We also expanded the CIDI in a number of ways in both the NCS-A and NCS-R. First, we lowered the CIDI diagnostic thresholds in order to include complete assessments of sub-threshold cases. Our goal here was to gather information that could help inform the refinement of diagnostic thresholds in the upcoming DSM-V and ICD (International Classification of Diseases)-11 revisions. For example, we added an assessment of binge-eating disorder among respondents who reported symptoms of eating disorder but who did not meet full criteria for either bulimia nervosa or anorexia nervosa.38 (link) We also added a full assessment of the other symptoms of generalized anxiety disorder among respondents who reported episodes of worry that lasted no longer than one month (the DSM-III minimum duration requirement) even though the DSM-IV minimum duration requirement is six months.39 (link) Similar expansions were made to most other diagnostic sections. In a related way, we added a number of questions to the CIDI to allow sub-typing distinctions to be made that have been discussed in the literature as relevant for DSM-V or ICD-11 revisions.
Second, we added a fully-structured version of a standard disorder-specific clinical severity scale to each major diagnostic section of the CIDI. This was done both to have a dimensional representation along with the categorical diagnostic classification of the disorder and to create a cross-walk between the results of our population surveys and the results of clinical studies that use these clinical severity scales. The dimensional severity scales included such scales as the Quick Inventory of Depressive Symptomatology Self-Report (QIDS-SR)40 (link) for major depressive episodes, the self-report version of the Young Mania Rating Scale (YMRS)41 (link) for mania/hypomania, and the Panic Severity Test42 (link) for panic disorder. The inclusion of dimensional assessments is especially important in light of concerns in the literature regarding the validity of the categorical approach to classification among children and adolescents43 (link) and the suggestion that a dimensional approach can enhance our understanding of the major components of childhood disorders, including disturbances in normal dimensions of emotions, behavior and cognition.44 (link)–55 (link)
Third, we enhanced the standard CIDI assessment of disorder-specific role impairment by including in each diagnostic section an expanded version of the Sheehan Disability Scales.56 (link) As part of this expansion, we added an assessment of the prevalence and impairments associated with a number of commonly occurring chronic physical disorders in order to make it possible to study the relative impairments of mental and physical disorders as well as to study patterns and consequences of mental-physical comorbidity.57 (link)
Second, we added a fully-structured version of a standard disorder-specific clinical severity scale to each major diagnostic section of the CIDI. This was done both to have a dimensional representation along with the categorical diagnostic classification of the disorder and to create a cross-walk between the results of our population surveys and the results of clinical studies that use these clinical severity scales. The dimensional severity scales included such scales as the Quick Inventory of Depressive Symptomatology Self-Report (QIDS-SR)40 (link) for major depressive episodes, the self-report version of the Young Mania Rating Scale (YMRS)41 (link) for mania/hypomania, and the Panic Severity Test42 (link) for panic disorder. The inclusion of dimensional assessments is especially important in light of concerns in the literature regarding the validity of the categorical approach to classification among children and adolescents43 (link) and the suggestion that a dimensional approach can enhance our understanding of the major components of childhood disorders, including disturbances in normal dimensions of emotions, behavior and cognition.44 (link)–55 (link)
Third, we enhanced the standard CIDI assessment of disorder-specific role impairment by including in each diagnostic section an expanded version of the Sheehan Disability Scales.56 (link) As part of this expansion, we added an assessment of the prevalence and impairments associated with a number of commonly occurring chronic physical disorders in order to make it possible to study the relative impairments of mental and physical disorders as well as to study patterns and consequences of mental-physical comorbidity.57 (link)
