clinical practice Interview may be used as part of a comprehensive and standardized intake evaluation Clinical training Interviews used to train mental health professionals

Advantages: Structured Interviews Increased reliability Decreases the chances that two different interviewers will elicit different information from the same client, which may result in different diagnoses Increased validity Forces clinicians to assess all of the specified criteria for a broad range of diagnoses, and to offer a more thorough and valid assessment of many disorders compared to unstructured interviews Utility as a training tool May help clinicians develop or enhance their understanding of the flow, format, and questions inherent in a comprehensive diagnostic interview

Disadvantages: Structured Interviews May hinder rapport May impede the connection between client and clinician, because interviews are problem-centered rather than person-centered Limited by the validity of the classification system Some disorders (e.g., most of the personality disorders) and their criteria have not been examined as consistently or as completely, therefore leaving questions about their attendant validity The trade-off of breadth versus depth Focusing on a few specific areas will provide clinicians and researchers with a wealth of information about those specific areas, but it may result in missing information that could lead to additional diagnoses or a different case conceptualization

Semistructured Interviews for Clinical Disorders Anxiety Disorders Interview Schedule for DSM-IV (ADIS-IV) Provides differential diagnosis among anxiety disorders Includes sections on mood, somatoform, and substance use disorders because anxiety disorders are frequently comorbid with such conditions Each disorder is given a rating of clinical severity ranging from 0 to 8 Ratings of 3 or below indicate subsyndromal symptomatology Ratings of 4 and above indicate the presence of a disorder

Semistructured Interviews for Clinical Disorders cont. Schedule for Affective Disorders and Schizophrenia (SADS) Evaluates a range of clinical disorders, with a focus on mood and psychotic disorders To be administered by trained mental health professionals with graduate degrees and clinical experience Infrequently chosen for use in many traditional purely clinical settings because of length and complexity Is not completely aligned with the DSM system, representing a significant point of concern

Semistructured Interviews for Clinical Disorders cont. Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I) Has widespread popularity and is designed for use in clinical settings Modular design represents a major strength of the instrument because administration can be easily customized to meet the unique needs of the user Formal diagnostic criteria are included in the SCID booklet, permitting interviewers to see the exact criteria to which the SCID questions pertain

Structured Interviews for Clinical Disorders Diagnostic Interview Schedule for DSM-IV (DIS-IV) Fully structured interview specifically designed for use by nonclinician interviewers Computerized administration is required Designed for epidemiological research with normative samples All questions are closed-ended, and replies are coded with a forced-choice “yes” or “no” response format

Semistructured Interviews for Personality Disorders Diagnostic Interview for Personality Disorders (DIPD) Also includes depressive personality disorder and passive-aggressive personality disorder in the DSM-IV appendix Behavior exhibited during the interview is valued and may override client self-report if there are contradictions Information about administration and scoring of the DIPD-IV is relatively sparse compared to other personality interviews At least a bachelor’s degree is required to administer, among other requirements

Semistructured Interviews for Personality Disorders cont International Personality Disorder Examination (IPDE) Evaluates personality disorders for both the DSM-IV and the International Classification of Diseases, 10th edition (ICD-10), classification systems Only personality disorder interview based on worldwide field trials Intended to be administered by experienced clinicians Widely used for international and cross-cultural investigations of personality disorders

Semistructured Interviews for Personality Disorders cont Structured Clinical Interview for DSM-IV Axis II Personality Disorders (SCID-II) Similar semistructured format as the SCID Axis I version Includes a 119-item self-report screening component Personality Questionnaire Only items scored in the pathological direction are further evaluated during a structured interview

Semistructured Interviews for Personality Disorders cont Structured Interview for DSM-IV Personality (SIDP-IV) Does not cover DSM personality categories on a disorder-by-disorder basis; rather, they are grouped according to 10 topical sections that reflect a different dimension of personality functioning Specific DSM-IV criterion associated with each question is provided for interviewers to view easily Given multiple sources of diagnostic data, final ratings are made after all sources of information are considered

The Cultural Formulation Interview (CFI) of DSM-5 16-question semistructured interview designed to assess the impact of cultural factors on an individual’s mental health Not used to diagnose mental disorders per se Improves cultural validity of assessment, aids in treatment planning, and fosters commitment and satisfaction

Review: Interviews for Clinical Disorders Name Time Required Format Comment Anxiety Disorders Interview Schedule for DSM-IV (ADIS-IV) 45 to 60 minutes Semistructured, interviewer administered Provides in-depth assessment of anxiety disorders and other frequently comorbid conditions Diagnostic Interview Schedule for DSM-IV (DIS-IV) 90 to 150 minutes Fully structured, computerized, closed-ended questions Designed for epidemiological research; can be administered by nonclinicians with specialized training Schedule for Affective Disorders and Schizophrenia (SADS) In-depth coverage on mood and psychotic disorders; administration by trained mental health professionals Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I) 45 to 90 minutes Covers Axis I DSM-IV disorders most commonly seen in clinical settings

Review: Interviews for Personality Disorders International Personality Disorder Examination (IPDE) 15 minutes (self-administered screen), 90 minutes (interview) Contains self-administered pencil-and-paper questionnaire and semistructured interview Evaluates personality disorders for both the DSM-IV and the ICD-10 Structured Clinical Interview for DSM-IV Axis II Personality Disorders (SCID-II) 20 minutes (self-administered screen), 60 minutes (interview) Contains self-report screening questionnaire and semistructured interview Administration by professionals with knowledge of psychopathology, DSM-IV criteria, and interviewing skills Structured Interview for DSM-IV Personality (SIDP-IV) 60 to 90 minutes Semistructured interview Collateral sources encouraged and dimensions of personality functioning included