Examining the psychometric properties of the flexible interview for ICD-11 (FLII-11) among adults in India

The Flexible Interview for ICD-11 (FLII-11) is a fully-structured interview for diagnosing mental disorders responsible for most of the global disease burden consistent with the ICD-11 diagnostic requirements, developed via a collaborative international process under the auspices of the World Health Organization (WHO). The FLII-11 (Version 0.2) was developed for use in epidemiological and clinical studies and can be administered by trained lay interviewers. This study at the NIMHANS, Bengaluru, India is the first to examine its psychometric properties. The diagnostic validity and reliability of the FLII-11 was examined by comparing diagnoses made using the FLII-11 administered by lay interviewers with diagnoses made by consultant psychiatrists. A total of 365 patients and 260 controls were assessed. The level of agreement between raters for both patients and controls were assessed using kappa (κ). In addition, the sensitivity, specificity, positive predictive value, and negative predictive value were estimated. The FLII-11 diagnoses showed very good agreement (κ-0.81) with consultant psychiatrist diagnoses and had acceptable values of sensitivity (83.3 %) and specificity (78.8 %) for the diagnoses of any mental disorder. Among the diagnostic categories examined, the psychometric properties of primary psychotic disorder, bipolar disorder, depressive disorder, substance use disorders, anxiety disorders, and obsessive-compulsive and related disorders were adequate, however inferences for diagnostic categories of eating disorders and stress related disorders could not be made as a sufficient sample size was not achieved. The study indicates that the FLII-11 (Version 0.2) has strong psychometric properties in this setting. Future directions include replication to confirm these findings and explore their applicability to diverse settings and other countries.