This article presents observations on the function and validity of the Composite International Diagnostic Interview (CIDI) 2.1 in a study of major depression in Chinese American women. CIDI symptom items for depression had good apparent validity and acceptability. However, CIDI probe flow chart (PFC) ‘clinical significance’ criteria appeared to underidentify cases of major depression if they occurred in China, or in deprived conditions within the U.S. and other developed countries. Validity of the CIDI PFC was affected by social, political and cultural factors. Patterns of bias are discussed and related to assumptions underlying the PFC regarding resource availability, help-seeking and the expression of distress.
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