A new study published in JAMA Network Open has cast doubt on the reliability of diagnostic interviews, which are widely considered the gold standard for diagnosing mental health conditions such as depression, anxiety, bipolar disorder, and personality disorders. The research indicates that the reliability of these interviews varies significantly depending on the condition being assessed.
Study Findings on Diagnostic Interview Reliability
Laura Duncan, a psychiatry professor at McMaster University in Ontario, Canada, and one of the study's authors, noted that while diagnostic interviews are often treated as a definitive benchmark, they fall short of providing excellent validity and reliability. Despite mixed evidence on their reliability, these interviews continue to be widely used due to a lack of better alternatives.
The review analyzed studies on test-retest reliability from February 2024 to September 2025, using Cohen's kappa coefficient to measure how often patients received the same diagnosis when given the same interview twice. The average reliability was highest for substance use disorders, particularly opioid use disorder, likely because criteria are based on observable behaviors such as alcohol consumption, which are easier to quantify than emotional states.
Expert Critiques and Perspectives
Dr. Michael First, a psychiatrist and professor at Columbia University who authored the Structured Clinical Interview for DSM-5 (SCID), expressed frustration with the study. He agreed that diagnostic interviews vary in reliability but wanted more detailed information about which specific instruments perform best. Duncan responded that the study was limited by the available research during the review period.
The review included tools like the SCID, the Mini International Neuropsychiatric Interview (Mini), and the Clinically Administered PTSD Scale (CAPS). First also criticized the study for grouping fully structured and semi-structured interviews together. Fully structured interviews, which follow a strict script, yield more consistent results but may miss nuances. Semi-structured interviews allow clinicians to ask follow-up questions, leading to more accurate diagnoses but potentially greater variability between sessions.
Duncan acknowledged that addressing these concerns would require more detailed data, which is currently lacking. She emphasized that the absence of such information highlights the need for greater rigor in psychiatric diagnosis.
Future Directions in Mental Health Diagnosis
Both experts agree that current diagnostic interviews are imperfect. First noted that psychiatrists have long hoped for objective laboratory tests for mental conditions, a goal that remains unfulfilled after 50 years. Duncan suggested a future shift away from strict diagnostic categories toward a spectrum-based approach, where symptoms are considered on a continuum rather than simply present or absent.
