The third major research group is based at Washington University, St Louis, Missouri, and is well known as the originator of the first widely used sets of Diagnostic Criteria for Research.(66> Following the publication of DSM-III in 1980, there was considerable interest in discovering how the disorders it contained were distributed in the American population. Supported by the National Institute of Mental Health, Lee Robins and her colleagues designed the Diagnostic Interview Schedule ( DIS)(67) for this purpose. This is composed of questions covering the symptoms required to identify what were considered to be the 15 most important disorders in DSM-III. The Epidemiological Catchment Area study of the National Institute of Mental Health, the very large study in which the DIS was first used, included a population sample of more than 18 000 subjects in five largely urban areas. (68>
So as to avoid the costs and other problems involved in employing trained psychiatrists or psychologists as interviewers, the DIS was designed as a highly structured questionnaire administered as an interview by lay interviewers. The interviewers, usually already experienced in interviewing for market research, had to undergo a week-long intensive training course on the DIS. The DIS questions must be given in the order printed in the schedule. Possible symptoms are not rated as present if in the opinion of the subject they may be due to physical disorders, but there is no free questioning about timing, severity, and other details of the symptoms. Questions may be repeated, but only questions provided in the schedule may be asked of the subject. This is a very different concept from that of the PSE technique, and it is based upon the assumption made by the designers of the DIS that by controlling the interviewer in this way, the DIS would 'enable the interviewer to obtain psychiatric diagnoses comparable to those a psychiatrist would obtain'.(67) Put in another way, this is an assumption that expressed complaints can be used as near equivalents of inferred symptoms for the purposes of identifying psychiatric disorders.
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