Validity of DSM-III-R diagnosis by psychological autopsy: a comparison with clinician ante-mortem diagnosis

Authors

  • T. M. Kelly,

    1. Mental Health Clinical Research Center for the Study of Suicidal Behavior, Laboratories of Neuropharmacology, Western Psychiatric Institute and Clinic. Pittsburgh, PA, USA
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  • J. J. Mann

    Corresponding author
    1. Mental Health Clinical Research Center for the Study of Suicidal Behavior, Laboratories of Neuropharmacology, Western Psychiatric Institute and Clinic. Pittsburgh, PA, USA
      J. J. Mann, New York State Psychiatric Institute, Box 28. 722 West 168th Street, New York. NY 10032, USA
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J. J. Mann, New York State Psychiatric Institute, Box 28. 722 West 168th Street, New York. NY 10032, USA

Abstract

Psychological autopsies are an important research tool in establishing risk factors associated with suicide. We report the results of a validity study comparing psychological autopsy-generated DSM-III-R diagnoses in suicides and non-suicides with chart diagnoses generated by clinicians who had treated the subjects prior to death. The Structured Clinical Interview for DSM-III-R Disorders (SCID-P) and the Structured Clinical Interview for DSM-III-R Personality Disorders (SCID-II) were used to make independent post-mortem diagnoses. Comparison of research diagnoses with clinician ante-mortem diagnoses generated kappa coefficients of 0.85 for Axis I diagnoses and 0.65 for Axis II conditions. These kappa coefficients compare favourably with direct patient interview reliability studies. This provides evidence for the validity of the psychological autopsy as a method of determining psychiatric diagnosis.

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