Abstract
For years, clinicians have struggled to increase diagnostic agreement for mental illnesses. However, there are a number of factors that may contribute to inconsistency in diagnosis. The three studies described here were designed to consider some of these factors. In Study 1, diagnostic agreement between a brief, unstructured interview and a longer, more structured interview was calculated for 415 patients at a university psychology clinic. Overall, diagnostic agreement was poor between the two interviews, though female therapists had better agreement for schizophrenia spectrum disorders and eating disorders while male therapists showed better agreement for anxiety disorders. Additionally, the use of a structured interview during the longer evaluation improved agreement for several categories of disorders. In Study 2, 357 graduate students in clinical psychology and practicing psychologists completed a survey asking them to match DSM symptoms or client statements to their parent disorders. Accuracy was significantly higher for Axis I disorders than Axis II disorders, and graduate students performed significantly better than practicing psychologists on the Axis I disorders, particularly when presented with client statements. For both Axis I and Axis II disorders, agreement was significantly higher for the DSM symptoms rather than client statements. Study 3 asked 205 graduate students and practicing psychologists to diagnose four case examples, which varied by gender and race. Diagnosis did not vary systematically by race or gender of the case, and the participants’ years of experience significantly increased diagnostic agreement in only one case. Overall, it is clear that a myriad of factors contribute to inconsistency in diagnosis, particularly those factors related to the method of evaluation and the expertise of the clinician.
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