Implementing the semi-structured interview Kiddie-SADS-PL into an in-patient adolescent clinical setting: impact on frequency of diagnoses

BACKGROUND Research is needed to establish the utility of diagnostic interviews in clinical settings. Studies comparing clinical diagnoses with diagnoses generated with structured instruments show generally low or moderate agreement and clinical diagnostic assignment (e.g. admission or chart diagnoses) are often considered to underdiagnose disorders. The objective of this study was to evaluate the impact of implementing the Schedule for Affective Disorders and Schizophrenia for School-Age Children - Present and Lifetime Version (Kiddie-SADS-PL) into an in-patient adolescent clinical setting. METHODS Participants were all adolescents admitted through the years 2001-2004 (N = 333 admissions, age 12-17 years). The authors reviewed the charts of the previous three years of consecutive admissions, patients being evaluated using routine psychiatric evaluation, before the Kiddie-SADS-PL was introduced. They then reviewed the charts of all consecutive admissions during the next twelve months, patients being evaluated by adding the instrument to routine practice. RESULTS The rates of several main diagnostic categories (depressive, anxiety, bipolar and disruptive disorders) increased considerably, suggesting that those disorders were likely underreported when using non-structured routine assessment procedures. The rate of co-morbidity increased markedly as the number of diagnoses assigned to each patient increased. CONCLUSION The major differences in diagnostic assignment rates provide arguments for the utility of diagnostic interviews in inpatient clinical settings but need further research, especially on factors that affect clinical diagnostic assignment in "real world" settings.