Response to Spitzer et al. letter

摘要

Homage must be paid to the DSM-III field trials (1) that strongly influenced the design of the DSM-5 field trials. It could hardly be otherwise, since methods for evaluating categorical diagnoses were developed for DSM-III by Dr. Spitzer and his colleagues, Drs. Fleiss and Cohen. However, in the 30 years after 1979, the methodology and the understanding of kappa have advanced (2), and DSM-5 reflects that as well.Like DSM-III, DSM-5 field trials sampled typical clinic patients. However, in the DSM-III field trials, participating clinicians were allowed to select the patients to evaluate and were trusted to report all results. In the DSM-5 field trials, symptomatic patients at each site were referred to a research associate for consent, assigned to an appropriate stratum, and randomly assigned to two participating clinicians for evaluation, with electronic data entry. In DSM-III field trials, the necessary independence of the two clinicians evaluating each patient was taken on trust. Stronger blinding protections were implemented in the DSM-5 field trials. Selection bias and lack of blindness tend to inflate kappas.