The diagnosis of personality disorders in psychopathology and in the forensic field is a very complex topic. Studies on the topic show that the degree of agreement between raters who diagnose these disorders is relatively low. This meta-analysis, divided into two parts, describes and compares 22 studies related to the inter-rater reliability of diagnostic tools for personality disorders, from the main diagnostic manuals (DSM-IV/5 and ICD-10/11) to semi-structured interviews and unstructured interviews. The results of the first meta-analysis (n=16), despite a high heterogeneity among the included studies (I2 = 96%), report a moderate-good inter-rater reliability index [K=0.65 (95% CI: 0.59, 0.71)], in particular with regard to semi-structured interviews, such as the SCID-II. In the second meta-analysis (n=7), the heterogeneity detected was more moderate (I2 = 67.83%) and the inter-rater reliability index was high [ICC=0.85 (95% CI: 0.82-0.87]. The diagnostic tools of the second meta-analysis were mainly semi-structured interviews. In both studies, the factors that could have contributed to the high heterogeneity and to the results obtained regarding the inter-rater reliability index were investigated. In particular, the following were observed: the characteristics of the diagnostic tools used; the diagnostic manual of reference for the diagnoses; the level of experience of the raters; the risk of bias. Finally, the presence of a moderate publication bias was detected in both meta-analyses. The implications of the present study were discussed with regard to the complexity of the diagnosis in clinical psychopathology and to the imputability in the forensic field.
La diagnosi dei disturbi di personalità in psicopatologia e in ambito forense è un tema molto complesso. Gli studi sul tema mostrano come il grado di accordo tra i valutatori che svolgono la diagnosi di questi disturbi è relativamente basso. La presente metanalisi, suddivisa in due parti, descrive e confronta 22 studi relativi all’affidabilità inter-rater degli strumenti diagnostici per i disturbi di personalità, dai principali manuali diagnostici (DSM-IV/5 e ICD-10/11) alle interviste semi-strutturate, alle interviste non strutturate. I risultati della prima metanalisi (n=16) , nonostante sia stata rilevata un’elevata eterogenità tra gli studi inclusi (I2 = 96%), riportano un indice di affidabilità inter-rater moderato-buono [K=0.65 (IC 95%: 0.59, 0.71)], in particolare per quanto riguarda le interviste semi-strutturate, come la SCID-II. Nella seconda metanalisi (n=7) l’eterogeneità rilevata è stata più moderata (I2 = 67.83%) e l’indice di affidabilità inter-rater è elevato [ICC=0.85 (95 % CI: 0,82-0,87]. Gli strumenti diagnostici della seconda metanalisi erano principalmente interviste semi-strutturate. In entrambi gli studi sono stati indagati i fattori che potrebbero aver controbuito all’elevata eterogenità, e ai risultati ottenuti in merito all’indice di affidabilità inter-rater. In particolare, sono stati osservati: le caratteristiche degli strumenti diagnostici utilizzati; il manuale diagnostico di riferimento per le diagnosi; il livello di esperienza dei valutatori; il rischio di bias. Infine, è stata rilevata la presenza di un bias di pubblicazione moderato in entrambe le metanalisi. Le implicazioni del presente studio sono state discusse in merito alla complessità della diagnosi in psicopatologia clinica e all’imputabilità in ambito forense.
Inter-rater reliability nella diagnosi dei disturbi di personalità: dalla psicopatologia clinica all’imputabilità in ambito forense
GALLI, GIORGIA
2023/2024
Abstract
The diagnosis of personality disorders in psychopathology and in the forensic field is a very complex topic. Studies on the topic show that the degree of agreement between raters who diagnose these disorders is relatively low. This meta-analysis, divided into two parts, describes and compares 22 studies related to the inter-rater reliability of diagnostic tools for personality disorders, from the main diagnostic manuals (DSM-IV/5 and ICD-10/11) to semi-structured interviews and unstructured interviews. The results of the first meta-analysis (n=16), despite a high heterogeneity among the included studies (I2 = 96%), report a moderate-good inter-rater reliability index [K=0.65 (95% CI: 0.59, 0.71)], in particular with regard to semi-structured interviews, such as the SCID-II. In the second meta-analysis (n=7), the heterogeneity detected was more moderate (I2 = 67.83%) and the inter-rater reliability index was high [ICC=0.85 (95% CI: 0.82-0.87]. The diagnostic tools of the second meta-analysis were mainly semi-structured interviews. In both studies, the factors that could have contributed to the high heterogeneity and to the results obtained regarding the inter-rater reliability index were investigated. In particular, the following were observed: the characteristics of the diagnostic tools used; the diagnostic manual of reference for the diagnoses; the level of experience of the raters; the risk of bias. Finally, the presence of a moderate publication bias was detected in both meta-analyses. The implications of the present study were discussed with regard to the complexity of the diagnosis in clinical psychopathology and to the imputability in the forensic field.| File | Dimensione | Formato | |
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https://hdl.handle.net/20.500.14239/26406