Background. Comparisons of structured diagnostic interviews with clinical assessments in general
population samples show marked discrepancies. In order to validate the CIS-R, a fully structured
diagnostic interview used for the National Survey of Psychiatric Morbidity in Great Britain, it was
compared with SCAN, a standard, semi-structured, clinical assessment.
Methods. A random sample of 1882 Leicestershire addresses from the Postcode Address File
yielded 1157 eligible adults: of these 860 completed the CIS-R; 387 adults scores [ges ]8 on the CIS-R
and 205 of these completed a SCAN reference examination. Neurotic symptoms, in the previous
week and month only, were enquired about. Concordance was estimated for ICD-10 neurotic and
depressive disorders, F32 to F42 and for depression symptom score.
Results. Sociodemographic characteristics closely resembled National Survey and 1991 census
profiles. Concordance was poor for any ICD-10 neurotic disorder (kappa = 0·25 (95% CI, 0·1–0·4))
and for depressive disorder (kappa = 0·23 (95% CI, 0–0·46)). Sensitivity to the SCAN reference
classification was also poor. Specificity ranged from 0·8 to 0·9. Rank order correlation for total
depression symptoms was 0·43 (Kendall's tau b; P<0·001; N=205).
Discussion. High specificity indicates that the CIS-R and SCAN agree that prevalence rates for
specific disorders are low compared with estimates in some community surveys. We have revealed
substantial discrepancies in case finding. Therefore, published data on service utilization designed
to estimate unmet need in populations requires re-interpretation. The value of large-scale CIS-R
survey data can be enhanced considerably by the incorporation of concurrent semi-structured