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Table 3.3.3 Are clinical evaluation and best estimate (LEAD) equal
for diagnosing affective disorders
Author
Year
Reference
Country
Study design
Setting
Population
Inclusion & exclusion criteria
Prevalence
Index test
Reference test
Number of patients
Drop-out rate
Rater
Rater training
Interobserver reliability
Sensitivity
Specificity
Study quality
Comments
Miller et al
2001
[3]
USA
Design
Cross sectional and longitudinal
Setting
University-affiliated public
psychiatric hospital
Population
First patient each week
was screened
n=75 inpatients eligible
Inclusion criteria
>18 years, enough English
fluency and cognitive function
to participate in interviews
Exclusion criteria
Too acutely ill
Prevalence
Mania: 10.7% (6/56)
Depression: 21.4% (12/56)
Schizoaffective: 37.5% (21/56)
Index test
TDA (traditional
diagnostic assessment).
At discharge comprising
unstructured interview
and medical records
Reference test
LEAD
Consensus by raters using
discharge diagnoses, SCID-I,
structured interview, all data
1–10 days after discharge
Number of patients
n=56 (45% females)
Mean age: 36.9 years
(SD 12.4, range 19–59)
Drop-out rate
0
Rater of index test
6 experienced clinicians
(5 psychiatrists, 1 PhD
psychologist)
Rater training
NA
Rater of reference test
Three to four of the index
test raters
Training of reference test
Extensive training
Interobserver reliability
NA for LEAD
Bipolar disorder
Sensitivity: 50%
Specificity: 94%
Depression
Sensitivity: 83%
Specificity: 86%
Schizoaffective disorder
Sensitivity: 33%
Specificity: 89%
High
Comments
Sampling method
Adequate
Blinding
Satisfactory
Handling of missing data
NA
Other comments
Withdrawals explained
The table continues on the next page
104 diagnostik och uppföljning av förstämningssyndrom
KAPITEL 3 • Systematisk litteraturgenomgång
105