Is there a structured interview for ICD‑11 diagnostic coding?

Is There a Structured Interview for ICD-11?

Yes, the Flexible Interview for ICD-11 (FLII-11) is a fully-structured diagnostic interview specifically developed for ICD-11 mental disorders and can be administered by trained lay interviewers. 1

Available Structured Interviews for ICD-11

The FLII-11 (Primary ICD-11 Tool)

• The FLII-11 (Version 0.2) was developed through a collaborative international process under WHO auspices specifically to diagnose mental disorders according to ICD-11 diagnostic requirements. 1

• The instrument demonstrates very good agreement (κ=0.81) with consultant psychiatrist diagnoses, with 83.3% sensitivity and 78.8% specificity for detecting any mental disorder. 1

• The FLII-11 can be administered by trained lay interviewers in both epidemiological and clinical studies, making it accessible for settings with limited psychiatric expertise. 1

• Psychometric validation shows adequate performance for psychotic disorders, bipolar disorder, depressive disorders, substance use disorders, anxiety disorders, and obsessive-compulsive disorders. 1

Existing DSM-Based Interviews (Not ICD-11 Specific)

The evidence shows that structured interviews currently available are primarily DSM-based, not ICD-11 specific, though they may be adapted:

• The Structured Clinical Interview for DSM-5 (SCID-5) exists in both clinician and research versions for adults, but is designed for DSM-5, not ICD-11. 2

• The Mini International Neuropsychiatric Interview (MINI version 7.0) has been revised for DSM-5 and is available for adults and children, but again follows DSM rather than ICD-11 criteria. 2

• The Anxiety Disorders Interview Schedule for DSM-5 (ADIS-5) includes adult and child versions but aligns with DSM-5 diagnostic frameworks. 2

Critical Limitations of Structured Interviews

Evidence Against Over-Reliance

Structured diagnostic interviews performed by professionals without solid psychopathological knowledge are not recommendable for clinical practice, showing poor agreement (κ=0.21) with best-estimate consensus diagnoses in first-admission psychosis patients. 3

Key problems identified include:

• Over-reliance on patient self-report without clinical judgment leads to misdiagnosis, particularly when patients are dissimulating or lack insight. 3

• Standardized interviews catch unspecific syndromes rather than making specific differential diagnoses, especially problematic with somatic comorbidity. 4

• The wording and definition of underlying criteria in structured interviews is often vague, producing "garbage in, garbage out" diagnostic outcomes. 4

• In one cardiology study, only 1 of 15 patients with structured interview diagnoses of major depression was confirmed on expert clinical examination. 4

Practical Recommendations for ICD-11 Diagnostic Assessment

When to Use the FLII-11

• Deploy the FLII-11 in epidemiological studies or resource-limited settings where trained lay interviewers must conduct assessments without direct psychiatric supervision. 1

• Use the FLII-11 for screening and case identification in primary care or community settings, recognizing its 83.3% sensitivity means it will miss approximately 17% of cases. 1

• Prioritize the FLII-11 for disorders with demonstrated adequate psychometric properties: psychotic, bipolar, depressive, substance use, anxiety, and obsessive-compulsive disorders. 1

When Clinical Judgment Must Supplement or Replace Structured Interviews

• Require expert clinical examination with solid psychopathological knowledge when making definitive diagnoses in complex cases, particularly first-episode psychosis or when medical comorbidity is present. 3, 4

• Conduct thorough psychiatric history and mental status examination as the core assessment, using structured interviews only as adjuncts to assist with symptom identification and severity measurement. 2

• Gather collateral information from family members and other observers, as patient self-report alone—the basis of most structured interviews—is insufficient when insight is limited. 5, 6

• Create detailed longitudinal life charts documenting symptom course over time, as structured interviews capture only cross-sectional snapshots. 5, 7

ICD-11 Dimensional Assessment Approach

ICD-11 incorporates dimensional symptom severity rating across six domains (positive, negative, depressive, manic, psychomotor, cognitive) on a 4-point scale at each assessment, providing flexibility beyond categorical diagnosis. 7

• This dimensional approach allows tracking of partial remission, symptom evolution, and treatment response without requiring patients to meet full categorical thresholds. 2

• Field studies with 928 clinicians showed 82.5%-83.9% rated ICD-11 as quite or extremely easy to use, accurate, clear, and understandable—significantly higher than ICD-10. 2, 6

• The dimensional framework captures nuances that categorical diagnosis misses, particularly important when presentations are atypical or complicated by medical conditions. 7