A standardized psychiatric interview for use in community surveys.

Abstract

Surveys of psychiatric illness in the community are at present handicapped by the lack of valid and reliable methods of case-identification. The widely varying estimates of psychiatric prevalence made by different workers in this field (Lin and Standley, 1962) emphasize the urgent need for such tech niques, which could be used both in field surveys and in the screening of general practice populations. In large-scale psychiatric surveys, the use of a two-stage screening procedure is desirable and may, indeed, be essential for economic reasons. The first stage entails the selection of possible or 'potential' cases by means of a rapid and simply administered screening test; the second comprises detailed clinical examination of such potential cases in order that they may be confirmed as actual cases (Blum, 1962) and given an accurate diagnostic assessment. The present paper is concerned only with the second of these stages, namely, the development of a standard ized psychiatric interview and rating technique suitable for application to potential cases in a com munity setting. A number of standardized psychiatric interviews, including some which are highly reliable, have been developed in recent years, but for various reasons all are unsuitable for field surveys. In the United States, Lorr, Klett, and McNair (1963) have de scribed an assessment based on the Inpatient Multi dimensional Psychiatric Scale (IMPS), and Overall and Gorham (1962) have used a psychiatric assess ment derived from a shortened version of the Lorr scale; both these scales heavily emphasize psychotic phenomena which are relatively uncommon in the general population. The interview described by Spitzer, Fleiss, Burdock, and Hardesty (1964), although in some ways more suitable, is still in sufficiently flexible and contains many items which would make it unacceptable to normal individuals. In this country, Wing, Birley, Cooper, Graham, and Isaacs (1967) and Kendell, Everitt, Cooper, Sar torius, and David (1968) have published accounts of the 'Present State Examination' which has been designed primarily for use in international studies. This very comprehensive 500-item schedule was designed for administration to known psychiatric patients and again does not readily lend itself in its present form for use in community surveys. With these considerations in mind, a standardized psychiatric interview has been constructed to meet the following requirements: (1) Psychiatric assessment should be made by an experienced psychiatrist in a realistic ciinical setting; (2) The interview should be acceptable to indi viduals who may not see themselves as psychiatrically disturbed; (3) The content of the interview should be appro priate to the types of psychiatric disturbance com monly encountered in the community; (4) The interview should generate information about individual symptoms and signs of illness as well as an overall diagnostic assessment;