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Accuracy of diagnostic classification and clinical utility assessment of ICD-11 compared to ICD-10 in 10 mental disorders: findings from a web-based field study


In this web-based field study, we compared the diagnostic accuracy and clinical utility of 10 selected mental disorders between the ICD-11 Clinical Descriptions and Diagnostic Guidelines (CDDG) and the ICD-10 CDDG using vignettes in a sample of 928 health professionals from all WHO regions. On average, the ICD-11 CDDG displayed significantly higher diagnostic accuracy (71.9% for ICD-11, 53.2% for ICD-10), higher ease of use, better goodness of fit, higher clarity, and lower time required for diagnosis compared to the ICD-10 CDDG. The advantages of the ICD-11 CDDG were largely limited to new diagnoses in ICD-11. After limiting analyses to diagnoses existing in ICD-11 and ICD-10, the ICD-11 CDDG were only superior in ease of use. The ICD-11 CDDG were not inferior in diagnostic accuracy or clinical utility compared to the ICD-10 CDDG for any of the vignettes. Diagnostic accuracy was consistent across WHO regions and independent of participants’ clinical experience. There were no differences between medical doctors and psychologists in diagnostic accuracy, but members of other health professions had greater difficulties in determining correct diagnoses based on the ICD-11 CDDG. In sum, there were no differences in diagnostic accuracy for diagnoses existing in ICD-10 and ICD-11, but the introduction of new diagnoses in ICD-11 has improved the diagnostic classification of some clinical presentations. The favourable clinical utility ratings of the ICD-11 CDDG give reason to expect a positive evaluation by health professionals in the implementation phase of ICD-11. Yet, training in ICD-11 is needed to further enhance the diagnostic accuracy.

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Fig. 1


  1. World Health Organization (2018) Disease burden 2000–2016. Accessed 25 Jul 2019

  2. Bloom DE, Cafiero ET, Jané-Llopis E et al (2012) The global economic burden of non-communicable diseases. In: PGDA working papers 8712, program on the global demography of aging

  3. Mack S, Jacobi F, Gerschler A et al (2014) Self-reported utilization of mental health services in the adult German population–evidence for unmet needs? Results of the DEGS1-Mental Health Module (DEGS1-MH). Int J Methods Psychiatr Res 23(3):289–303.

    Article  PubMed  PubMed Central  Google Scholar 

  4. First MB, Rebello TJ, Keeley JW et al (2018) Do mental health professionals use diagnostic classifications the way we think they do? A global survey. World Psychiatry 17(2):187–195.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Reed GM, First MB, Kogan CS et al (2019) Innovations and changes in the ICD-11 classification of mental, behavioural and neurodevelopmental disorders. World Psychiatry 18(1):3–19.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Peterson DL, Webb CA, Keeley JW et al (2019) The reliability and clinical utility of ICD-11 schizoaffective disorder: a field trial. Schizophr Res.

    Article  PubMed  Google Scholar 

  7. Keeley JW, Reed GM, Roberts MC et al (2016) Developing a science of clinical utility in diagnostic classification systems: field study strategies for ICD-11 mental and behavioral disorders. Am Psychol 71(1):3–16.

    Article  PubMed  Google Scholar 

  8. Reed GM, Roberts MC, Keeley J et al (2013) Mental health professionals’ natural taxonomies of mental disorders: implications for the clinical utility of the ICD-11 and the DSM-5. J Clin Psychol 69(12):1191–1212.

    Article  PubMed  Google Scholar 

  9. International Advisory Group for the Revision of ICD-10 Mental and Behavioural Disorders (2011) A conceptual framework for the revision of the ICD-10 classification of mental and behavioural disorders. World Psychiatry 10(2):86–92.

    Article  PubMed Central  Google Scholar 

  10. Reed GM (2010) Toward ICD-11: improving the clinical utility of WHO’s International Classification of mental disorders. Prof Psychol Res Pract 41(6):457–464.

    Article  Google Scholar 

  11. Gaebel W, Riesbeck M, Zielasek J et al (2018) Internetbasierte Untersuchungen zur diagnostischen Klassifikation und Kodierung psychischer Störungen im Vergleich von ICD-11 und ICD-10. Fortschritte Neurol Psychiatrie 86(03):163–171.

    Article  Google Scholar 

  12. Medina-Mora ME, Robles R, Rebello TJ et al (2019) ICD-11 guidelines for psychotic, mood, anxiety and stress-related disorders in Mexico: clinical utility and reliability. Int J Clin Health Psychol 19(1):1–11.

    Article  PubMed  Google Scholar 

  13. Reed GM, Sharan P, Rebello TJ et al (2018) The ICD-11 developmental field study of reliability of diagnoses of high-burden mental disorders: results among adult patients in mental health settings of 13 countries. World Psychiatry 17(2):174–186.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Reed GM, Keeley JW, Rebello TJ et al (2018) Clinical utility of ICD-11 diagnostic guidelines for high-burden mental disorders: results from mental health settings in 13 countries. World Psychiatry 17(3):306–315.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Brechbiel JK, Keeley JW (2019) Pathways linking clinician demographics to mental health diagnostic accuracy: an international perspective. J Clin Psychol.

    Article  PubMed  Google Scholar 

  16. Evans SC, Roberts MC, Keeley JW et al (2015) Vignette methodologies for studying clinicians’ decision-making: validity, utility, and application in ICD-11 field studies. Int J Clin Health Psychol 15(2):160–170.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Peabody JW, Luck J, Glassman P et al (2000) Comparison of vignettes, standardized patients, and chart abstraction: a prospective validation study of 3 methods for measuring quality. J Am Med Assoc 283(13):1715–1722.

    CAS  Article  Google Scholar 

  18. Reed GM, Correia JM, Esparza P (2011) The WPA–WHO global survey of psychiatrists’ attitudes towards mental disorders classification. World Psychiatry 10(2):118–131.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Kazlauskas E, Zelviene P, Lorenz L et al (2017) A scoping review of ICD-11 adjustment disorder research. Eur J Psychotraumatol.

    Article  PubMed  Google Scholar 

  20. American Psychiatric Association (2013) Diagnostic and statistical manual of mental disorders, 5th edn. APA, Washington, DC

    Book  Google Scholar 

  21. Cullen S (2010) Survey-driven romanticism. Rev Philos Psychol 1(2):275–296.

    Article  Google Scholar 

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The collection of data from German-speaking participants (recruitment step 1) was funded by the German Federal Ministry of Health, Grant no. D105–01_09_ICD-11_TMF_DGPPN. We thank the following institutions and persons for their support in conducting this study: DGPPN (Prof. Dr. Arno Deister, Julie Holzhausen, Gabriel Gerlinger), TMF (Dr. Sebastian Semler and Dr. Annette Pollex-Krüger), DIMDI (Dr. Stefanie Weber, Maria Lange), KKG (Prof. Dr. Holger Reinecke and Prof. Dr. Jürgen Stausberg), BDK (Prof. Dr. Thomas Pollmächer), BPtK (Dr. Dietrich Munz and Dr. Tina Wessels), BVDN (Dr. Sabine Köhler), BVDP (Dr. Christa Roth-Sackenheim).

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Correspondence to Wolfgang Gaebel.

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Gaebel, W., Stricker, J., Riesbeck, M. et al. Accuracy of diagnostic classification and clinical utility assessment of ICD-11 compared to ICD-10 in 10 mental disorders: findings from a web-based field study. Eur Arch Psychiatry Clin Neurosci 270, 281–289 (2020).

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  • International Classification of Diseases
  • ICD-11
  • Mental and behavioural disorders
  • Field study
  • Diagnosis
  • Diagnostic accuracy
  • Clinical utility