The Composite International Diagnostic Interview (CIDI-auto)

Problems and Remedies for Diagnosing Panic Disorder and Social Phobia

Published in: International Journal of Methods in Psychiatric Research, Vol. 12, No. 4, 2003, p. 167-181

Posted on on January 01, 2003

by Adrienne Means-Christensen, Cathy D. Sherbourne, Peter Roy-Byrne, Michelle G. Craske, Alexander Bystritsky, Murray Stein

Read More

Access further information on this document at

This article was published outside of RAND. The full text of the article can be found at the link above.

In a recent study of treatment for panic disorder in primary care, the Composite International Diagnostic Interview (CIDI-Auto) was used to provide psychiatric diagnoses. However, during and after data collection, it was discovered that the CIDI appeared to place, or fail to place, a substantial number of people into diagnostic categories in ways that conflicted with the investigators' clinical experience. The wording of questions in the panic module, coupled with a lack of structured follow-up probes, resulted in apparent false negatives for panic disorder. Moreover, patients who would otherwise meet criteria for panic disorder or social phobia did not receive a diagnosis based on rules that may be discordant with clinical practice and, at times, the design of the DSM-IV. For this study, changes were made to the interview, including additional probes for the panic disorder module and modification of the decision rules used to assign or rule out diagnoses of panic disorder and social phobia. The changes resulted in greater inclusion of patients in the panic disorder and social phobia diagnostic categories and we argue that these changes to the CIDI-Auto increase the clinical validity of this instrument. We did not examine the false positive rate for the unmodified or modified CIDI, but this is an important issue that needs to be evaluated in future research.

This report is part of the RAND Corporation External publication series. Many RAND studies are published in peer-reviewed scholarly journals, as chapters in commercial books, or as documents published by other organizations.

Our mission to help improve policy and decisionmaking through research and analysis is enabled through our core values of quality and objectivity and our unwavering commitment to the highest level of integrity and ethical behavior. To help ensure our research and analysis are rigorous, objective, and nonpartisan, we subject our research publications to a robust and exacting quality-assurance process; avoid both the appearance and reality of financial and other conflicts of interest through staff training, project screening, and a policy of mandatory disclosure; and pursue transparency in our research engagements through our commitment to the open publication of our research findings and recommendations, disclosure of the source of funding of published research, and policies to ensure intellectual independence. For more information, visit

The RAND Corporation is a nonprofit institution that helps improve policy and decisionmaking through research and analysis. RAND's publications do not necessarily reflect the opinions of its research clients and sponsors.