The stability of diagnosis with an application to bipolar II disorder

John P. Rice, Patricia McDonald-Scott, Jean Endicott, William Coryell, William M. Grove, Martin B. Keller, Debby Altis

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A temporal stability study (where independent diagnostic interviews are conducted at widely separated time points) is discussed and compared to a test/retest reliability study. We introduce a new battery of statistics, based on the sensitivity, specificity, and true base rate of a disorder, that qualifies either reliability or stability over time, and provide a table that relates these underlying parameters to the opening characteristics of the battery. We analyze data on 50 relatives who participated in the family study component of the National Institute of Mental Health's collaborative "Psychobiology Depression Program". The subjects received an interview 5 years after their initial evaluation by raters without knowledge of the initial assessment. The stability of mania, hypomania, major depression, and alcoholism is considered. Although the kappa coefficient for hypomania was small (0.09), all diagnoses of hypomania in the relatives occured in the families of bipolar probands, suggesting that the low value of kappa isdue to a low sensitivity rather than to a low specificity. This is compatible with earlier findings and demonstrates the value of multiple independent assessments when studying this disorder.

Original languageEnglish (US)
Pages (from-to)285-296
Number of pages12
JournalPsychiatry Research
Issue number4
StatePublished - Dec 1986

Bibliographical note

Funding Information:
Acknowledgments. This study was completed with the participation of the collaborative program investigators:G .L. Klerman, M.D. (Chairperson) (Boston); R.M.A. Hirschfeld, M.D. (Project Director and Co-Chairperson), and P. Griffith, Ph.D. (Rockville, MD); M.B. Keller, M.D., and P. Lavori, Ph.D. (Boston); J.A. Fawcett, M.D., and W.A. Scheftner, M.D. (Chicago); N.C. Andreasen, M.D., W. Coryell, M.D., G. Winokur, M.D., and T. Wasek, B.A. (Iowa City); J. Endicott, Ph.D., P. McDonald Scott, M.A., and J.E. Loth, M.S. W. (New York); J. Rice, Ph.D., T. Reich, M.D., and D. Altis, B.S. (St. Louis). Other contributors include: P.J. Clayton, M.D., J. Croughan, M.D., M.M. Katz, Ph.D., E. Robins, M.D., R.W. Shapiro, M.D., and R. Spitzer, M.D. The research reported was supported, in part, by USPHS grants M H-25430, M H-37685, M H-3 1302,a nd AA-03539.


  • Stability
  • bipolar II
  • kappa
  • reliability
  • test/retest


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