Structured Interview Based on ICD-11 CDDR for Mental Health Disorders
A comprehensive structured interview for mental health disorders based on ICD-11 Clinical Descriptions and Diagnostic Requirements (CDDR) should include standardized assessment modules for all major disorder categories, dimensional rating scales, cultural formulation components, and functional impairment measures to ensure accurate diagnosis and treatment planning. 1
Core Components of the Structured Interview
Initial Assessment Framework
- Demographic Information: Age, gender, education, occupation, marital status, living situation
- Chief Complaint: Primary reason for seeking help in patient's own words
- History of Present Illness: Onset, duration, pattern, and progression of symptoms
- Functional Impact Assessment: Effects on work/school, relationships, self-care
- Previous Treatment History: Past diagnoses, interventions, hospitalizations, medication trials and responses
Diagnostic Modules by Disorder Grouping
Mood Disorders Module
- Assessment of depressive episodes using dimensional severity ratings (mild, moderate, severe)
- Specific symptom qualifiers: melancholic features, anxiety symptoms, panic attacks, seasonal pattern
- Bipolar disorder assessment including manic/hypomanic episodes with dimensional symptom specifiers
- Mixed states evaluation (when depressive and manic symptoms occur simultaneously or alternate rapidly)
- Dysthymia assessment as a separate diagnostic entity 2
- Course specifiers: single episode, recurrent, in partial/full remission
Psychotic Disorders Module
- Dimensional assessment across six symptom domains: positive symptoms, negative symptoms, depressive symptoms, manic symptoms, psychomotor symptoms, cognitive symptoms
- Each domain rated on 4-point severity scale from "not present" to "present and severe"
- Course qualifiers: first episode, multiple episodes, continuous course
- Current clinical status: currently symptomatic, partial remission, full remission 3
Anxiety and Fear-Related Disorders Module
- Panic attack assessment (expected vs. unexpected)
- Specific phobia evaluation with type specifiers
- Social anxiety disorder assessment
- Generalized anxiety disorder evaluation
- Separation anxiety disorder assessment
- Panic disorder assessment
Disorders Specifically Associated with Stress Module
- Post-traumatic stress disorder (PTSD) assessment
- Complex PTSD evaluation (new to ICD-11)
- Prolonged grief disorder assessment (new to ICD-11)
- Adjustment disorder evaluation
Obsessive-Compulsive and Related Disorders Module
- Assessment of obsessions and compulsions with dimensional symptom checklist
- Evaluation across five symptom dimensions: contamination, harm-related, unacceptability, symmetry, and hoarding symptoms 3
- Assessment of insight (good, poor, or absent)
- Evaluation of tic-related features
- Assessment of related disorders (body dysmorphic disorder, hoarding disorder, etc.)
Personality Disorders Module
- Single personality disorder diagnosis with severity rating (mild, moderate, severe)
- Assessment of core personality dysfunction in self and interpersonal functioning
- Evaluation of trait domain qualifiers: negative affectivity, detachment, dissociality, disinhibition, anankastia, and borderline pattern 3
Neurodevelopmental Disorders Module
- Disorders of intellectual development assessment using behavioral indicators when standardized testing unavailable 4
- Autism spectrum disorder evaluation
- Attention deficit hyperactivity disorder assessment
- Developmental learning disorder evaluation
Dimensional Assessment Components
Severity Ratings
- Standardized severity scales for each major disorder category
- Functional impairment assessment using WHO Disability Assessment Schedule (WHODAS 2.0)
- Symptom frequency, intensity, and duration measures
Cross-Cutting Symptom Measures
- Suicidality and self-harm risk assessment
- Psychosis screening
- Substance use screening
- Sleep disturbance evaluation
Cultural Formulation Components
- Cultural identity of the individual
- Cultural conceptualizations of distress
- Cultural factors affecting self-coping and help-seeking
- Cultural factors affecting current functioning and recovery
- Cultural assessment for diagnosis and care
Implementation Considerations
Interview Structure
- Semi-structured format allowing both standardized questions and clinical probing
- Skip patterns to enhance efficiency based on screening responses
- Modular design allowing selection of relevant sections based on presenting concerns
Clinical Utility Features
- Clear diagnostic algorithms aligned with ICD-11 CDDR
- Decision trees to guide differential diagnosis
- Guidance for distinguishing normal from pathological responses (especially important for bereavement and stress responses) 2
- Guidance for assessing comorbidities
Practical Administration
- Training requirements for interviewers
- Estimated administration time for each module
- Guidelines for documentation and coding
Special Considerations
Developmental Adaptations
- Modified questions for children and adolescents
- Parent/caregiver interview components
- Age-appropriate behavioral indicators for disorders of intellectual development 4
Assessment Tools Integration
- Integration with validated screening tools (PHQ-9, GAD-7, etc.)
- Recommendations for supplementary assessments when indicated
- Guidance on when to use specialized assessment tools
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
- Not addressing cultural factors that may influence symptom presentation
- Inadequate assessment of insight and subjective distress 1
Clinical Utility Validation
- Field studies have demonstrated excellent inter-rater reliability for ICD-11 CDDR-based assessments
- Clinicians rate ICD-11 guidelines as clear, understandable, and easy to use
- Majority of clinicians (82.5% to 83.9%) perceive the ICD-11 CDDR as accurate and providing appropriate level of detail 5
- Systematic reviews confirm positive clinical utility across different cultural contexts 6
The structured interview should be designed to balance comprehensive assessment with practical clinical utility, ensuring that it can be effectively implemented across diverse healthcare settings worldwide.