Am J Psychiatry 1995; 152:1427-1437
Copyright © 1995 by American Psychiatric Association
Progress toward achieving a common language in psychiatry, II: Results from the international field trials of the ICD-10 diagnostic criteria for research for mental and behavioral disorders
N Sartorius, TB Ustun, A Korten, JE Cooper and J van Drimmelen
University of Geneva, Switzerland.
OBJECTIVE: In preparing for the publication of ICD-10, the Division of
Mental Health of the World Health Organization developed several versions
of chapter V, which deals with mental and behavioral disorders. The version
for research purposes is called the Diagnostic Criteria for Research
(ICD-10 DCR) and gives operational criteria for the diagnosis of mental
disorders. This article describes the results of international field trials
undertaken to evaluate the draft criteria and refine them further. METHOD:
Data were obtained to assess interrater agreement, the confidence with
which diagnoses could be made, and the ease of use of the criteria.
Additional substudies examined the concordance between ICD-10 DCR, ICD-10
Clinical Descriptions and Diagnostic Guidelines, and other national
classification systems (e.g., DSM-IV). The field trials were carried out at
151 clinical centers in 32 countries by 942 clinician/researchers who
conducted 11,491 individual assessments of patients. Results for cases
assessed by at least two raters are reported here. RESULTS: Most
clinician/researchers found the criteria to be explicit and easy to apply.
Interrater agreement was high for most diagnostic categories. For some
categories, such as those dealing with certain polymorphic psychotic
disorders or milder forms of affective disorders, the criteria were rated
as somewhat difficult to use, and reliability was lower. Comparison of the
results of these field trials with those of the ICD-10 Clinical
Descriptions and Diagnostic Guidelines demonstrated that there are
increases in interrater agreement when the operational criteria are used.
CONCLUSIONS: The use of internationally accepted research criteria enhances
the reliability of diagnosis of mental disorders made in research settings
worldwide.
