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Am J Psychiatry 1994; 151:574-579
Copyright © 1994 by American Psychiatric Association
Effects of informant mental disorder on psychiatric family history data
TF Chapman, S Mannuzza, DF Klein and AJ Fyer
Department of Therapeutics, New York State Psychiatric Institute, NY 10032.
OBJECTIVE: In family history interviews, mentally ill individuals ascribe
their own disorders to relatives more frequently than informants who are
not ill. Whether this reflects increased or decreased reporting accuracy
remains unknown. This study addressed this issue by examining the
sensitivity and specificity of diagnoses based on information from
different types of informants classified by their own illness status.
METHOD: Both members of 2,193 pairs of individuals participating in a
psychiatric family study were directly interviewed. One individual in each
pair (the informant) also provided family history data about the other (the
subject). Informant-subject pairs were grouped according to the illness
status of the informant based on the direct interview. Patterns of
ascription of mental illness to subjects by groups of ill and not-ill
informants were then compared with the subjects' psychiatric status based
on direct interview. RESULTS: For depression, alcoholism, panic disorder,
and "any diagnosis," ill informants demonstrated significantly increased
sensitivity in family history reports when compared to never-mentally- ill
informants; specificity, by contrast, was always significantly reduced. For
each disorder, the aggregate disorder rate derived from family history
reports was closer to the rate derived from direct interviews if
information from ill informants as a group was used. CONCLUSIONS: The
sensitivity and specificity of family history information appears to vary
systematically with informant mental illness status. This may introduce a
serious bias into psychiatric family study data, leading to overestimation
of the strength of the tendency for mental disorders to "run in families."
Family studies that rely on the informant method in their diagnostic
evaluations should be aware of this problem.
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