Study Questions 'Gold Standard' of Mental Health Interviews

Diagnostic interviews, frequently treated as the benchmark for assessing mental health and substance use disorders, demonstrate inconsistent reliability across different conditions, according to a recent review in Jama Network Open. These interviews, commonly used in both clinical practice and research settings, are essential due to the absence of superior diagnostic alternatives.

The reliability of these diagnostic tools was evaluated using Cohen's kappa coefficient, which measures agreement between repeated assessments. Generally, the study found better test-retest reliability for substance use disorders, with opioid use disorder showing the highest consistency. This is attributed to the more behavioral nature of criteria for substance use disorders compared to subjective states like mood or anxiety.

Experts noted limitations in the study, including the pooling of fully structured and semi-structured interviews, which have different diagnostic approaches. While structured interviews offer greater consistency by adhering strictly to a script, semi-structured interviews allow clinicians flexibility for clarification, potentially improving accuracy but introducing more variability. The review highlighted a scarcity of research comparing specific interview instruments and formats, underscoring a broader need for increased rigor in psychiatric diagnostics.