Diagnostic validity Polish language version of the questionnaire MINI-KID (Mini International Neuropsychiatry Interview for Children and Adolescent)

    Diagnostic validity Polish language version of the questionnaire MINI-KID (Mini International Neuropsychiatry Interview for Children and Adolescent) Adamowska Sylwia, Adamowski Tomasz, Frydecka Dorota, Kiejna Andrzej PII: DOI: Reference:

S0010-440X(14)00144-8 doi: 10.1016/j.comppsych.2014.05.019 YCOMP 51324

To appear in:

Comprehensive Psychiatry

Received date: Revised date: Accepted date:

14 November 2013 19 May 2014 31 May 2014

Please cite this article as: Sylwia Adamowska, Tomasz Adamowski, Dorota Frydecka, Andrzej Kiejna, Diagnostic validity Polish language version of the questionnaire MINI-KID (Mini International Neuropsychiatry Interview for Children and Adolescent), Comprehensive Psychiatry (2014), doi: 10.1016/j.comppsych.2014.05.019

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ACCEPTED MANUSCRIPT Diagnostic validity Polish language version of the questionnaire MINI-KID (Mini International Neuropsychiatry Interview for Children and Adolescent)

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Adamowska Sylwia Ph.D., Adamowski Tomasz Ph.D., Frydecka Dorota Ph.D., Kiejna Andrzej

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Prof.,Ph.D.

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Department of Psychiatry, Medical University of Wroclaw, Poland.

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The authors declare no conflicts of interest.

Publication of this article was supported by the Ministry of Science and Higher Education in Poland (grant number N N407 318136).

Address correspondence to: Sylwia Adamowska Ph.D., Department of Psychiatry,

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Wroclaw Medical University, L. Pasteur Str.10, 50-367 Wroclaw, Poland.

Fax: 0048717841602

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Tel.: 0048717841600

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E-mail address:[email protected]

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ACCEPTED MANUSCRIPT Abstract

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Objective: Since over forty years structuralized interviews for clinical and epidemiological

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research in child and adolescent psychiatry are being developed that should increase validity and reliability of diagnoses according to classification systems (DSM and ICD). The aim of the

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study is to assess the validity of the Polish version of MINI-KID (Mini International

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Neuropsychiatric Interview for Children and Adolescents) in comparison to clinical diagnosis made by a specialist in the field of child and adolescent psychiatry. Materials and methods: There were 140 patients included in the study (93 boys, 66,4%, mean age 11,8±3,0 and 47 girls 33,5%, mean age 14,0±2,9). All the patients were diagnosed

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by the specialist in the field of child and adolescent psychiatry according to ICD-10 criteria

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and by the independent interviewer with the Polish version of MINI-KID (version 2.0, 2001). Results: There was higher agreement between clinical diagnoses and diagnoses based on

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MINI-KID interview with respect to eating disorders and externalizing disorders ( 0,43-0,56)

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and lower in internalizing disorders ( 0,13 – 0,45). In the clinical interview, there was smaller number of diagnostic categories (maximum 3 diagnoses per one patient) in comparison to MINI-KID (maximum 10 diagnoses per one patient), and the smaller percentage of patients with one diagnosis (65,7%) in comparison to MINI-KID interview (72%). Conclusion: Our study has shown satisfactory validity parameters of MINI-KID questionnaire, promoting its use for clinical and epidemiological settings. Key words: MINI-KID, diagnostic validity, child and adolescent psychiatry

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ACCEPTED MANUSCRIPT Implications and Contribution: The Mini International Neuropsychiatry Interview for Children and Adolescent (MINI-KID) is the first structuralized diagnostic interview for

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assessing mental status in children and adolescents, which has been translated into Polish

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language. Our validation study demonstrated satisfactory psychometric properties of the

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questionnaire, enabling its use in clinical practice and in research projects.

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ACCEPTED MANUSCRIPT Introduction Together with the development of the international classification systems in

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psychiatry and introduction of the operationalized diagnostic criteria, intensive work has

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been started to standardize diagnostic interviews. So far, structuralized diagnostic interviews are not mandatory in everyday clinical practice; however, they are required for the well-

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designed research projects searching for epidemiological indices, pharamcotherapeutic drug

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effects or genetic background of psychiatric disorders [1]. Such approach requires access to the diagnostic questionnaires in the native language together with validation study [2]. Using structuralized diagnostic interviews allows to standardize the interviewing process and to reduce variability in diagnosis, as well as to assess psychosocial and cultural factors

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influencing psychiatric disorders.

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There are various diagnostic instruments dedicated specifically for children and adolescents; however, the majority of them are either detailed, academic interviews or short

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screening tests for primary care use. The gap between those two groups is bridged by Mini-

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International Neuropsychiatric Interview for Children and Adolescents (MINI-KID), which is a brief but valid and reliable diagnostic instrument that can be used in clinical settings in psychiatry [3]. MINI-KID is a structured clinical diagnostic interview designed to assess the presence of psychiatric disorders according to ICD-10 and DSM-IV criteria in children and adolescents aged 6 to 17 years without mental retardation. The MINI-KID was created based on the adult version of the interview (MINI) (Lecrubier et al., 1997, Sheehan et al., 1998) to allow for the brief interview easily conducted by a trained surveyor. For the English version of MINI, good inter-rater and test-retest reliability has been reported, together with moderate validity of MINI versus CIDI [4] and SCID [3] as well as MINI-KID versus K-SADS-PL [5]. MINI has been translated into over 40 different languages 4

ACCEPTED MANUSCRIPT and validity and reliability has been reported for the French [4], Japanese [6], Italian [7] , Moroccan [8], Brazilian Portuguese [9] and Norwegian [10] versions. The initial study using

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Polish version of MINI-KID [11,12] was conducted on a small number of patients, we decided

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to investigate the validity on a wider population of psychiatric patients. Material and Methods

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The study was conducted in the Neuropsychiatric Center (day hospital and outpatient

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clinic) in Wrocław, Poland. The study was approved by the Institutional Ethics Committee and all the participants were given the description of the objective and the method of the study. All the participants and their statutory caregivers provided the written informed consent for the participation in the study. The exclusion criteria for the study was the age

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below 6 years old and above 18 years old, diagnosis of organic psychiatric disorder

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confirmed with neuroimaging examination and diagnosis of mental retardation based on psychological examination. There were 140 patients included in the study (93 boys, 66,4%,

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mean age 11,8±3,0 and 47 girls 33,5%, mean age 14,0±2,9). The mean age of the sample was

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12.5±3.2, and the age range was 6-17 years. In our sample, 46% (n=64) were children aged 612 years, and 54% (n=76) were adolescents aged 13 to 17 years. All participants were of Caucasian origin and Polish nationality. The patients below the 13 years old were interviewed in their parents presence. Discrepancies between parent and child reports were resolved by asking for further input from th e child and the parent using clinical judgment to break ties. In cases when during the MINI-KID interview the patient confirmed having suicidal ideation or suicidal tendencies, such patients were referred to their treating clinician. All the patients included in the study presented active psychiatric symptoms at the time of the interviews.

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ACCEPTED MANUSCRIPT Clinical diagnoses were made according to ICD-10 criteria by the trained specialist in the field of child and adolescent psychiatry. On the same day during their visit at the

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outpatient clinic, patients were additionally interviewed with the Polish version of MINI-KID

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(2.0, 2001) by the independent clinician blinded to the clinical diagnoses. The Polish version of MINI-KID has been translated from the original English version into Polish language by two

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experienced trained clinicians with the proficiency in the English language. This Polish

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version has been shown to have satisfactory validity [11] and reliability [12] parameters based on the study conducted and published in 2006 on Polish child and adolescents psychiatric patients. This study was based on 34 children, 11-17 years old, from the outpatient and day clinic of psychiatric care with the clinical diagnosis as a reference. In the

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validity assessment, the Cohen’s kappa agreement values were 0.38-0.71 (for anxiety and

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adaptive disorders 0.65, for hyperkinetic disorder 0.71, for conduct disorders 0.38). The testretest reliability was assessed as 0.68 -1.0 (for anxiety disorder 0.72, for adaptive disorders

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disorders 0.8).

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1.0, for oppositional defiant disorder 0.68, for hyperkinetic disorder 0.71 and for conduct

MINI-KID instrument is organized in diagnostic modules with screening questions for each disorder. In case screen questions are positively endorsed, additional symptom questions within each disorder are asked. Diagnostic criteria are summarized and documented within each disorder section and on a summary shit. Each module refers to the separate diagnostic entity and can be used independently. The instrument screens for 24 psychiatric disorders that occur in developmental age excluding organic mental disorders and specific learning difficulties. Additionally, MINI-KID screens for suicide risk defined as any suicidal ideation, intent, plan or attempt or self-injuring act. Both current and lifetime

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ACCEPTED MANUSCRIPT suicide risk can be assessed in a dichotomous suicide risk rating as well as in low, moderate and high risk ratings [3,5].

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Statistical analysis

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For the statistical purposes clinical ICD-10 diagnoses were coded as follows: mixed disorders of conduct and emotions (F92.x) were coded separately as disorders of conduct (F91.x) and

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disorders of emotions (depressive F32, manic F30, anxiety F40-F42), bipolar disorder with

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current depressive episode were coded as manic episode (F30) and depressive episode (F32), recurrent depressive disorder was coded as depressive episode (F32). The agreement between clinical and MINI-KID diagnoses was assessed using the Cohen’s kappa and Yule’s coefficients. Additionally sensitivity, specificity, positive and negative predictive values (PPV

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and NPV) were calculated. Cohen’s coefficient was used as a validity measure for the

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disorders that had prevalence higher than 5% and Yule’s coefficient higher than 1%. Additionally, analysis of suicide risk has been performed using Spearman’s rank correlations

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with psychiatric diagnosis as well as with the number of comorbid psychiatric diagnoses.

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Results

The mean length of the interview was 20 minutes (min. 8, max. 40 minutes, 20,14±6.35).

Number of diagnoses According to clinical interview, 65,7% (n=92) of the patients met criteria of one current diagnosis, 31,4% (n=44) met criteria for two current diagnoses and only 2,85% (n=4) for three current diagnoses. The mean number of diagnoses was 1,3 per person. On the other hand, based on the MINI-KID interview 17,8% (n=25) of the patients met criteria of one current diagnosis, 22% (n=31) met criteria for two, 19% (n=27) for three, 14% (n=20) for

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ACCEPTED MANUSCRIPT four, 9% (n=13) for five, 5,7% (n=8) for six and 1,4% (n=2) for more than six current diagnoses. The mean number of diagnoses was 3,0 per patient.

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Agreement between clinical diagnoses and diagnoses based on MINI-KID interview

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The agreement between clinical diagnoses and diagnoses based on MINI-KID interview at the level of syndromal diagnoses are shown in the Table 2, and at the level of

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individual disorders are shown in the Table 3.

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At the syndromal level (Table 2), Cohen’s kappa scores were slight for mood disorders (0,1), fair for anxiety disorder, conduct disorders and psychotic disorders (0,24; 0,39, 0,36 respectively), moderate for hyperkinetic disorders (0,39) and substantial for eating disorders (0,75). According to Yule’s coefficient, there was no agreement in the tic disorder,

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moderate agreement for substance use disorders and excellent for pervasive developmental

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disorders.

At the level of individual disorders (Table 3), Cohen’s kappa agreement values were

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substantial (0,61-0,80) for pervasive developmental disorders (0,75), moderate (0,43–0,56)

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for mixed hyperkinetic disorder and with hyperactivity (0,43), depressive disorders (0,45), conduct disorders (0,49) and anorexia nervosa (0,56); fair (0,21–0,40) for psychotic disorders (0,4) and slight (0,01–0,20) for hyperkinetic disorder with attention deficit (0,06), adjustment disorders (0,13) as well as for obsessive-compulsive disorder (0,2). There was almost complete agreement (1,0) for alcohol abuse and dependence, dysthymia, manic episode, bulimia nervosa, oppositional defiant disorder and substantial agreement for panic disorder. There was no agreement (-1-0) for social phobia, separation anxiety disorder and tic disorder. The higher level of agreement was observed in eating disorders, conduct disorders and hyperkinetic disorders (0,73, 0,57, 0,65) in comparison to mood and anxiety disorders 8

ACCEPTED MANUSCRIPT (0,56, 0,59). The higher concordance rates was obtained in eating disorders and externalizing disorders (0,43-0,56), while the lower concordance rates were noted in internalizing

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disorders (0,13 – 0,45).

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Sensitivity was high (>0,80) for alcohol abuse and dependence, mania, dysthymia, bulimia nervosa, oppositional defiant disorder, depressive episode and obsessive-compulsive

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disorder. Sensitivity was substantial (0,61 - 0,8) for panic disorder, mixed hyperkinetic

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disorder and conduct disorder. It was acceptable (0,43-0,6) for anorexia nervosa and low (00,38) for psychotic disorders, adjustment disorders, hyperkinetic disorder with attention deficit, social phobia, tic disorder and separation anxiety disorder. Specificity was high (>0,8) for the majority of diagnoses (23 diagnoses) and only in case of manic episode (0,64) and

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oppositional defiant disorder (0,56) were lower suggesting higher number of false negative

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results on the MINI-KID in comparison to clinical interview. Positive predictive values (PPV) were almost ideal (1,0) for adjustment disorders and

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bulimia nervosa; moderate to substantial (0,41-0,67) for alcohol abuse (0,50), psychotic

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disorders (0,50), anorexia nervosa (0,67), mixed hyperkinetic disorder (0,58), conduct disorder (0,66) and depressive episode(0,41). PPV was moderate (0,21-0,41) for alcohol dependence (0,33), dysthymia (0,33) and panic disorder (0,21). PPV was low (0,03-0,18) for manic episode (0,04), obsessive-compulsive disorder (0,18), hyperkinetic disorder with attention deficit (0,13) and oppositional defiance disorder (0,03). Low PPV values indicate high percentage of patients with false positive diagnosis, meaning that using MINI-KID instrument patients were diagnosed more often and had higher number of diagnoses in comparison to classical clinical examination. Negative predictive values (NPV) for all diagnoses were very high (>0,84), indicating that using MINI-KID small percentage of false negative diagnoses was obtained which is in line with the instrument initial assumption. 9

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Suicidality assessment

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In our study 48% (n=68) patients confirmed suicidal ideation, plan or attempt. The highest

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suicide risk based on clinical interview was observed in affective disorders (27%,n=12), followed by anxiety disorders (22%, n=5), eating disorders (15%, n=2), conduct disorders

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(13.9%, n=6) and hyperkinetic disorders (4.8%, n=6). Based on MINI-KID interview, the

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highest suicide risk was observed in psychotic disorders (80%, n=4), followed by anxiety disorders (22%,n=10), substance misuse disorders (20%,n=2), depressive disorders (15%, n=10), conduct disorders (12%, n=8) and hyperkinetic disorders (9%, n=4). The suicide risk was correlated with the psychiatric diagnosis (rho=0.17, p=0.0041) as well as with the

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number of comorbid psychiatric diagnoses (rho=0.35, p=0.00018). The highest number of

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suicide risk was among patients 15 years old. Discussion

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The MINI-KID is an instrument created to assess the presence of current and some

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lifetime ICD-10 and DSM-IV psychiatric disorders among children and adolescents. In our study we have shown that overall, Polish version of MINI-KID succeeds in validity eliciting symptom criteria used in making ICD-10 diagnoses. There are numerous validity and reliability studies on the adult MINI version [4,6,7,8,9,10]; however, to the best of our knowledge there is scarcity of research based on the MINI-KID version. There is one validation study assessing English version of MINI-KID in relation to Schedule for Affective Disorders and Schizophrenia for School Aged Children – Present and Lifetime Version (KSADS-PL) [5]. Additionally, there is one Hungarian adaptation of the MINI-KID instrument [13] and one initial validity and reliability study for the Polish version of MINI-KID [11,12]. Both Hungarian and Polish versions of MNI-KID have produced very good reliability 10

ACCEPTED MANUSCRIPT parameters and good validity parameters in comparison to clinical diagnosis [11,12,13]. There are also studies in other countries using MINI-KID without validation, such as in China

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[14,15], India [16] or Uganda [17].

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In our study, the concordance with clinical diagnoses was slight to substantial at the syndromal level and slight to substantial at the level of the individual disorder diagnoses,

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with the majority at the moderate level. In Sheehan’s study the concordance levels were

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higher, which might be due to the fact that the comparison was made based on diagnoses derived from structuralized interviews only [5]. The results of our study are also in line with the often reported fact that the highest concordance rates are usually observed for externalizing disorders (conduct disorders, hyperkinetic disorders) and eating disorders,

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while the lowest concordance rates are observed for internalizing disorders (mood and

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anxiety disorders) [5,13,14]. Additionally, the big differences in agreement were observed in mood disorders which may be partially explained by the fact, that these disorders tend to be

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over-diagnosed with structured interviews [5].

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In our study, similarly as in the study performed by Sheehan et al. (2010) as well as Balazs and Gadoros (2005) higher number of hipomania and mania diagnoses MINI-KID vs clinical interview: Sheehan: 32% vs 18%, Balazs: 20,7% vs 0%, Adamowska:38,5% vs 1,43%). Balazs and Gadoros (2005) argue that this result may be due to the MINI-KID characteristics, however, it may also be a sign of the overlap between criteria of different diagnostic groups [18]. Geller et al. (2002) have shown that some manic symptoms are often diagnosed among children with hyperactive disorders. These symptoms, such as irritability (98% CHAD vs 72% ADHD), pressure of speech (97% vs. 82%), inattention (94% vs. 96%), hyperactivity (100% vs. 95%) often complicate differential diagnosis [19]. In our study, we have shown also higher

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ACCEPTED MANUSCRIPT rate of oppositional defiant disorders as well as their common co-occurrence with other disorders.

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In our study, the sensitivity level was low to high, while specificity was high for the vast

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majority of diagnoses suggesting that MINI-KID is a proper tool for confirmatory diagnoses. Overall, sensitivity was higher for disorders with external manifestations (mania, substance

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abuse, conduct disorders, depression, hyperkinetic disorders, conduct disorders) in

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comparison to disorders that might not have apparent external expression (supranational anxiety disorder, social phobia, adjustment disorder).

Additionally, we have shown that in comparison to diagnoses based on the clinical interview, MINI-KID is more inclusive and identifies more cases of disorders. This has also

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been reported by the Hungarian study (co-occurrence of disorders diagnosed by MINI-KID

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74,5%, maximum number of co-occurring disorders 9, while co-occurrence of disorders diagnosed during clinical interview was 25,4% with the maximum 2 disorders co-

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occurring)[18]. Also in comparison other structured interviews (K-SADS-PL), the number of

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diagnoses based on MINI-KID is higher (co-occurrence of disorders diagnosed by MINI-KID was 78%, while diagnosed by K-SADS 56%, the maximum number of co-occurring disorders diagnosed by MINI-KID was 14, while by K-SADS was 9) [5]. Although the MINI-KID had a high rate of false-positive diagnoses, it is arguable that this is the cost of having brief yet less accurate and precise structured diagnostic interview. On the other hand, it has been shown in the study performed by Lauth et al. (2008) that structuralized interviews in the everyday clinical practice, significantly increases the number of psychiatric diagnoses, including depressive, anxiety and bipolar disorders, as well as increases the number of comorbid disorders[20]. It remains as an open question whether

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ACCEPTED MANUSCRIPT the higher number of internalizing disorders diagnosed with MINI-KID is an indicator of the false positive cases or else some of them are underrated in clinical interviews.

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The comparison of our results with other validation studies is problematic, since

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there is a limited number of such studies using instruments only in child and adolescent version (MINI-KID). On the other hand, our MINI-KID validity parameters are comparable

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with other diagnostic instruments used in child and adolescent psychiatry, such as DISC

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(Diagnostic Interview Schedule for Children) [21,22,23,24,25], DICA-R Child Adolescent (Diagnostic Interview for Children and Adolescent) [26] or CHIPS Youth version (Children’s Interview for Psychiatric Syndromes) [27] showing agreement with clinical diagnoses ranging from -0.18 to 1,0.

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Metaanalysis performed by Rettew et al. (2009) showed that concordance between

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different structuralized interviews and clinical diagnoses are low to moderate[1], while when comparing concordance between to structuralized interviews the validity parameters are

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usually higher. In Otsumbo et al. (2005) study using Japanese MINI for adults, when

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comparing MINI results with SCID-P results, the concordance for the majority of diagnoses was from good to excellent, while the concordance with clinical diagnoses was poor. It has been argued that such discrepancies are due to the fact that clinicians often make an intuitive diagnosis without checking precisely diagnostic criteria and they usually tend to neglect comorbid diagnoses. Validity of clinical diagnoses is dependent on the knowledge and experience of the medical doctor [6]. Moreover, Sheehana et al. (2010) study has showed that the concordance rate on the syndromal level between MINI-KID and K-SADS-PL for internalizing disorders (any mood disorder, any anxiety disorder) was moderate (0,56-0,59) while for the externalizing disorders (any hyperactivity disorder, any behavioral disorder) was from moderate to 13

ACCEPTED MANUSCRIPT substantial (0,57- 0,65), for any eating disorder was substantial (0,73), and for any psychotic disorder was moderate (0,41). On the level of individual diagnoses the concordance was the

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lowest in psychotic disorders (0,1-0,44), followed by affective disorders (0,16–0,5),anxiety

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disorders (0,18-0,77), higher for externalizing disorders (0,34-0,64) and highest for eating disorders. Similar pattern of results were obtained in our study [5].

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Results from our study on the suicide risk are in agreement with previous research,

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showing that psychiatric disorders such as depressive disorders, anxiety disorders, psychotic disorders, conduct disorders and psychotic disorders increase suicide risk among children and adolescents [5,28,29] as well as among adults [30]. Moreover, comorbid psychiatric disorders additionally increase the suicide risk [5,31]. Suicide assessment is very important in

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clinical practice with children and adolescents and plays crucial role in therapy planning and

and scaling suicide risk.

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prognosis. The use of structuralized interview, such as MINI-KID, may help further assessing

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In conclusion, Polish version of MINI-KID demonstrated good psychometric properties

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for screening and can be considered for use in various clinical settings. The validity parameters are comparable with other diagnostic instruments used in child and adolescent psychiatry. The instrument has high practical value as it is easy to use, the interview time is short and it does not require time consuming training for surveyors and it is available in electronic version together with paper version. Limitations of the study: 1. There was high variabilty in the numer of patients in different diagnostic modules and in the age of participants. 2. We did not include MINI-KID version for parents.

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ACCEPTED MANUSCRIPT 3. We did not use additional scales that would allow to assess the functional impairment of the patients. It has been shown in previous studies that such an approach increases the

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validity of diagnoses due to the reduction of the comorbid disorders.

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clinicians and the Diagnostic Interview for Children and Adolescents--DICA-R--in an outpatient sample. J Child Psychol Psychiatry 1997;38: 431-440. Teare M, Fristad MA, Weller EB, et al. Study II: concurrent validity of the DSM-

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Khasakhala LI, Ndetei DM, Mathai M . Suicidal behaviour among youths

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psychiatric clinic in Kenya. Annals of general psychiatry 2013,12:13.

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ACCEPTED MANUSCRIPT Table 1. MINI-KID diagnostic modules

T

Diagnosis Depressive episode

2.

Suicidality

3.

Dysthymia

4.

Hipomanic/ manic episode

5.

Panic attacks

6.

Agoraphobia

7.

Separation anxiety disorder

8.

Social phobia

9.

Specific phobias

10.

Obsessive-compulsive disorder

11.

Posttraumatic stress disorder

12.

Alcohol abuse

13.

Alcohol dependence

14.

Non-alcohol substance abuse

15.

Non-alcohol substance dependence

16.

Tic disorders (Tourette’s syndrome, vocal tics, motor tics, transient tics)

SC MA NU

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Hyperkinetic disorder (disturbance of activity and attention, attention deficit disorder

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17.

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1.

without hiperactivity)

18.

Conduct disorder

19.

Oppositional defiant disorder

20.

Psychotic disorders, mood disorders with psychotic features

21.

Anorexia nervosa

22.

Bulimia nervosa

23.

Generalized anxiety disorder

24.

Adjustment disorder

25.

Pervasive developmental disorder

20

ACCEPTED MANUSCRIPT

PA

sensiti vity

specifi city

0,53

Cohe n’s kapp a

ba se rat e

positiv e predict ive value

negati ve predict ive value

0,12

0,3 4

0,39

0,71

0,24

0,33

0,1 6

0,29

0,91

0,96

0,6

1

0,0 3

0,4

1

20,7

67,1

55

0,58

Any anxiety disorders

10,0

68,5

70, 71

0,59

0,73

Any substance use disorder

2,8

7,1

95, 71

1

Hiperkinet ic disorder

29,2

31,4

Tic disorder

2,1

2,1

Any conduct disorder

30,7

0,1

MA NU

Any mood disorder

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(%)

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Yule’s coeffici ent

RI P

Prevale nce based on MINIKID (%)

SC

Syndromal diagnoses *

Prevale nce based on clinical diagnos is

T

Table 2. Validity assessment ant the level of syndromal diagnoses

0,61

0,82

0,43

0,45

0,2 9

0,58

0,84

95, 71

0

0,98

0

-1

0,0 2

0

0,98

73,5

69, 29

0,79

0,65

0,37

0,45

0,3 1

0,5

0,88

5,7

4,2

92, 86

0,38

0,96

0,36

0,59

0,0 6

0,38

0,96

Any eating disorder

9,2

7,7

95, 71

0,69

0,98

0,75

0,84

0,0 9

0,82

0,97

Pervasive developm ental disorder

2,1

1,4

99, 29

0,67

1

0,75

1

0,0 2

1

0,99

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Any psychotic disorder

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75, 71

* Syndromal diagnoses according to ICD-10 classification system: mood disorders (F30-F39, F43.2) anxiety disorders (all F4, F93 excluding F43.2), substance use disorders (F10-F19), hyperkinetic disorder (F90, F98), tic disorder (F95), conduct disorder ( F91.x,F91.3), psychotic disorders (F 20.0F29, F32.3/F33.3, F30.2,F31.2/F31.5), eating disorders (F50.0-F50.2), pervasive developmental disorder (F84). 21

ACCEPTED MANUSCRIPT

Prevalence based on MINI-KID PA (%)

sensitivity specificity

positive negative Cohen’s Yule’s base predictive predictiv kappa coefficient rate value e value

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Individual diagnoses*

Prevalence based on clinical diagnosis

T

Table 3 . Validity assessment at the level of individual diagnoses

0,75

1

0,01

0,5

1

0,97

0,5

1

0,01

0,33

1

0,99

0

0

0

1

0,99

0

-

0

0

1

94,29 0,38

0,98

0,4

0,67

0,06

0,5

0,96

38,5

64,29 1

0,64

0,05

1

0,01

0,04

1

10,0

23,5

84,29 0,81

0,85

0,45

0,66

0,11

0,41

0,97

Mood disorder with psychotic features

0,0

0,7

98,57 -

0,99

0

-

0

0

1

Dysthymia

1,4

4,2

97,14 1

0,97

0,5

1

0,01

0,33

1

Agoraphobi a

0,0

12,1

93,57 -

0,94

0

-

0

0

1

Panic disorder

1,4

15,0

87,86 0,67

0,89

0,29

0,6

0,04

0,21

0,98

2,8

98,57 1

Alcohol dependenc e

1,4

4,2

97,14 1

Nonalcoholic substance abuse

0,0

1,4

98,57 -

Nonalcoholic substance dependenc e

0,0

0,7

Psychotic disorder

5,7

4,2

Manic episode

1,4

Depressive episode

0,99

MA NU

1,4

-

ED

Alcohol abuse

PT

SC

(%)

AC

CE

98,57 -

22

ACCEPTED MANUSCRIPT 89,29 0

Specific phobias

0,0

1,4

98,57

Generalized anxiety disorder

0,0

2,1

Obsessivecompulsive disorder

5,7

Posttrauma tic stress disorder

-0,1

-1

0,01

0

0,98

0,99

0

-

0

0

1

97,86 -

0,98

0

-

0

0

1

27,8

76,43 0,88

0,76

0,2

0,65

0,06

0,18

0,99

0,0

0,7

99,29 -

0,99

0

-

0

0

1

Adjustment disorder

7,8

0,7

92,86 0,09

1

0,13

1

0,08

1

0,93

Anorexia nervosa

5,7

4,2

96,43 0,57

0,98

0,56

0,81

0,05

0,67

0,98

Bulimia nervosa

3,5

3,5

100

1

1

1

1

0,04

1

1

Pervasive developme ntal disorder

2,1

1,4

1

0,75

1

0,02

1

0,99

Separation anxiety disorder

1,4

1,4

97,14 0

0,99

0

-1

0,01

0

0,99

Transient tic disorder

0,7

0,7

98,57 0

0,99

0

-1

0,01

0

0,99

Motor and vocal tic disorder

2,1

0,7

97,86 0

0,99

0

-1

0,01

0

0,99

Tourette’s syndrome

0,0

0,0

99,29 -

0,99

0

-

0

0

1

Hiperkinetic disorder, disturbance of activity and attention

29,2

30,7

75,71 0,61

0,82

0,43

0,45

0,29

0,58

0,84

ED

CE

99,29 0,67

AC

MA NU

-

23

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0,91

T

19,2

SC

1,4

PT

Social phobia

ACCEPTED MANUSCRIPT

8,4

10,5

82,86 0,15

0,9

0,06

Conduct disorder

29,2

27,8

79,29 0,61

0,87

0,49

45,7

56,43 1

0,56

0,02

0,12

0,09

0,13

0,91

0,53

0,29

0,66

0,84

1

0,01

0,03

1

*

SC

Oppositiona l defiant 1,4 disorder

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T

Attention deficit disorder without hiperactivit y

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Individual diagnoses according to ICD-10 classification system: alcohol abuse (F10.1), alcohol dependence (F10.2), non-alcoholic substance abuse (F11.1-F19.1), non-alcoholic substance dependence (F11.2–F19.2), psychotic disorder (F 20.0-F29), hypomanic/manic episode (F30.0-F31.2), depressive episode (F32.0-F33.9, F31.3-F31.5, F20.4), mood disorders with psychotic features (F32.3/F33.3, F30.2,F31.2/F31.5), dysthymia (F34.1), agoraphobia (F40.0), panic disorder (F40.01F41.0), social phobia (F40.1), specific phobias (F40.2), generalized anxiety disorder (F41.1), obsessive-compulsive disorder (F42.0-F42.8), posttraumatic stress disorder (F43.1), adjustment disorder (F43.2), anorexia nervosa (F50.0), bulimia nervosa (F50.2), pervasive developmental disorder (F84.0/2/3/5/9), supranational anxiety disorder (F93.0), transient tic disorder (F95.0), motor and vocal tic disorder (F95.1), Tourette’s syndrome (F95.2), hyperkinetic disorders disturbance of activity and attention (F90.0), attention deficit disorder without hyperactivity (F98.8), conduct disorder(F91.0-F91.9 excluding F91.3), oppositional defiant disorder (F91.3)

24