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Non-Standard Diagnostic Assessment reliability in psychiatry: A study in a Brazilian outpatient setting using Kappa

Published online by Cambridge University Press:  27 August 2024

H. Rocha Neto ,
D. Telles-Correia ,
L. Koiller  and
M. Cavalcanti
H. Rocha Neto
Affiliation:
1Psiquiatria, Faculdade de Medicina de Lisboa, Lisbon, Portugal
D. Telles-Correia*
Affiliation:
1Psiquiatria, Faculdade de Medicina de Lisboa, Lisbon, Portugal
L. Koiller
Affiliation:
2Programa de Pós Graduação em Psiquiatria e Saúde Mental, Universidade Federal do Rio de Janeiro, Rio de janeiro, Brazil
M. Cavalcanti
Affiliation:
2Programa de Pós Graduação em Psiquiatria e Saúde Mental, Universidade Federal do Rio de Janeiro, Rio de janeiro, Brazil
*
*Corresponding author.

Abstract

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Introduction

The use of Structured Diagnostic Assessments (SDAs) is a solution for unreliability in psychiatry and the gold standard for diagnosis. However, except for studies between the 50s and 70s, reliability without the use of Non-SDAs (NSDA) is seldom tested, especially in non-Western, Educated, Industrialized, Rich, and Democratic (WEIRD) countries.

Objectives

We aim to measure reliability between examiners with NSDAs for psychiatric disorders.

Methods

We compared diagnostic agreement after clinician change, in an outpatient academic setting. We used inter-rater Kappa measuring 8 diagnostic groups: Depression (DD: F32, F33), Anxiety Related Disorders (ARD: F40–F49, F50–F59), Personality Disorders (PD: F60–F69), Bipolar Disorder (BD: F30, F31, F34.0, F38.1), Organic Mental Disorders (Org: F00–F09), Neurodevelopment Disorders (ND: F70–F99) and Schizophrenia Spectrum Disorders (SE: F20–F29) (Check table 1 about diagnosis hyerarchy and observed frequency in sample). Cohen’s Kappa measured agreement between groups, and Baphkar’s test assessed if any diagnostic group have a higher tendency to change after a new diagnostic assessment. This research was approved by IPUB’s ethical committee, registered under the CAAE33603220.1.0000.5263, and the UTN-U1111-1260-1212.

Results

We analyzed 739 reevaluation pairs, from 99 subjects who attended IPUB’s outpatient clinic. Overall inter-rater Kappa was moderate, and none of the groups had a different tendency to change (Check table 2 for diagnostic change distribution). Our tests achieved the followinf results: Cohen Kappa 0.70, IC: 0.66– 0.74; Weighted Kappa 0.72, IC:0.72 – 0.72; Bhapkar Test X² = 5.98, Df = 7, P-value = .55; Achieved Power (w=0.1): 0.93Table 2

Agreement between examiners for eight diagnostic groups

ARDBDDDDRDNDOrganicPDSSD
ARD393902033
BD11547322410
DD9107100259
DRD02040002
ND121051116
Organic010032005
PD421100333
SSD520112854192

Conclusions

NSDA evaluation was moderately reliable, but the lack of some prevalent hypothesis inside the pairs raised concerns about NSDA sensitivity to some diagnoses. Diagnostic momentum bias (that is, a tendency to keep the last diagnosis observed) may have inflated the observed agreement.

Disclosure of Interest

None Declared

Type
Abstract
Information
European Psychiatry , Volume 67 , Special Issue S1: Abstracts of the 32nd European Congress of Psychiatry , April 2024 , pp. S471 - S472
Creative Commons
Creative Common License - CCCreative Common License - BY
This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Copyright
© The Author(s), 2024. Published by Cambridge University Press on behalf of European Psychiatric Association
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