Comparing mental health semi-structured diagnostic interviews and symptom checklists to predict poor life outcomes: an 8-yearcohort studyfrom childhoodtoyoung adulthood in Brazil

Background Semi-structured diagnos t i c interviews and symptom checkli s t s present similar internal relia b i l i t y . We a i m to investigate whether they differ in predicting poor life outcomes in the transition from childhood to young adulthood. Methods For this longitudinal st u d y , we used data from the Brazilian High Risk Cohort St u d y for Childhood Ment a Health Conditions. Eligible participants were a g e d 6-14 years on the day of study enrolment (January to February, 2010) and were enrolled in public schools by a biological parent in Porto Alegre and Sao Paulo, Brazil. 2511 young people and their caregivers were assessed at baseline in 2010-11, and 1917 were assessed 8 years later (2018-19; 76 center dot 3% retention). Clinical thresholds were derived using semi-structured parent-report interview based on the Diagnostic and Statistical Manual of Mental Disorders, according to the Developmental and Well-being Assessment (DAWBA), and clinical scores as defined by the Child Behavior Checklist (CBCL; T-score >= 70 considered positive caseness). At 8 years, participants were assessed for a composite life-threatening outcome (a composite of death, suicide attempts, severe self-harm, psychiatric inpatient admission, or emergency department visits) and a composite poor life chances outcome (a composite of any criminal conviction, substance misuse, or school dropout). We evaluated the accuracy of DAWBA and CBCL to predict these outcomes. Logistic regression models were adjusted for age, sex, race or ethnicity, st u d y site, and socioeconomic class. Findings DAWBA and CBCL had similar sensitivity, specificity , predictive values, and test accuracy for both composi t e outcomes and t h e i r components. Any mental health problem, as classified by DAWBA and CBCL, was independently associated with the composite life-threatening outcome (DAWBA adjusted odds ratio 1 center dot 62, 95% CI 1 center dot 20-2 center dot 18; CBCL 1 center dot 66, 1 center dot 19-2 center dot 30), but only CBCL independe n t l y predic t e d poor life chances (1 center dot 56, 1 center dot 19-2 center dot 04). Participants classified by b o t h approaches did not have higher odds of the life-threatening outcome when compared with participants classified by DAWBA or CBCL alone, nor for the poor life chances outcome when compared with those classified by CBCL alone. Interpretation Classifying children and adolescents based on a semi-structured diagnostic interview was not statistic a l l y different to symptom checklist in terms of test accuracy and predictive validity for relevant life outcomes. Classification based on symptom checklist might be a valid alternative to costly and time-consuming methods to identif y young peopl e a t risk f o r poor lif e outcomes.