American Journal of Epidemiology Vol. 144, No. 6: 589-597
Copyright © 1996 by The Johns Hopkins University School of Hygiene and Public Health
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Interviewer Effects on Epidemiologic Diagnoses of Posttraumatic Stress Disorder
1Centre for Education and Research on Ageing, Repatriation General Hospital at Concord Concord, Australia
2Department of Psychiatry, University of Queensland Herston, Australia
3National Health & Medical Research Council of Australia Social Psychiatry Research Unit Canberra, Australia
4Institute of Psychiatric Evaluation, Berowra Heights Australia
5School of Public Health, Queensland University of Technology Queensland, Australia
6Valley Community Mental Health Service, Fortitude Valley Australia
In an epidemiologic study of 641 interviewed subjects in the Australian Vietnam Veterans Health Study, three diagnoses of Vietnam combat-related posttraumatic stress disorder (PTSD) were obtained: lifetime prevalence using a variant of the Diagnostic Interview Schedule and lifetime and current (1-month) PTSD prevalence using the Standardized Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Third Revision. Prevalence estimates using the Standardized Clinical Interview varied according to interviewer characteristics (female vs. male, clinician vs. nonclinician) but not for the Diagnostic Interview Schedule. The authors use a simple variant of logistic regression to distill estimates of two informative parameters characterizing interviewers' judgments: severity threshold (related to the individual interviewers' criterion of "case-ness") and reliability (related to degree of classification error of the individual interviewers). Examination of these estimates shows that female clinicians adopted lower severity thresholds for diagnosis of PTSD than other interviewers and hence had higher prevalence estimates while being relatively reliable in their judgments. Examination also shows that nonclinician interviewers can perform at least as reliably as clinicians. The Diagnostic Interview Schedule measure of PTSD was not moderated by these interviewer aspects. This use of threshold and reliability parameters is offered for routine use in epidemiologic field studies to examine potential interviewer effects. Am J Epidemiol 1996; 144: 589–97.
interviews; logistic models; reproducibility of results; stress disorders, post-traumatic
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