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This page is an AI-assisted Turkish summary of the study presented at the 26th World Congress of Psychiatry. The study belongs to the presenting authors; please refer to the original source when citing it.

The Validity of Diagnostic Interviews

Validity of diagnostic interviews

Although structured interviews improve reliability, they do not guarantee validity; valid diagnosis requires recognition of the psychopathological whole (gestalt) and competence in interviewing techniques.

The talk questions the validity of structured diagnostic interviews, which were developed for research and large-scale screening, are increasingly recommended for routine clinical practice, and have become the gold standard for diagnostic assessment. Standardizing the wording and sequence of questions and the scoring of responses improves reliability by reducing information and criterion variance; however, reliability is not validity, and whether an interview measures what it is intended to measure is a separate question that must be answered. Theoretically, psychiatric symptoms are not objects that can be read off from yes-or-no responses to prepared questions, but phenomena of consciousness; transforming first-person experience into valid third-person psychopathological data requires a conversational, phenomenologically oriented second-person process in which patients’ own descriptions are elicited, illustrated with examples, and evaluated in context (Nordgaard, Sass and Parnas, 2013). The speaker presents the view that operationalized psychopathology has sacrificed validity to achieve reliability (Andreasen, 2007). Empirically, agreement between SCID diagnoses and best-estimate consensus diagnoses in first-admission samples is low: kappa 0.18 (Nordgaard et al., 2012) and 0.21 in a replication study (Kvig and Nilssen, 2023), with substantial underdiagnosis of schizophrenia spectrum disorders. Consequently, standardization alone cannot guarantee the quality of clinical information; valid diagnosis requires recognition of the psychopathological whole (gestalt)—the meaningful interconnectedness of experiences, symptoms, and signs. This is less likely in criterion-focused structured interviews because predetermined questions and a rigid question sequence do not allow the interviewer to dwell on psychopathological experiences and suspend interpretation until those experiences are fully understood (Henriksen, Jansson and Nordgaard, 2022). Competence in psychopathology and training in interviewing techniques are therefore presented as essential prerequisites for valid diagnostic assessment.

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