DSM-5 Field Trials in the United States and Canada, Part II: Test-Retest Reliability of Selected Categorical Diagnoses
DSM-5 Field Trials in the United States and Canada, Part II: Test-Retest Reliability of Selected Categorical Diagnoses
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DOI：
10.1176/appi.ajp.2012.12070999
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发表时间：
2013-01-01
影响因子：
17.7
通讯作者：
Kupfer, David J.
中科院分区：
文献类型：
--
作者：
Regier, Darrel A.;Narrow, William E.;Kupfer, David J.
目的：DSM-5田间试验旨在获得精确的（标准误差< 0.1）组内kappa的估计值，作为两名临床医生在临床环境中，在不同场合对同一患者进行访谈，并使用常规临床访谈方法进行评估时，对是否存在所选DSM-5诊断独立达成一致的程度的度量。方法：在美国和加拿大的11个学术中心被选中，每个中心都被分配了几个经常在该环境中治疗的目标诊断。根据DSM-IV诊断或症状表现，对研究期间访问某个研究中心的连续性患者进行筛选和分层。患者被随机分配给两名临床医生进行诊断访谈;临床医生对任何先前的诊断都是盲目的。所有数据都通过基于互联网的软件系统直接输入安全的中央服务器。详细的研究设计和统计方法中提出了相应的article.Results：共有15个成人和8个儿童/青少年的诊断，获得足够的样本量报告足够精确的估计intraclasskappa。总体而言，5个诊断处于非常好的范围（kappa=0.60-0.79），9个处于良好范围（kappa=0.40-0.59），6个处于可疑范围（kappa=0.20-0.39），3个处于不可接受范围（kappa值< 0.20）。八个诊断样本量不足，以产生精确的kappa估计在任何site.Conclusions：大多数诊断充分测试有很好的可靠性，这些代表性的临床人群与通常的临床访谈方法进行评估。一些诊断经过修订，以涵盖更广泛的症状表达，或在良好至非常好的范围内测试了更多维的方法。(Am J Psychiatry 2013; 170：59-70）
Objective: The DSM-5 Field Trials were designed to obtain precise (standard error < 0.1) estimates of the intraclass kappa as a measure of the degree to which two clinicians could independently agree on the presence or absence of selected DSM-5 diagnoses when the same patient was interviewed on separate occasions, in clinical settings, and evaluated with usual clinical interview methods.Method: Eleven academic centers in the United States and Canada were selected, and each was assigned several target diagnoses frequently treated in that setting. Consecutive patients visiting a site during the study were screened and stratified on the basis of DSM-IV diagnoses or symptomatic presentations. Patients were randomly assigned to two clinicians for a diagnostic interview; clinicians were blind to any previous diagnosis. All data were entered directly via an Internet-based software system to a secure central server. Detailed research design and statistical methods are presented in an accompanying article.Results: There were a total of 15 adult and eight child/adolescent diagnoses for which adequate sample sizes were obtained to report adequately precise estimates of the intraclass kappa. Overall, five diagnoses were in the very good range (kappa=0.60-0.79), nine in the good range (kappa=0.40-0.59), six in the questionable range (kappa=0.20-0.39), and three in the unacceptable range (kappa values < 0.20). Eight diagnoses had insufficient sample sizes to generate precise kappa estimates at any site.Conclusions: Most diagnoses adequately tested had good to very good reliability with these representative clinical populations assessed with usual clinical interview methods. Some diagnoses that were revised to encompass a broader spectrum of symptom expression or had a more dimensional approach tested in the good to very good range. (Am J Psychiatry 2013; 170:59-70)