The study population included all outpatients and inpatients referred to three psychiatric centers in Tehran, including Iran Psychiatric Hospital, Rasoul Akram Hospital and Clinic of Behavioral Sciences and Mental Health (Tehran Psychiatric Institute).Among them, 250 people according to the inclusion criteria in this study, which include age between 18 to 65 years, written Informed consent and the ability to speak Persian, as well as exclusion criteria, including severe mental retardation or dementia, symptoms severe psychosis. Sampling in this study was done by Convenience sampling. After the required coordination with the mentioned centers, the researchers referred to the centers and prepared a list of all hospitalized and outpatient patients every day. Then, patients who met the criteria for entering the study were invited to enter the study with their written Informed consent. It should be noted that interviews with outpatients were performed on the same day of referral and interviews with hospitalized patients during the first week of hospitalization. Interviewers included PhD students in clinical psychology who had undergone a special training course. Interviews were conducted with the presence of two evaluators without access to patients' records. One of the evaluators conducted the interview, but both filled out the checklist independently. Also, in order to evaluate the reliability of the test-retest among the sample members, 109 patients were evaluated independently in the second round at intervals of 7-10 days.
Also, in the present study, in order to evaluate the psychometrics of the Persian version of SCID-5-PD, the translated version of SCID-5-PD by Amini et al.(18) Was used. The following methods of validity and reliability in the present study will be briefly explained:
1. Face validity: To determine the face validity, 5 clinical specialists, all of whom had at least 2 years of clinical experience, were asked to answer the questions raised in the forms regarding the evaluation of face validity and content. Formal validity was achieved through two methods, qualitative and quantitative.
A) Determining qualitative face validity: In qualitative assessment of face validity, observance of grammar, use of appropriate words, importance of items, placement of items in their proper place, time of completing the designed tool were considered. After collecting the opinions of experts, in consultation with the members of the research team, the required changes were made in the translation of SCID-5-PD.
B) Determining the quantitative face validity: The face validity of the measures was measured quantitatively using the item effect method. For this purpose, the specialists completed a questionnaire that based on each item SCID-5-PD in terms of importance. It is quite important (score 5), it is important (score 4), it is moderately important (score 3), it is slightly important (score 2) and it is not important at all (score 1). After completing the questionnaires face validity was calculated by experts using the formula of item effect method. If the impact score of the item was more than 1.5, the item was considered suitable for the next analysis.
2. Content validity: To determine the content validity, two qualitative and quantitative methods were used:
A) Determining the validity of qualitative content: In the qualitative method, the Persian translation version was provided to the experts to make them desirable in terms of clarity in terms of clarity (use of simple and understandable words), use of common language (avoidance of using Technical and specialized terms) to examine. If necessary, changes were made to the translated text of SCID-5-PD for simplification and greater comprehensibility. Experts also examined the text in terms of difficulty in understanding phrases and words, the appropriate fit and relevance of items, the possibility of ambiguity and incorrect interpretations of phrases or the existence of inadequacies in meanings, and if there are problems, their comments as minor changes in the questionnaire applied.
B) Determining the validity of Quantitative content: Content validity was also quantitatively calculated based on the opinions of experts and by calculating two content validity ratio (CVR) and content validity index (CVI). The content validity ratio index was used to ensure that the most important and correct content (item necessity) was selected, and the content validity index was used to ensure that the tool items were best designed to measure content. To determine the content validity ratio, experts responded to each of the SCID-5-PD items in a range of essential, useful, but not necessary and unnecessary. Then the content validity ratio (CVR) was calculated. Finally, if the calculated value is greater than 0.99 (minimum validity value for a panel of 5 experts), the validity of the content of that item will be accepted.
3. Diagnostic validity: Psychiatrists diagnosis was considered the gold standard. The gold standard of diagnosis was the records in the hospital/clinic files according to the routine standards of this university-affiliated hospitals/clinic. This routine include 1) early interview with the patient by a resident of Psychiatry, 2) gathering the history data of patient including lifetime course of the disorder, and any previous treatment and recorded Psychiatric diagnosis in outpatient and inpatient settings, 3) interview with accessible family members, and 4) recording the final diagnosis by a supervisor Psychiatrist based on an independent interview with the patient and all the gathered data, according to the DSM-5. Then, after a short break, the client was invited to participate in the research and his rights, including the freedom not to continue the research at any stage, etc. were explained and a written consent form was completed. patients who met the research requirements and agreed to take the test were referred to a SCID interviewer. The interviews were conducted in a separate room, privately, without access to patients' records. The SCID interviewer completed the interview without any knowledge of the patient's diagnosis. Considering the psychiatrist's diagnosis as a gold standard, the agreement between SCID diagnoses and psychiatrist's diagnosis through kappa criteria as well as sensitivity, specificity, positive and negative Likelihood ratios(LR+/LR-) were investigated.
4. Reliability of the test-retest: To check the reliability of the test-retest, after the first SCID interview, the interviewer asked the client to come for the next 7-10 days for the next interview. In the second visit, the second interviewer, who had no knowledge of the diagnostic results and previous interviews, conducted the SCID interview in full. Correlation between the first and second scores of the SCID interview was used to determine the test-retest reliability. The test-retest reliability between the first and second rounds of SCID-5-PD was evaluated using the intra-cluster correlation index.
5. Inter-rater reliability: To evaluate the inter-experimental reliability, the kappa value obtained from SCID-5-PD by two interviewers was used.
In the present study, in addition to the demographic questionnaire, the Persian version of SCID-5-PD was used:
- Demographic Characteristics Questionnaire: Personal information questionnaire includes gender, age, level of education, marital status and occupation and number of children, history of psychiatric disorder and substance or alcohol abuse, history of suicide and legal problems, and history of medication and hospitalization.
- Structured diagnostic clinical interview for DSM-5 (R) personality disorders (SCID-5-PD): SCID-5-PD was introduced in 2016 by First et al. To assist therapists and researchers in assessing 10 DSM-5 personality disorders in clusters A, B, and C and identified personality disorders in a different way. SCID-5-PD can be used for dimensional or categorical diagnostics. This structured interview is an updated version of the structured interview based on the DSM-IV for Axis II. The questions assess 10 personality disorders: avoidant, dependent, obsessive-compulsive, paranoid, schizotypal, schizoid, hysterical, narcissistic, and antisocial personality disorders (10).
Finally, in order to describe and analyze the research data, descriptive and inferential indicators and statistical methods such as sensitivity, specificity, positive and negative likelihood and phi coefficient were used.