A Coefficient of Agreement for Nominal Scales

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Abstract
Background : Efforts to develop and validate fully‐structured diagnostic interviews of mental disorders in non‐Western countries have been largely unsuccessful. However, the principled methods of translation, harmonization, and calibration that have been developed by cross‐national survey methodologists have never before been used to guide such development efforts. The current report presents the results of a rigorous program of research using these methods designed to modify and validate the Composite International Diagnostic Interview (CIDI) for an epidemiological survey in Nepal. Methods : A five‐step process of translation, harmonization, and calibration was used to modify the instrument. A blinded clinical reappraisal design was used to validate the instrument. Results : Preliminary interviews with local mental health expert led to a focus on major depressive episode, mania/hypomania, panic disorder, post‐traumatic stress disorder, generalized anxiety disorder, and intermittent explosive disorder. After an iterative process of multiple translations‐revisions guided by the principles developed by cross‐national survey methodologists, lifetime DSM‐IV diagnoses based on the final Nepali CIDI had excellent concordance with diagnoses based on blinded Structured Clinical Interview for DSM‐IV (SCID) clinical reappraisal interviews. Conclusions : Valid assessment of mental disorders can be achieved with fully‐structured diagnostic interviews even in low‐income non‐Western settings with rigorous implementation of replicable developmental strategies. Copyright © 2013 John Wiley & Sons, Ltd

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