Description:
The Diagnostic Interview Schedule for Children (DISC) is a structured psychiatric diagnostic interview for children and adolescents aged 6 to 18, and their parents (Shaffer et al., 2000). The DISC was originally developed to be comparable to the Diagnostic Interview Schedule (DIS) used with adult populations. As its name implies, the most recent revision of the DISC (NIMH DISC-IV) is based on DSM-IV diagnostic criteria. However, an earlier version of the DISC, the NIMH DISC-2.3, is also in use and can be used to diagnose disorders in accordance with DSMIIIR criteria (Shaffer et al., 1996; Schwab-Stone et al., 1996). The NIMH DISC can be administered by trained lay interviewers who are instructed to administer the queries exactly as written. The majority of DISC questions have been worded so that they can be answered "yes," "no," and "somewhat" or "sometimes."

A computer-assisted version of the DISC, the C-DISC, has been developed to aid in administration (Fisher et al., 1997; Shaffer et al., 2000). In addition to the English language version, Spanish (Ribera et al., 1996), French (Breton et al., 1998), and Xhosa (Robertson et al., 1999) versions of the NIMH DISC have been developed.

On the basis of the DISC-2.3, the self-report DSM Scale for Depression (DSD) was developed; this instrument is reviewed separately in the section on depression inventories (Roberts et al., 1998).

A suicidality scale (a Guttman scale) derived from the items on an earlier version of the DISC assessing suicidal behaviors also was developed (Brent et al., 1986). However, no reports could be located regarding whether a suicidality scale based on more recent versions of the DISC had been developed or evaluated.

Potential Use:
Primarily developed for epidemiologic/screening surveys but also useful for clinical research

Populations Studied:
Versions of the DISC have been used to examine suicidal behaviors in incarcerated adolescents (Kempton and Forehand, 1992), clinically ascertained children and adolescents (Borst et al., 1991; Brent et al., 1986; Campbell et al., 1993; King et al., 1997; Milling et al., 1992), and community and school-based samples of children and adolescents (Shaffer et al., personal communication, 10/99; Gould et al., 1998).

Assessment and Definitions of Suicidal Behaviors:
The NIMH DISC 2.3 has separate inquiries about thoughts of death, suicidal ideation, the presence of a suicide plan, and whether these thoughts were associated with dysphoria. These questions reference the 2 weeks, and the 6 months preceding the interview. The queries of the NIMH DISC-IV are similar, and reference the 2 weeks, 4 weeks, and the year preceding the interview. These queries occur in the context of the depressive disorders section, but are asked of all interviewees.

The NIMH DISC 2.3 also has inquires about lifetime suicide attempts, number of suicide attempts, age at first suicide attempt, suicide attempts within the last 6 months, suicide attempts when dysphoric, and methods of suicide attempts. The inquiries of the NIMH DISC-IV are again similar, but focus on lifetime attempts, as well as attempts in the 4 weeks and in the last year preceding the interview. The question about age of first suicide attempt (in the NIMH DISC 2.3) was not included in the NIMH DISC-IV. However, a question about whether the suicide attempts required medical attention was added.

Neither version of the DISC has an item assessing non-suicidal self-damaging behaviors.

The stem query regarding suicidal ideation in both the Parent and Youth versions of the DISC-IV and the child version of the DISC-2.3 are likely to elicit a conservative estimate of suicidal ideation because of the word "seriously" used in the query. Without being explicitly defined, the word "seriously" can be interpreted in various ways by respondents.

The queries regarding suicide attempts ("tried to kill himself/herself or made a suicide attempt") queries are consistent with recommendations by O'Carroll et al. (1996).

Reliability:
In a sample of child psychiatric outpatients clinically diagnosed as having "common" DSM-IV disorders (and their parents), the NIMH DISC-IV was administered twice at approximately a one week interval (Shaffer et al., personal communication, 10/99). Test-retest agreement for whether children met criteria for DSM-IV Major Depression criterion A (recurrent thoughts of death, suicidal ideation without a specific plan, suicide attempt, or specific plan) was good (k=.79 for parents, k=.67 for youths). Indices of agreement were also computed for the individual questions to youths and parents on the NIMH DISC-IV regarding suicidality. Indices of agreement (k) are summarized by question and informant below:

Canino et al. (personal communication, 11/99) conducted a test-retest study of the Spanish version of the DISC-IV in Puerto Rico. The test-retest interval for the DISC-IV administrations was approximately 12 days. Indices of agreement (k) are summarized by question and informant below.

In a sample of child and parent pairs from a multisite community sample (half of whom were thought to meet diagnostic criteria for DSM-IV disorders), the NIMH DISC 2.3 was administered twice, 1 to 15 days apart (Shaffer et al., personal communication, 10/99). Indices of agreement were computed for the individual questions to children and parents on the NIMH DISC 2.3 regarding suicidality. Indices of agreement (k) are summarized by question and informant below.

Concurrent Validity:
In a sample of juvenile delinquents, suicide attempts assessed with the DISC-2 were related to number of depressive symptoms in Caucasian adolescents, but not African-American adolescents (Kempton and Forehand, 1992).

In a community sample, suicide ideation and attempts assessed with the DISC-2.3 were found to be associated with elevated rates of almost all psychiatric disorders relative to nonsuicidal youths (Gould et al., 1998). Consistent with the other reports (Kandel, 1988; Garrison et al., 1993), suicide attempts but not suicidal ideation were found to be related to substance use disorders (Gould et al., 1998).

Adolescent psychiatric inpatients who reported the DSM-III-R Major Depression symptom of thoughts of wanting to die or suicidality were more likely to score above the cut-off on the Suicide Ideation Questionnaire (SIQ) than other inpatient youths (King et al., 1997). DISCassessed suicidal ideation and lifetime suicide attempts were also associated with Spectrum of Suicidal Behavior (SSB) scores (King et al., 1997).

Predictive Validity:
In one study pertinent to predictive validity (Shaffer et al., personal communication, 10/99), a large number of high school students were screened with several measures including the DISC. A portion of the students, approximately half of whom were thought to be "at risk" because of their responses to another instrument (the Columbia Teen Screen), were followed up approximately 3 to 4 years later. Reports of current suicidal ideation (as assessed with the DISC at the initial screening) had 38% sensitivity and 78% specificity in predicting later DISC-assessed suicidal thoughts. Reports of lifetime suicide attempts yielded 31% sensitivity and 88% specificity in predicting later ideation. Reports of attempts in the last 6 months yielded only 7% sensitivity and 98% specificity in the prediction of later suicidal thoughts.

In this same study (Shaffer et al., personal communication, 10/99), reports of current ideation (on the DISC) at the initial screen had 50% sensitivity and 81% specificity in predicting suicide attempts over the next 3 to 4 years. Reports of lifetime attempts yielded 47% sensitivity and 90% specificity in the prediction of later attempts. Reports of suicide attempts within 6 months of the initial screening yielded only 18% sensitivity and 99% specificity in the prediction of later attempts.

Treatment Studies:
No published treatment studies of suicidality using the DISC were located.

Summary and Evaluation:
The Diagnostic Interview Schedule for Children (DISC) is perhaps the most widely used structured psychiatric diagnostic interview in studies of suicidal behavior and is well-designed for epidemiologic research. Responses to the NIMH DISC-IV stem suicidal ideation items are likely to yield conservative estimates of the prevalence of suicidal thoughts, but have been shown to have predictive validity. The test-retest reliability of the query assessing lifetime suicide attempts in the NIMH DISC-IV is considerably higher than the reliability of the item assessing lifetime attempts in an earlier version of the DISC, the DISC-2.3. For researchers or clinicians using the Spanish version of the DISC-IV, it should be noted that the test-retest reliability of the stem item regarding suicidal ideation was not high for youths. Similarly, the test-retest reliability of the follow-up questions for suicidal ideation (in the Spanish version of the DISC-IV) was not high for parents. In one study in the New York area, responses to the questions regarding suicide attempts within the last six months had poor sensitivity (perhaps because of low base rate of the predictor variable) in predicting later suicidal ideation and attempts; the questions regarding lifetime suicide attempts were more sensitive predictors of later suicide ideation and attempts.

Where to Obtain:
English language version: Division of Child and Adolescent Psychiatry, Columbia University - New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032 Spanish language version: Glorisa Canino, Ph.D., Professor and Director, Behavioral Science Research Institute, Medical Sciences Campus, University of Puerto Rico, PO Box 365067, San Juan, PR 00936-5067