Semistructured and Structured Interviews - Ch.3

Issues with Unstructured 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.

Semi-structured Interview - Description

- 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.

Structured Interviews - Advantages & Disadvantages

Advantages • 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 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 tradeoff 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 Axis I

Anxiety Disorders Interview Schedule for DSM‐IV (ADIS‐IV) - Provides differential diagnosis among anxiety disorders - Includes sections on mood, somatoform, and substance use disorders, as 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. Schedule for Affective Disorders and Schizophrenia (SADS) - Evaluates a range of Axis I clinical disorders, with a focus on mood and psychotic disorders - To be administered by professionals with graduate degrees and clinical experience - Infrequently chosen for use in many traditional pure clinical settings because of length and complexity - Is not completely aligned with the DSM system, representing a significant point of concern 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 customized easily 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 Axis I

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 Axis II

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 Axis II interviews. - At least a Bachelor's degree is required to administer, among other requirements. 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 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.further evaluated during a structured interview. 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.

Full Structured Interview - Description

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.

Important Purposes of 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

Applications of Interviews

Research Applications - 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.

Structured and Semi-structured interviews

• Developed in the 1970s 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.