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

Geoffrey M. Reed, Pratap Sharan, Tahilia J. Rebello, Jared W. Keeley, María Elena Medina-Mora, Oye Gureje, José Luis Ayuso-Mateos, Shigenobu Kanba, Brigitte Khoury, Cary S. Kogan, Valery N. Krasnov, Mario Maj, Jair de Jesus Mari, Dan J. Stein, Min Zhao, Tsuyoshi Akiyama, Howard F. Andrews, Elson Asevedo, Majda Cheour, Tecelli Domínguez-MartínezJoseph El-Khoury, Andrea Fiorillo, Jean Grenier, Nitin Gupta, Lola Kola, Maya Kulygina, Itziar Leal-Leturia, Mario Luciano, Bulumko Lusu, J. Nicolas, I. Martínez-López, Chihiro Matsumoto, Lucky Umukoro Onofa, Sabrina Paterniti, Shivani Purnima, Rebeca Robles, Manoj K. Sahu, Goodman Sibeko, Na Zhong, Michael B. First, Wolfgang Gaebel, Anne M. Lovell, Toshimasa Maruta, Michael C. Roberts, Kathleen M. Pike

Research output: Contribution to journalArticlepeer-review

88 Citations (Scopus)


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.

Original languageEnglish
Pages (from-to)174-186
Number of pages13
JournalWorld Psychiatry
Issue number2
Publication statusPublished - Jun 2018

All Science Journal Classification (ASJC) codes

  • Phychiatric Mental Health
  • Psychiatry and Mental health


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