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World Psychiatry. 2018 Jun;17(2):174-186. doi: 10.1002/wps.20524.

The ICD-11 developmental field study of reliability of diagnoses of high-burden mental disorders: results among adult patients in mental health settings of 13 countries.

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Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, NY, USA.
National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico City, Mexico.
Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India.
New York State Psychiatric Institute, New York, NY, USA.
Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA.
Department of Psychiatry, University of Ibadan, Nigeria.
Department of Psychiatry, Universidad Autonoma de Madrid, IIS-P and Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain.
Department of Neuropsychiatry, Kyushu University, Fukuoka City, Japan.
Department of Psychiatry, American University of Beirut Medical Center, Beirut, Lebanon.
School of Psychology, University of Ottawa, Ottawa, Ontario, Canada.
Moscow Research Institute of Psychiatry, National Medical Research Centre for Psychiatry and Narcology, Moscow, Russian Federation.
Department of Psychiatry, University of Campania "L. Vanvitelli", Naples, Italy.
Department of Psychiatry, Universidade Federal de São Paulo, São Paulo, Brazil.
Department of Psychiatry, University of Cape Town and South African Medical Research Council Unit on Risk and Resilience in Mental Disorders, Cape Town, South Africa.
Shanghai Mental Health Center and Department of Psychiatry, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China.
NTT Medical Center Tokyo, Tokyo, Japan.
Departments of Biostatistics and Psychiatry, Columbia University College of Physicians and Surgeons, New York, NY, USA.
Department of Psychiatry, Tunis Al Manar University and Al Razi Hospital, Tunis, Tunisia.
Cátedras CONACYT, National Council for Science and Technology, Mexico City, Mexico.
Institut du Savoir Montfort - Hôpital Montfort & Université d'Ottawa, Ottawa, Ontario, Canada.
Department of Psychiatry, Government Medical College and Hospital, Chandigarh, India.
Japanese Society of Psychiatry and Neurology, Tokyo, Japan.
Federal Neuropsychiatric Hospital Aro, Abeokuta, Nigeria.
Institute of Mental Health Research, Royal Ottawa Mental Health Centre, and Department of Psychiatry, University of Ottawa, Ontario, Canada.
Pt. Jawahar Lal Nehru Memorial Medical College, Raipur, Chhattisgarh, India.
Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany.
Institut National de la Santé et de la Recherche Médicale U988, Paris, France.
Health Management Center, Seitoku University, Matsudo City, Japan.
Office of Graduate Studies and Clinical Child Psychology Program, University of Kansas, Lawrence, KS, USA.


Reliable, clinically useful, and globally applicable diagnostic classification of mental disorders is an essential foundation for global mental health. The World Health Organization (WHO) is nearing completion of the 11th revision of the International Classification of Diseases and Related Health Problems (ICD-11). The present study assessed inter-diagnostician reliability of mental disorders accounting for the greatest proportion of global disease burden and the highest levels of service utilization - schizophrenia and other primary psychotic disorders, mood disorders, anxiety and fear-related disorders, and disorders specifically associated with stress - among adult patients presenting for treatment at 28 participating centers in 13 countries. A concurrent joint-rater design was used, focusing specifically on whether two clinicians, relying on the same clinical information, agreed on the diagnosis when separately applying the ICD-11 diagnostic guidelines. A total of 1,806 patients were assessed by 339 clinicians in the local language. Intraclass kappa coefficients for diagnoses weighted by site and study prevalence ranged from 0.45 (dysthymic disorder) to 0.88 (social anxiety disorder) and would be considered moderate to almost perfect for all diagnoses. Overall, the reliability of the ICD-11 diagnostic guidelines was superior to that previously reported for equivalent ICD-10 guidelines. These data provide support for the suitability of the ICD-11 diagnostic guidelines for implementation at a global level. The findings will inform further revision of the ICD-11 diagnostic guidelines prior to their publication and the development of programs to support professional training and implementation of the ICD-11 by WHO member states.


ICD-11; International Classification of Diseases; anxiety disorders; diagnosis; disorders specifically associated with stress; mental disorders; mood disorders; reliability; schizophrenia

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