Hostname: page-component-cd9895bd7-jn8rn Total loading time: 0 Render date: 2024-12-31T15:19:44.887Z Has data issue: false hasContentIssue false
  • English
  • Français

A Re-analysis of the Reliability of Psychiatric Diagnosis

Published online by Cambridge University Press:  29 January 2018

Robert L. Spitzer  and
Joseph L. Fleiss
Robert L. Spitzer
Affiliation:
Biometrics Research, New York State Department of Mental Hygiene at the Psychiatric Institute, 722 West 168 Street, New York, New York 10032; and Columbia University, New. York
Joseph L. Fleiss
Affiliation:
Biometrics Research, New York State Department of Mental Hygiene at the Psychiatric Institute; and Columbia University, New York
Get access Rights & Permissions [Opens in a new window]

Extract

Classification systems such as diagnosis have two primary properties, reliability and validity. Reliability refers to the consistency with which subjects are classified; validity, to the utility of the system for its various purposes. In the case of psychiatric diagnosis, the purposes of the classification system are communication about clinical features, aetiology, course of illness and treatment. A necessary constraint on the validity of a system is its reliability. There is no guarantee that a reliable system is valid, but assuredly an unreliable system must be invalid.

Type
Research Article
Information
The British Journal of Psychiatry , Volume 125 , Issue 587 , October 1974 , pp. 341 - 347
Copyright
Copyright © Royal College of Psychiatrists, 1974 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

American Psychiatric Association (1952) Diagnostic and Statistical Manual of the Mental Disorders. Google Scholar
American Psychiatric Association (1968) Diagnostic and Statistical Manual of the Mental Disorders. 2nd Edition. Google Scholar
Beck, A. T., Ward, C. H., Mendelson, M., Mock, J. E., & Erbaugh, J. K. (1962). Reliability of psychiatric diagnoses: 2. A study of consistency of clinical judgments and ratings. Amer. J. Psychiat., 119, 351–7.Google ScholarPubMed
Cohen, J. (1960) A coefficient of agreement for nominal scales. Educ. psychol. Measmt., 20, 37–46.CrossRefGoogle Scholar
Cohen, J. (1968) Weighted kappa: Nominal scale agreement with provision for scaled disagreement or partial credit. Psychol. Bull., 70, 213–20.CrossRefGoogle ScholarPubMed
Cooper, J. E., Kendell, R. E., Gurland, B. J., Sharpe, L., Copeland, J. R. M. & Simon, R. (1972) Psychiatric Diagnosis in New York and London. (U.S.–U.K. Diagnostic Project.) London: Oxford University Press.Google Scholar
Copeland, J. R. M., Cooper, J. E., Kendell, R. E., & Gourlay, A. J. (1971) Differences in usage of diagnostic labels amongst psychiatrists in the British Isles. Brit. J. Psychiat., 118, 629–40.CrossRefGoogle ScholarPubMed
Feighner, J. P., Robins, E., Guze, S. B., Woodruff, R. A., Winokur, G. & Munoz, R. (1972) Diagnostic criteria for use in psychiatric research. Arch. gen. Psychiat., 26, 57–63.Google Scholar
Fleiss, J. L. (1971) Measuring nominal scale agreement among many raters. Psychol. Bull., 76, 378–82.CrossRefGoogle Scholar
Fleiss, J. L. & Cohen, J. (1973) The equivalence of weighted kappa and the intraclass correlation coefficient as measures of reliability. Educ. psychol. Measmt., 33, 613–19.Google Scholar
Fleiss, J. L. Spitzer, R. L., Endicott, J. & Cohen, J. (1972) Quantification of agreement in multiple psychiatric diagnosis. Arch. gen. Psychiat., 26, 168–71.CrossRefGoogle ScholarPubMed
Gurland, B. J., Fleiss, J. L., Sharpe, L., Simon, R. & Barrett, J. E. (1972) The mislabeling of depressed patients in New York State hospitals. Disorders of Mood (eds. Zubin, J. & Freyhan, F. A.), pp. 17–28. Baltimore: Johns Hopkins Press.Google Scholar
Her Majesty's Stationery Office (1968) A Glossary of Mental Disorders. General Register Office Studies on Medical and Population Subjects, no. 22.Google Scholar
Katz, M. M., Cole, J. O. & Lowry, H. A. (1969) Studies of the diagnostic process: The influence of symptom perception, past experience, and ethnic background on diagnostic decisions. Amer. J. Psychiat., 125, 937–47.Google Scholar
Kendell, R. E., Cooper, J. E., Gourlay, A. J., Copeland, J. R. M., Sharpe, L. & Gurland, B.J. (1971) The diagnostic criteria of American and British psychiatrists. Arch. gen. Psychiat., 25, 123–30.Google Scholar
Kreitman, N. (1961) The reliability of psychiatric diagnosis. J. ment. Sci., 107, 876–86.Google ScholarPubMed
Light, R.J. (1971) Measures of agreement for qualitative data: Some generalizations and alternatives. Psychol. Bull., 76, 365–77.CrossRefGoogle Scholar
Lorr, M., McNair, D. M., Klett, C. J. & Lasky, J. J. (1962) Evidence of ten psychiatric syndromes. J. consult. Psychol, 26, 185–9.Google Scholar
Sandifer, M. G., Hordern, A., Timbury, G. C. & Green, L. M. (1968) Psychiatric diagnosis: A comparative study in North Carolina, London and Glasgow. Brit. J. Psychiat., 114, 1–9.CrossRefGoogle ScholarPubMed
Sandifer, M. G., Pettus, C. & Quade, D. (1964) A study of psychiatric diagnosis. J. nerv. ment. Dis., 139, 350–6.CrossRefGoogle ScholarPubMed
Schmidt, H. O. & Fonda, C. P. (1956) The reliability of psychiatrie diagnosis: A new look. J. abnor. soc., Psychol., 52, 262–7.Google Scholar
Sharpe, L., Gurland, B. J., Fleiss, J. L., Kendell, R. E., Cooper, J. E. & Copeland, J. R. M. Some comparisons of American, Canadian and British psychiatrists in their diagnostic concepts. Canad. J. Psychiat. In press.Google Scholar
Spitzer, R. L., Cohen, J., Fleiss, J. L. & Endicott, J. (1967a) Quantification of agreement in psychiatric diagnosis: A new approach. Arch. gen. Psychiat., 17, 83–7.Google Scholar
Spitzer, R. L., Endicott, J., Cohen, J. & Fleiss, J. L. Constraints on the validity of computer diagnosis. (In preparation).Google Scholar
Spitzer, R. L., Endicott, J., Fleiss, J. L. & Cohen, J. (1970) Psychiatric Status Schedule: A technique for evaluating psychopathology and impairment in role functioning. Arch. gen. Psychiat., 23, 41–55.CrossRefGoogle ScholarPubMed
Spitzer, R. L., Fleiss, J. L., Endicott, J. & Cohen, J. (1967b) Mental Status Schedule: Properties of factor analytically derived scales. Arch. gen. Psychiat., 16, 479–93.Google Scholar
Wing, J. K., Birley, J. L. T., Cooper, J. E., Graham, P. & Isaacs, A. D. (1967) Reliability of a procedure for measuring and classifying ‘present psychiatric state’. Brit. J. Psychiat, 113, 499–515.CrossRefGoogle ScholarPubMed
Zubin, J. (1967) Classification of the behavior disorders. In Annual Review of Psychology (eds. Farnsworth, P. R. & McNemar, O.). Palo Alto, California, Annual Reviews , pp. 373–406.CrossRefGoogle Scholar
Submit a response

eLetters

No eLetters have been published for this article.