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1.14: Clinical Assessments

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    Learning Objectives
    • Describe methods for clinical interviews and the mental status examination

    The Clinical Interview

    The clinical interview is the most widely used means of assessment. A clinical interview is a face-to-face encounter between a mental health professional and a patient in which the professional observes the patient and gathers data about the person’s behavior, attitudes, current situation, personality, and life history. The interview may be unstructured, in which open-ended questions are asked; structured, in which a specific set of questions according to an interview schedule are asked; or semi-structured, in which there is a pre-set list of questions but clinicians are able to follow up on specific issues that catch their attention.

    Unstructured Interview

    An unstructured interview or non-directive interview is an interview in which questions are not pre-arranged. These non-directive interviews are considered to be the opposite of a structured interview that offers a set amount of standardized questions. They tend to be more informal and free flowing than a structured interview, much like an everyday conversation. The chief feature of the unstructured interview is the idea of using probing questions aimed at determining the client’s reason for being in treatment, symptoms, health status, family background, and life history that are designed to be as open as possible. Open-ended questions that have no prepared response choices enable and empower the client to shift the direction of the interview and to bring in unanticipated information. It can require a skillful clinician to bring a talkative respondent back on topic, or to help a client end an awkward silence. However, these open-ended questions give the ability for the respondent to reply about a topic that neither the interviewee nor the interviewer may have thought about before. Some evidence shows that using open-ended questions in interviews results in greater reporting of sensitive subjects, such as domestic violence, or socially disapproved behavior than when closed-ended questions on a self-reporting questionnaire are used. A typical clinical interview will cover the following:

    • age and sex
    • reason for referral
    • education and work history
    • current social situation
    • physical and mental health history
    • drug/alcohol use and current medication
    • family history
    • behavioral observations

    Structured Interview

    A structured interview (also known as a standardized interview) can provide a diagnosis or classify the client’s symptoms into a DSM-5 disorder. The aim of this approach is to ensure that each interview is presented with exactly the same questions in the same order. This aim ensures that answers can be reliably aggregated. The Structured Clinical Interview for DSM-5 Disorders (SCID-5) is one of the most widely used clinical interviews. It is a diagnostic exam and covers the diagnoses most commonly seen in clinical settings.

    Both of these methods (unstructured and structured) have their pros and cons. A highly unstructured interview and informal observations provide key findings about the patient that are both efficient and effective. A potential issue with an unstructured, informal approach is that the clinician may overlook certain areas of functioning or not notice them at all. Or they might focus too much on presenting complaints. The highly structured interview, although very precise, can cause the clinician to make the mistake of focusing a specific answer to a specific question without considering the response in terms of a broader scope or life context. They may fail to recognize how the patient’s answers all fit together.

    As mentioned above, a semi-structured interview is another option. In this situation, the clinician follows a general outline of questions designed to gather essential information, but is free to ask the questions in any particular order and to branch off into other directions to follow up on relevant information.

    Other Clinical Assessments

    There are many other clinical assessments used by mental health professionals to aide them in the diagnositc process. One common instrument is the Beck Depression Inventory (BDI). The BDI-II is the current version being used. This is a 21-question, self-report questionnaire that assesses for the symptoms of depression. The patient answers questions and their score is added up, indicating either normal, mild, moderate, or severe depression. The Beck Anxiety Inventory is a self-report questionnaire and that assesses for symptoms of anxiety. It is common for practictioners to give these assessments to patients to establish a baseline and to also determine if progress is being made over time. 

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    Glossary

    clinical interview: a face-to-face encounter between a mental health professional and a patient in which the former observes the latter and gathers data about the person’s behavior, attitudes, current situation, personality, and life history

    semi-structured interview: a pre-set list of questions but clinicians are able to follow up on specific issues that catch their attention

    Structured Clinical Interview for DSM-5 Disorders (SCID-5): a diagnostic exam and covers the diagnoses most commonly seen in clinical settings.

    structured interview (also known as a standardized interview): approach to ensure that each interview is presented with exactly the same questions in the same order

    unstructured interview: non-directive interview, or an interview in which questions are not prearranged

    Beck Depression Inventory: self-report questionnaire that assesses for symptoms of depression.

    Beck Anxiety Inventory: self-report questionnaire that assesses for symptoms of anxiety.

    1. Briden & Daffin. Essentials of Abnormal Psychology. ↵
    2. Bhugra D & Bhui K (1997) Cross-cultural psychiatric assessment. Advances in Psychiatric Treatment (3):103–110 ↵
    3. Sheldon M (August 1997). "Mental State Examination." Psychiatric Assessment in Remote Aboriginal Communities of Central Australia. Australian Academy of Medicine and Surgery. Archived from the original on 2008-07-19. Retrieved 2008-06-28. ↵
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