Inter-Rater Reliability in Psychiatric Diagnosis

Other important sources of inter-rater divergence are external pressures, such as different reimbursement practices by insurance companies, exposure to popular diagnoses through the media or pharmaceutical marketing, and the cognitive biases and heuristics that affect the practice of all medical specialties.8 Clearly, interview styles vary widely and no single approach is the right one. While some validated structured instruments (eg, the Structured Clinical Interview for DSM Disorders-Clinician Version [SCID-CV]) require too much time for administration to be practical in everyday clinical work, others (eg, the Diagnostic Interview Schedule for Children [DISC]) may be successfully administered by lay providers or by computer, allowing the clinician to subsequently focus on one or more identified areas of concern.9,10 Similarly, systematic screening instruments are available for all major categories of psychiatric illness.