1. Structured and Semistructured Interviews
Chapter 3
Structured and Semistructured Interviews

2. Structured and Semistructured Interviews
Developed to address an important problem in the mental health field:
Clinicians and researchers had tremendous difficulty in making consistent and accurate diagnoses of mental disorders with unstructured clinical interviews
Questions lacked uniformity or standardization

3. Basic Issues Unstructured clinical interviews
Dependent on the clinician’s unique background, knowledge base, theoretical model, and interpersonal style, and thus are highly flexible
Clinicians are entirely responsible for asking whatever questions they decide are necessary to reach a diagnostic conclusion
High variability across interviews from one clinician to another

4. Structured Interviews
Important purposes
Increases coverage of many mental disorders that otherwise might be overlooked
Enhances the diagnostician’s ability to accurately determine whether particular symptoms are present or absent
Reduces variability among interviewers, which improves reliability

5. Structured Interviews cont.
Fully structured
Questions are asked verbatim to the respondent
Wording of probes used to follow up on initial questions is specified
Interviewers are trained to not deviate from this rigid format
Can be administered by nonclinicians who receive training on the specific instrument

6. Semistructured Interviews
Interviewer has substantial latitude to follow up on responses for questions typically asked verbatim
Interviewer can modify or augment the standard inquiries with individualized and contextualized probes to more accurately rate specific symptoms
Requires clinically experienced examiners to administer the interview and to make diagnoses

7. Applications Research Clinical practice Clinical training
Interviews used to formally diagnose participants for inclusion into a study so that research topics can be explored for a particular diagnosis or group of diagnoses
Clinical practice
Interview may be used as part of a comprehensive and standardized intake evaluation
Clinical training
Interviews used to train mental health professionals

8. Advantages: Structured Interviews
Increased reliability
Decreases the chances that two different interviewers will elicit different information from the same client, which may result in different diagnoses
Increased validity
Forces clinicians to assess all of the specified criteria for a broad range of diagnoses, and to offer a more thorough and valid assessment of many disorders compared to unstructured interviews
Utility as a training tool
May help clinicians develop or enhance their understanding of the flow, format, and questions inherent in a comprehensive diagnostic interview

9. Disadvantages: Structured Interviews
May hinder rapport
May impede the connection between client and clinician, because interviews are problem-centered rather than person-centered
Limited by the validity of the classification system
Some disorders (e.g., most of the personality disorders) and their criteria have not been examined as consistently or as completely, therefore leaving questions about their attendant validity
The trade-off of breadth versus depth
Focusing on a few specific areas will provide clinicians and researchers with a wealth of information about those specific areas, but it may result in missing information that could lead to additional diagnoses or a different case conceptualization

10. Semistructured Interviews for Clinical Disorders
Anxiety Disorders Interview Schedule for DSM-IV
(ADIS-IV)
Provides differential diagnosis among anxiety disorders
Includes sections on mood, somatoform, and substance use disorders because anxiety disorders are frequently comorbid with such conditions
Each disorder is given a rating of clinical severity ranging from 0 to 8
Ratings of 3 or below indicate subsyndromal symptomatology
Ratings of 4 and above indicate the presence of a disorder

11. Semistructured Interviews for Clinical Disorders cont.
Schedule for Affective Disorders and Schizophrenia (SADS)
Evaluates a range of clinical disorders, with a focus on mood and psychotic disorders
To be administered by trained mental health professionals with graduate degrees and clinical experience
Infrequently chosen for use in many traditional purely clinical settings because of length and complexity
Is not completely aligned with the DSM system, representing a significant point of concern

12. Semistructured Interviews for Clinical Disorders cont.
Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I)
Has widespread popularity and is designed for use in clinical settings
Modular design represents a major strength of the instrument because administration can be easily customized to meet the unique needs of the user
Formal diagnostic criteria are included in the SCID booklet, permitting interviewers to see the exact criteria to which the SCID questions pertain

13. Structured Interviews for Clinical Disorders
Diagnostic Interview Schedule for DSM-IV (DIS-IV)
Fully structured interview specifically designed for use by nonclinician interviewers
Computerized administration is required
Designed for epidemiological research with normative samples
All questions are closed-ended, and replies are coded with a forced-choice “yes” or “no” response format

14. Semistructured Interviews for Personality Disorders
Diagnostic Interview for Personality Disorders (DIPD)
Also includes depressive personality disorder and passive-aggressive personality disorder in the DSM-IV appendix
Behavior exhibited during the interview is valued and may override client self-report if there are contradictions
Information about administration and scoring of the DIPD-IV is relatively sparse compared to other personality interviews
At least a bachelor’s degree is required to administer, among other requirements

15. Semistructured Interviews for Personality Disorders cont
International Personality Disorder Examination (IPDE)
Evaluates personality disorders for both the DSM-IV and the International Classification of Diseases, 10th edition (ICD-10), classification systems
Only personality disorder interview based on worldwide field trials
Intended to be administered by experienced clinicians
Widely used for international and cross-cultural investigations of personality disorders

16. Semistructured Interviews for Personality Disorders cont
Structured Clinical Interview for DSM-IV Axis II Personality Disorders (SCID-II)
Similar semistructured format as the SCID Axis I version
Includes a 119-item self-report screening component Personality Questionnaire
Only items scored in the pathological direction are further evaluated during a structured interview

17. Semistructured Interviews for Personality Disorders cont
Structured Interview for DSM-IV Personality (SIDP-IV)
Does not cover DSM personality categories on a disorder-by-disorder basis; rather, they are grouped according to 10 topical sections that reflect a different dimension of personality functioning
Specific DSM-IV criterion associated with each question is provided for interviewers to view easily
Given multiple sources of diagnostic data, final ratings are made after all sources of information are considered

18. The Cultural Formulation Interview (CFI) of DSM-5
16-question semistructured interview designed to assess the impact of cultural factors on an individual’s mental health
Not used to diagnose mental disorders per se
Improves cultural validity of assessment, aids in treatment planning, and fosters commitment and satisfaction

19. Review: Interviews for Clinical Disorders
Name
Time Required
Format
Comment
Anxiety Disorders Interview Schedule for DSM-IV
(ADIS-IV)
45 to 60 minutes
Semistructured, interviewer administered
Provides in-depth assessment of anxiety disorders and other frequently comorbid conditions
Diagnostic Interview Schedule for DSM-IV
(DIS-IV)
90 to 150 minutes
Fully structured, computerized, closed-ended questions
Designed for epidemiological research; can be administered by nonclinicians with specialized training
Schedule for Affective Disorders and Schizophrenia
(SADS)
In-depth coverage on mood and psychotic disorders; administration by trained mental health professionals
Structured Clinical Interview for DSM-IV Axis I Disorders
(SCID-I)
45 to 90 minutes
Covers Axis I DSM-IV disorders most commonly seen in clinical settings

20. Review: Interviews for Personality Disorders
International Personality Disorder Examination
(IPDE)
15 minutes (self-administered screen), 90 minutes (interview)
Contains self-administered pencil-and-paper questionnaire and semistructured interview
Evaluates personality disorders for both the DSM-IV and the
ICD-10
Structured Clinical Interview for DSM-IV Axis II Personality Disorders
(SCID-II)
20 minutes (self-administered screen), 60 minutes (interview)
Contains self-report screening questionnaire and semistructured interview
Administration by professionals with knowledge of psychopathology, DSM-IV criteria, and interviewing skills
Structured Interview for DSM-IV Personality
(SIDP-IV)
60 to 90 minutes
Semistructured interview
Collateral sources encouraged and dimensions of personality functioning included