Issues with the CIDI

Since the beginning of the study, two versions of the CIDI have been used. For the purposes of this memo, we will refer to these two versions as the “old CIDI” and the “new CIDI”. The old CIDI was used at the beginning of the study (version 1.05 and lower in Blaise) with a total of 567 subjects using the older version. Due to changes implemented by the Harvard group, we decided to update our version of the CIDI to correspond with the Harvard changes. The new version of the CIDI (version 1.06 and higher in Blaise) was implemented in August 2001 and, to date, we have collected data on approximately 683 subjects with this version.

As you know, we are only using a subset of the CIDI modules for our study. The following is a list of the modules that we are using:

Screening Questions

Depression

Dysthymia

Irritable Depression

Mania

Post-Traumatic Stress Disorder

Substance Use

Alcohol Abuse

Alcohol Dependence

Drug Abuse

Drug Dependence

The purpose of this memo is to highlight the differences between the old CIDI and the new CIDI. We review each of the CIDI modules separately and highlight only the questions that pose significant differences. When necessary, we provide a plan to remedy scoring problems.

Depression Module

Problems with question D15:

D15. Think of times lasting several days or longer when (this problem/these problems) with your mood (was/were) most severe and frequent. During those times, did your feelings of (sadness/or/discouragement/or/lack of interest) usually last

Change in responses for the question

Old

/

New

1. all day long / 1. less than 1 hour
2. most of the day / 2. between 1 and 3 hours
3. about half the day / 3. between 3 and 5 hours
4. less than half the day / 4. more than 5 hours
8. don’t know / 8. don’t know
9. refused / 9. refused

The old version did not use question D15 as a way to screen the subject out of the module. However, in the new CIDI, question D15 is used as a screener and if the subject answers a ‘1’ then the subject is skipped to the next module. Currently, the coding in Blaise is allowing both an answer of ‘1’ or ‘2’ to be skipped to the next module.

To date, no subjects have answered a ‘1’ to cause this question to be a problem.

Problems with question D16:

D16. Think of times lasting two weeks or longer when (this problem/these problems) with your mood (was/were) most severe and frequent. During those times, did your feelings of (sadness/or/discouragement/or/lack of interest) usually last

Change in responses for the question

Old

/

New

1. all day long / 1. less than 1 hour
2. most of the day / 2. between 1 and 3 hours
3. about half the day / 3. between 3 and 5 hours
4. less than half the day / 4. more than 5 hours
8. don’t know / 8. don’t know
9. refused / 9. refused

Again, the old CIDI does not use this question as a screener. The next question is asked no matter how the subject responded. The new version, however, does use this question as a screener. If the subject answers a ‘1’ then the subject is skipped to the next module.

As in D15, Blaise is skipping the subject to the next module if the answer is ‘1’ or ‘2’.

Only 6 subjects have answered a ‘1’ but 20 others have answered a ‘2’. Therefore, 26 individuals have been skipped to the next module as a result of the change in responses to question D16.

Problems with question D27:

D27. Interviewer Checkpoint

This question is an ‘interviewer checkpoint’ that either sends the subject to the next module or the next question. Because of a scoring change in the new CIDI, there is a chance that some individuals are being sent to the next module.

In the old cidi, the subject had to answer at least 2 or more ‘yes’ responses to questions D24 – D26ee. If 2 or more of these questions were endorsed, the next question was asked. If not, the subject was skipped to the next module.

For the new cidi, changes were made so that instead of responding to 2 or more individual questions the subject now has to receive scores in certain categories.

  1. The subject receives a score of ‘1’ if at least one of the responses in D24a - D24d is a ‘yes’. If all the answers are ‘no’ then the score stays a ‘0’.
  2. The above score is then incremented by ‘1’ if at least one of the responses in D24e - D24f is a ‘yes’.
  3. Then for each ‘yes’ response in D26a - D26ii, the score is then incremented by one.
  4. If the final count equals 2 or more, the next question is asked. Otherwise, the subject is skipped to the next module.

There is the possibility of some subjects being skipped to the next module. To date, no subjects have answered in a way that would allow them to skip but the possibility is still there.

Problem with question D29:

D29. Did you ever talk to a medical doctor about your episodes of (sadness/or/discouragement/or/lack of interest)?

In the old version, answering question D29 with a ‘yes’ meant subjects skipped questions D29a and D29b. In the new version, question D29 is removed and subjects answer both D29A and D29B. Since there is no longer a filter to D29a and D29b, all subjects are now asked these questions.

D29a. Episodes of this sort sometimes occur as a result of physical causes such as physical illness or injury or the use of medication, drugs, or alcohol. Do you think your episodes ever occurred as a result of such physical problems?

D29b. Do you think you episodes were always the result of physical causes?

Problems with question D40 +:

There are numerous logic changes for questions D40 and on. We will provide a detailed flow chart at the meeting to highlight these differences.

Dysthymia

The first question in the Dysthymia module (DY0) is an interviewer checkpoint. It checks to see how three questions in the depression module were answered.

D39. What was the longest episode you ever had when you were sad and also had some other problem most of the day nearly every day?

D50. What is the longest continuous number of years in a row in which you were in an episode most days?

D61. What is the longest continuous number of years in a row in which you were in an episode most days?

If any of these questions are answered with “at least 2 years”, then the Dysthymia module is skipped. The next question (DY1) is also a screener referring to question SC21 from the screening module.

SC21.Have you ever in your life had a period lasting several days or longer when most of the day you felt sad, empty or depressed?

If SC21 is answered ‘yes’ then the next question is asked. If it is answered ‘no’, then the rest of the Dysthymia module is skipped.

Because of the first two questions, the vast majority of subjects are skipped past the Dysthymia module. However, they are still scored because of their answers to questions in the depression module. The problem occurs with those individuals that skip the questions in the Depression module but are asked the same questions in the Dysthymia module. The SAS program that is used for scoring Dysthymia only looks at the questions from the Depression module. According to comments in the SAS syntax, the program should be looking at both the Depression questions and the Dysthymia questions for scoring but it does not.

We currently have 17 cases that are not being scored because they have the Dysthymia questions answered but not the same questions in the Depression module answered. Therefore, the SAS coding needs to be changed. (Will provide SAS program at meeting)

Irritable Depression

Problem with question IR9:

IR9 is an interviewer checkpoint to review the number of ‘yes’ responses to questions IR8a to IR8m. In the Old Cidi, 4 or more ‘yes’ responses were needed to continue in the module. The New Cidi only requires 2 or more ‘yes’ responses to continue.

The change in the New Cidi is allowing more subjects to continue with the module instead of skipping to the next module.

Problems with IR11:

IR11. During those times, did your irritability usually last . . .

Change in responses

Old

/

New

1. all day long / 1. less than 1 hour
2. most of the day / 2. between 1 and 3 hours
3. about half the day / 3. between 3 and 5 hours
4. less than half the day / 4. more than 5 hours
8. don’t know / 8. don’t know
9. refused / 9. refused

The New Cidi is now using this question as a screener. Also in the New Cidi, questions IR11.1 – IR11.4 were added.

IR11.1 How severe was your irritability during those times?

IR11.2 How often, during that time, were you so irritable or grouchy that nothing could get you into a good mood?

IR11.4 Interviewer Checkpoint

These three questions are used as screeners but, currently, no one has skipped out of the module.

Mania

Problem with question M9:

M9. You had episodes when you were very (excited and full of energy/irritable or grouchy) and also had some problems like . How much did these episodes ever interfere with either your work, your social life, or your personal relationships?

In the old version, subjects were automatically sent to the next question regardless of their response. In the new version, M9 serves as a screener. If the response is a 1 (not at all) or a 2 (a little), the subject is skipped out of the rest of the module.

Of the 588 youth with complete data, 42 (7.1%) have been skipped out of the module.

Problem with question M10:

M10. Did you ever talk to a medical doctor about one of these episodes?

In the old version – If M10 was answered as 1 (yes) then questions M10a and M10b were skipped. Some subjects may have not been scored correctly.

In the new version – If the subject makes it past M9, questions M10a and M10b are automatically asked. This possibly allows more subjects to have this module scored completely.

The primary concern with the changes to the Mania section is that a majority of the symptom level information is missing since there are numerous screener items that allow subjects to skip out of the module.

Substance Abuse and Dependency

Drug Abuse and Dependency

Old CIDI

  • The old cidi has two separate sets of substance use questions that are used as screeners in order to allow the subject to enter the substance abuse section.
  • The first set of 3 questions deal with tranquilizers, stimulants, and analgesics.
  • The second set of 5 questions deal with marijuana, cocaine, heroin/opiate, inhalants, and hallucinogens.
  • If any of the above items were endorsed, the subject was asked the frequency of use.
  • In order to pass the screening and get into the substance abuse section, the subject must have endorsed at least one item with a frequency over 20.
  • There are no impairment questions used as screeners. The impairment questions are only asked in the substance abuse section.
  • In other words, As long as a subject has used a substance more than 20 days in his/her life, then the impairment questions will be asked.

New CIDI

  • The new cidi has a set of impairment screeners as well as a set of usage screeners.
  • Three impairment questions are asked at the beginning of the cidi before entering any individual part of the cidi.
  • Family and friends worried or complained about use.
  • Usage caused repeated arguments or problems with family or friends, people at work or school, or with police.
  • Usage interfered with your responsibilities at work, school or at home.
  • Four usage questions are asked just prior to the substance abuse questions.
  • Marijuana Usage
  • Cocaine Usage
  • Stimulants/Tranquilizers
  • Other Drugs (LSD, Heroin, etc.)
  • One of the impairment questions as well as one of the usage questions must be endorsed in order to enter the substance abuse section.

From our data, we have 309 subjects who endorsed some sort of drug usage but because of the screener questions were not asked the questions needed for scoring.

Alcohol Abuse and Dependency

Both of these are affected the same way the drug abuse section was. The additional screening questions (those added at the very beginning) of the new cidi are eliminating subjects from answering the questions needed for both alcohol abuse and alcohol dependency.

From our data, we have 128 subjects who endorsed alcohol usage but because of the screener questions were not asked the questions needed for scoring.

Overall, a total of 319 subjects need the module repeated. 10 out of 319 need only the alcohol questions done while the rest need both sections done. As of 07/11/02, 66% can be done at 6 month and 34% at 12 month.

PTSD

The only problem with this module is item PT62.1. This question was added to the new CIDI. Subjects are now being skipped over the needed questions.

  • Question 62.1 asks the subject if any problems occurred after experiencing the traumatic event.
  • If answered yes:
  • Old CIDI – the questions are asked that are needed to score the section.
  • New CIDI – an additional question is asked: ‘Did these reactions (ever) last for 30 days or longer?’ - If this question is answered, ‘yes’ then additional questions needed for scoring PTSD are not asked.
  • The additional question is eliminating subjects from answering the needed questions.

From our data, 108 out of 588 (18.4%) were not asked some of the questions needed for scoring.