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Challenges for Psychiatric Epidemiology

Jane M. Murphy, PhD; Richard R. Monson, MD, DSc; Nan M. Laird, PhD; Arthur M. Sobol, MA; Alexander H. Leighton, MD

Arch Gen Psychiatry. 2000;57:230-236.

Background  High prevalence rates in psychiatric epidemiologic studies raise questions about whether data-gathering procedures identify transient responses rather than clinical disorders. This issue is explored relevant to depression using data from the Stirling County Study.

Methods  The study's customary method, the DPAX (DP for depression and AX for anxiety) was compared with the Diagnostic Interview Schedule (DIS), both of which were administered to a sample of 1396 subjects selected in 1992. Reasons for discordance were analyzed, and demographic correlates of responses to questions about dysphoria were examined. These lay-administered interviews were then compared with clinician-administered interviews that used the Structured Clinical Interview for DSM-III-R (SCID) with 139 subjects. The statistic and logistic regression were used for statistical assessment.

Results  For the level of agreement between the DPAX and the DIS for current and lifetime depression, = 0.40 and = 0.33, respectively. Subjects diagnosed only by the DPAX tended to have less education than those diagnosed only by the DIS. Some idioms for dysphoria seemed to work better than others. Using SCID interviews as a clinical standard, the DPAX had 15% sensitivity and 96% specificity and the DIS had 25% sensitivity and 98% specificity.

Conclusions  Comprehension of an interview can be improved by using multiple questions for dysphoria and a simpler mode of inquiry. Clinician-administered interviews tend to corroborate disorders identified in lay-administered interviews but suggest that survey methods underestimate prevalence. Further research is needed to evaluate the validity of both types of interviews, but evidence from a 16-year follow-up evaluation indicates that depression diagnosed by the DPAX is a serious disorder in terms of morbidity and mortality.

From the Departments of Psychiatry, Harvard Medical School and Massachusetts General Hospital (Dr Murphy and Mr Sobol); the Departments of Epidemiology (Drs Murphy and Monson) and Biostatistics (Dr Laird), Harvard School of Public Health, Boston, Mass; and the Departments of Psychiatry and of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia (Dr Leighton).

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