What assessments provide structured interview questions keyed to ICD-11 (International Classification of Diseases, 11th Revision) mental health concerns?

Structured Interview Assessments for ICD-11 Mental Health Concerns

The Composite International Diagnostic Interview (CIDI) is the most comprehensive structured interview assessment tool aligned with ICD-11 mental health diagnostic criteria, offering both categorical and dimensional elements for accurate diagnosis across different cultures.

Primary Assessment Tools for ICD-11 Mental Health Disorders

The transition from ICD-10 to ICD-11 has introduced significant changes in the classification of mental, behavioral, and neurodevelopmental disorders, with a shift toward both categorical and dimensional approaches to diagnosis 1. Several structured interview assessments are available that align with ICD-11 criteria:

Composite International Diagnostic Interview (CIDI)

• Primary recommendation: The CIDI is a fully structured diagnostic interview developed by the World Health Organization that maps symptoms onto diagnostic criteria for both ICD and DSM systems 2, 3
• Key features:
  • Excellent inter-rater reliability and good test-retest reliability 2
  • Available in multiple languages and formats (paper-and-pencil and computer-administered) 2
  • Modular structure covering 39 ICD diagnoses 3
  • Can be administered by trained non-clinical staff 4
  • Designed specifically for epidemiological and cross-cultural applications 4

CIDI-VENUS (Women-Specific Version)

• Specifically designed to address women's mental health needs with additional modules for:
  • Premenstrual symptoms using the Premenstrual Symptoms Screening Tool (PSST)
  • Perinatal mental health assessment with links to the Edinburgh Postnatal Depression Scale (EPDS)
  • Menopausal transition assessment with the Menopause Visual Analogue Scales (M-VAS)
  • Tracking mental disorders across reproductive stages 5

Disorder-Specific Assessment Tools Compatible with ICD-11

Depression Assessment Tools

• Patient Health Questionnaire (PHQ-9):

  • 9-item self-report scale assessing major depressive symptoms
  • Clinical cutoff ≥8 for significant depression 6
  • Interpretation: 0-7 (none/mild), 8-14 (moderate), 15-19 (moderate-to-severe), 20-27 (severe) 6

• Center for Epidemiological Studies-Depression Scale (CES-D):

  • 20-item self-report scale (10-item short form available)
  • Scores ≥16 suggest moderate to severe depressive symptoms
  • Relatively unaffected by physical symptoms 1

• Geriatric Depression Scale (GDS):

  • 30-item version or 15-item short form for elderly patients
  • GDS score ≥19 (or GDS-SF ≥5) suggests depression requiring follow-up 1

Anxiety Assessment Tools

• Generalized Anxiety Disorder 7-item scale (GAD-7):

  • Most validated tool for assessing anxiety severity
  • Scoring: 0-4 (minimal), 5-9 (mild), 10-14 (moderate), 15-21 (severe) anxiety
  • Cut-off score of ≥10 has good sensitivity and specificity 6

• Hospital Anxiety and Depression Scale (HADS):

  • 14-item self-report measure with separate anxiety and depression subscales
  • Score ≥8 on anxiety subscale indicates significant anxiety
  • Advantageous for excluding physical symptoms that might be confounded by medical conditions 1, 6

• Penn State Worry Questionnaire (PSWQ):

  • 16-item scale (8-item abbreviated form available)
  • Specifically assesses worry severity, the primary symptom of GAD
  • Can be scored continuously or dichotomously 1

Implementation Approach for Clinical Practice

1. Initial Screening:

   • Begin with brief screening tools like GAD-2 for anxiety or two-question depression screen 6
   • If positive, proceed to more comprehensive assessment

2. Comprehensive Assessment:

   • Use the CIDI for full diagnostic evaluation aligned with ICD-11 criteria
   • Supplement with disorder-specific scales for severity measurement and treatment monitoring

3. Regular Monitoring:

   • Reassess at 4 and 8 weeks after initiating treatment
   • Continue monitoring at 3,6, and 12 months after treatment 6

Important Considerations

• The ICD-11 Mental, Behavioral or Neurodevelopmental Disorders chapter contains 21 disorder groupings (compared to 11 in ICD-10), requiring more comprehensive assessment approaches 1

• ICD-11 incorporates dimensional elements alongside categorical diagnoses, particularly for:

  • Depressive episodes (with qualifiers for melancholic features, anxiety symptoms, panic attacks)
  • Schizophrenia and psychotic disorders (with dimensional symptom specifiers for positive, negative, depressive, manic, psychomotor, and cognitive symptoms) 1

• When selecting assessment tools, consider:

  • Cultural appropriateness and validation across different populations 1
  • Literacy level and cognitive capacity of the patient
  • Specific symptoms that need monitoring based on presenting concerns

• Common pitfalls to avoid:

  • Failing to follow up on positive screening results
  • Relying solely on symptom counts without considering functional impact
  • Overlooking medical causes of symptoms (e.g., thyroid disorders, medication side effects) 6
  • Not addressing barriers to treatment adherence

By using these structured assessment tools aligned with ICD-11 criteria, clinicians can improve diagnostic accuracy, monitor treatment response, and ultimately improve patient outcomes in terms of morbidity, mortality, and quality of life.