Composite International Diagnostic Instrument Research Articles

Prevalence and determinants of psychotropic medication use in Poland.

The aim of the study was to assess the prevalence of psychotropic medication use among adult population in Poland in past 12 months, and to analyse the relationship between psychotropic medication use and sociodemographic factors as well as mental health disorders experienced by respondents. Composite International Diagnostic Instrument (WHO CIDI 3.0) was used in Polish survey of general population aged 18-64. Respondents were randomly selected from the population register. Ten thousand interviews were completed with a response rate of 50,4%. In the general population, psychotropic medicines were used by almost 5% of the respondents in the past 12 months. These medicines were used more often by women, respondents from the oldest age group, with low level of education, retirees, unemployed, singles and residents of small and large cities. Among those experiencing mental health problems in the past 12 months, psychotropic medications were taken by up to 17% of the respondents. Pharmacological treatment was most often endorsed by over 40% of persons with symptoms of major depression and any mood disorders, while approximately 25% of respondents with major depression confirmed antidepressant use. Gender differences were small and mostly insignificant. The results indicate the need to improve access to mental health treatment and to educate better general practitioners (GPs) for appropriate diagnosing and treatment of mental health disorders.

Comorbidity profile of mental disorders among adolescents: A latent class analysis

The aim of this study was to identify the number of comorbidity profiles among adolescents. Sociodemographic factors associated with the comorbidity profiles were also examined. Latent class analysis was conducted using data from the National Comorbidity Survey Adolescent Supplement (NCS-A), a representative sample of adolescents (N = 10,123) in the United States. Latent classes were derived from 26 lifetime mental disorders which were assessed using the World Health Organization Composite International Diagnostic Instrument (CIDI). A three-class solution provided the best fit for the data, with classes labelled as comorbid emotional disorders (Class I), comorbid behavioural disorders (Class II), and normative (Class III). Class I (15.62% of the participants) included adolescents with a high probability of having anxiety, depressive, and intermittent explosive disorder. Class II (6.97%) was characterised by adolescents with a high probability of having substance use, behavioural disorders, and major depression. Class III (77.41%) was characterised by adolescents with a low probability of having any mental disorders. Characterising comorbid profile of mental disorders using person-based approach yields a higher-order classification that could have important clinical implications.

144. Heavy drinking may attenuate elevated inflammatory cytokine levels of major depression in alcohol disorders

There is scant data on immune function in the context of AUD and MD comorbidity. We aimed to determine and compare levels of circulating cytokines in AUD patients with and without MD. This is a cross-sectional study of 176 patients seeking treatment for their AUD from 8 treatment centers in Nepal. The Composite International Diagnostic Instrument was used to diagnose AUD and MD, and alcohol use parameters included frequent weekly alcohol use (>4 days) and 10 + drinks consumed per typical drinking day. We used ELISA to determine circulating levels of the cytokines IL-6, TNF- α , INF- γ , and IL-10. The Mann–Whitney U-test was employed to observe differences in cytokine levels across groups. The sample was 89% male with a mean age of 36 years, and 45% had comorbid MD. Patients with comorbid MD had elevated levels of IL-6 ( p = 0.019), TNF- α ( p = 0.020) and IFN- γ ( p = 0.001) compared to patients without MD. Significantly elevated levels of all cytokines were also observed among AUD patients with MD with less frequent weekly alcohol use (

Young adults' trajectories of Ecstasy use: A population based study

Young adults' Ecstasy use trajectories have important implications for individual and population-level consequences of Ecstasy use, but little relevant research has been conducted. This study prospectively examines Ecstasy trajectories in a population-based sample. Data are from the Natural History Study of Drug Use, a retrospective/prospective cohort study conducted in Australia. Population screening identified a probability sample of Ecstasy users aged 19–23years. Complete data for 30months of follow-up, comprising 4 time intervals, were available for 297 participants (88.4% of sample). Trajectories were derived using cluster analysis based on recent Ecstasy use at each interval. Trajectory predictors were examined using a generalized ordered logit model and included Ecstasy dependence (World Mental Health Composite International Diagnostic Instrument), psychological distress (Hospital Anxiety Depression Scale), aggression (Young Adult Self Report) and contextual factors (e.g. attendance at electronic/dance music events). Three Ecstasy trajectories were identified (low, intermediate and high use). At its peak, the high-use trajectory involved 1–2days Ecstasy use per week. Decreasing frequency of use was observed for intermediate and high-use trajectories from 12months, independently of market factors. Intermediate and high-use trajectory membership was predicted by past Ecstasy consumption (>70 pills) and attendance at electronic/dance music events. High-use trajectory members were unlikely to have used Ecstasy for more than 3years and tended to report consistently positive subjective effects at baseline. Given the social context and temporal course of Ecstasy use, Ecstasy trajectories might be better understood in terms of instrumental rather than addictive drug use patterns.

Cause for caution: culture, sensitivity and the World Mental Health Survey Initiative

This paper examines the cultural grounding and sensitivity in the concept, implementation, instrumentation and findings of the World Health Organization World Mental Health Survey Initiative (WHO-WMS). The WHO-WMS Initiative is managed by agencies in Boston and Geneva and covers 28 sites in 27 nations worldwide. It uses the Composite International Diagnostic Instrument (CIDI) translated to make diagnoses in 150,000 people. A large body of potentially influential data has been produced. The Initiative assumes that psychopathology is universal and not culturally determined. This assumption cannot be safely sustained. As a result, survey findings using ethnocentrically Western instruments and diagnoses may be uninterpretable, yet may misdirect policy and treatment. There are cautions here for ethnically and linguistically diverse nations such as Australia and New Zealand.

Influence of mental disorders on school dropout in Mexico.

To study the impact of mental disorders on failure in educational attainment in Mexico. Diagnoses and age of onset for each of 16 DSM-IV disorders were assessed through retrospective self-reports with the Composite International Diagnostic Instrument (CIDI) during fieldwork in 2001-2002. Survival analysis was used to examine associations between early onset DSM-IV/CIDI disorders and subsequent school dropout or failure to reach educational milestones. More than one of two Mexicans did not complete secondary education. More than one-third of those who finished secondary education did not enter college, and one of four students who entered college did not graduate. Impulse control disorders and substance use disorders were associated with higher risk for school dropout, secondary school dropout and to a lesser degree failure to enter college. Anxiety disorders were associated with lower risk for school dropout, especially secondary school dropout and, to a lesser degree, primary school dropout. The heterogeneity of results found in Mexico may be due to the effect of mental disorders being diminished or masked by the much greater effect of economic hardship and low cultural expectations for educational achievement. Future research should inquire deeper into possible reasons for the better performance of students with anxiety disorders in developing countries.

Prevalence of Self-Management Versus Formal Service Use for Common Mental Disorders in Australia: Findings from the 2007 National Survey of Mental Health and Wellbeing

To determine the proportion of Australian adults who use non-practitioner led support services and self-management strategies for common mental disorders. Data were drawn from the 2007 National Survey of Mental Health and Wellbeing, a representative survey of 8841 Australian adults aged 16 to 85 years. This survey included the Composite International Diagnostic Instrument to obtain diagnosis of International Classification of Diseases (Version 10; ICD-10) mental disorders. Information about consultations with health professionals for mental health problems and the use of support services and self-management strategies was also collected. Half of all adults who met the criteria for an affective or anxiety disorder in the last 12 months reported using non-practitioner led support services and/or self-management strategies for their mental health problems. Six per cent used support services, including Internet and non-online support groups and telephone counselling, and 51.9% used self-management strategies such as doing 'more of the things you enjoy' to 'help deal with' their mental health problems. Of people with a 12-month common mental disorder, 24% used support services and/or self-management strategies without additional formal services; 29.3% used both. Of adults with a 12-month affective or anxiety disorder, 37% used neither formal services nor self-management strategies. A substantial proportion of people who reported using self-management strategies for their mental health did not have a diagnosable affective or anxiety disorder. The use of non-practitioner led support services and self-management strategies for mental health problems, with and without adjunct use of formal health services, is widespread in Australia. Future research is needed to investigate why people may select these strategies over formal services, or whether self-management reflects the presence of barriers to use of formal services.

DSM-IV major depressive episode in the elderly: The relationship between the number and the type of depressive symptoms and impairment

Background There is a lack of studies that assess whether the DSM-IV criteria for Major Depressive Episode (MDE) that use a diagnostic threshold are valid for the elderly and whether each symptom of depression contributes equally to impairment in this group. Method The Australian National Survey of Mental Health and Wellbeing is a population-based epidemiological survey which utilized the Composite International Diagnostic Instrument to diagnose MDE. Analyses were based on the survey respondents who endorsed either (or both) the “depressed mood” or “loss of interest” core MDE symptoms (60+ years, n = 278; 40+ years, n = 1020). A series of multivariate linear regression analyses were run to assess the relationship between the number and the type of depressive symptoms and five measures of impairment. Results For those aged 60+ years, a linear relationship alone was observed for the relationship between the number of depressive symptoms and each of the five measures but not all symptoms of depression were equal predictors of impairment; loss of energy was the most consistent predictor. When the regression analyses were repeated using respondents aged 40+ years, consistent significant interactions between age and individual symptoms of depression were not observed. Limitations The dimensionality of MDE is assessed focusing solely on symptoms. Conclusions Our data illustrate the apparent dimensional structure of MDE and the differential impact of depressive symptoms on impairment in an elderly sub-sample. There was little support for systematic age-dependent changes. Adjustments to the diagnostic criteria of MDE may not require age-dependent distinctions.

Prevalence of Mental Disorder and Associated Factors in Civilian Guatemalans With Disabilities Caused By the Internal Armed Conflict

The 34-year-long, Guatemalan war left at least 1,841 persons disabled in the country. The aim of this study was to describe the prevalence of mental disorders in individuals who acquired their disability as a result of the war, and to identify probable risk factors. A cross-sectional study was conducted of a group of 99 civilians with a disability in Guatemala. Participants were selected from four civilian organizations serving disabled persons in the municipality of Nebaj, Quiche. The diagnostic instrument was the computerized version of the Composite International Diagnostic Instrument 2.1 (CIDI 2.1). Data were collected from 2002 to 2004. Of the 99 disabled persons who completed the interview, 44 had some type of lifetime psychiatric disorder. Post-traumatic stress disorder (PTSD) was the most prevalent, with 34.34% (34 cases), followed by dysthymia, with 10.10% (10 cases), and depression, with 6.06% (6 cases). The traumatic events experienced during the conflict caused long-term psychological sequelae in people who were disabled as a result of the war. Increased exposure to traumatic events, being married, physical disability, illiteracy and advanced age were identified as probable risk factors for mental disorders .

Status inconsistency and common mental disorders in the Israel-based world mental health survey

Research on status inconsistency (SI) and its impact on mental health has been dormant for many years. This study tested the association between SI and emotional distress, anxiety and mood disorders. Data were gathered from the Israel-based component of the World Mental Health Survey (n = 4,859). SI was defined by the combination of high education (13+ years) with low income (1st decile). Mood and anxiety disorders were diagnosed with the composite international diagnostic instrument (CIDI), and emotional distress was measured with the 12-item general health questionnaire (GHQ-12). Multivariate analysis showed increased risk for mood or anxiety disorders among SI subjects (n = 231), odds ratio (OR) = 1.75, 95% confidence interval (95% CI) 1.13-2.63. The estimate was slightly attenuated when marital status was added to the model (OR = 1.55, 95% CI 1.0-2.39). SI subjects showed higher GHQ-12 scores. SI, which can disrupt an individual's sense of coherence, is associated, although not causally, with increased 12 month prevalence rates for mood or anxiety disorders and with higher psychological distress.

Mental disorders and subsequent educational attainment in a US national sample

As part of a larger investigation of the adverse effects of mental disorders on role functioning, we examined the associations of early-onset mental disorders with subsequent educational attainment in a large nationally representative survey of the US adult population. Diagnoses and age of onset for each of 17 DSM-IV disorders were assessed through retrospective self-report with the fully structured WHO Composite International Diagnostic Instrument (CIDI). Survival analysis was used to examine the associations between early-onset DSM-IV/CIDI disorders and subsequent termination of schooling with controls for socio-demographic characteristics and childhood adversities (i.e. childhood traumatic events, childhood neglect, parental mental illness, family disruption, and low parental educational attainment). Mental disorders were found to be significantly associated with termination of schooling prior to completion of each of four educational milestones (primary school graduation, high school graduation, college entry, college graduation), with odds ratios in the range of 1.3–7.0. The proportion of school terminations attributable to mental disorders was largest for high school graduation (10.2%) but also meaningful for primary school graduation (3.8%), college entry (4.4%) and college graduation (2.6%). These results add to a growing body of evidence documenting a wide variety of adverse life course effects of mental disorders.

The Epidemiology of Suicide‐Related Outcomes in Mexico

Nationally representative data from the Mexican National Comorbidity Survey are presented on the lifetime prevalence and age-of-onset (AOO) distributions of suicide ideation, plan and attempt and on temporally prior demographic and DSM-IV psychiatric risk factors. Lifetime ideation was reported by 8.1% of respondents, while 3.2% reported a lifetime plan and 2.7% a lifetime suicide attempt. Onset of all outcomes was highest in adolescence and early adulthood. The risk of transition from suicide ideation to plan and attempt was highest within the first year of onset of ideation. The presence of one or more temporally prior DSM-IV/CIDI (Composite International Diagnostic Instrument) disorder was strongly related to each suicide-related outcome. Suicidal outcomes are prevalent, have an early AOO, and are strongly related to temporally prior mental disorders in Mexico. Given the early AOO, intervention efforts need to focus more than currently on children and adolescents with mental disorders to be effective in prevention.

A comparison between screened NIMH and clinically interviewed control samples on neuroticism and extraversion

The National Institute of Mental Health (NIMH) has supported the collection of DNA samples on over 4000 subjects for use primarily as controls in psychiatric genetic studies. These subjects, though screened online, were not directly interviewed or assessed on family history. We compared this sample to one that was directly interviewed using structured diagnostic assessments on comparable measures of neuroticism and extraversion. The screened sample completed an online self-report based on the Composite International Diagnostic Instrument Short-Form (CIDI-SF). The interviewed sample was assessed by clinically trained personnel using the Schedule for Affective Disorders and Schizophrenia (SADS-LA-IV) and Family History Screen; final diagnoses were made blind to trait scores by a clinician using the best-estimate procedure. Neuroticism and extraversion were assessed on the NEO five-factor inventory (NEO-FFI) and the revised Eysenck Personality Questionnaire short form (EPQ-R). We found that subjects in the NIMH-screened sample who did not report any psychiatric symptoms on the self-report were indistinguishable from interviewed diagnosis free and family history negative controls on neuroticism and extraversion. Subjects in the screened sample who screened positive for anxiety disorders, however, deviated significantly on these measures both from the screened subjects with no self-reported symptoms, as well as from subjects in the interviewed sample diagnosed with comparable disorders. These findings suggest that control groups generated from the NIMH sample should ideally be restricted to subjects free of any self-reported symptoms, regardless of the disorder being addressed, in order to maximize their reflection of diagnosis-free populations.

Retirement and mental health: Analysis of the Australian national survey of mental health and well-being

Nation-wide research on mental health problems amongst men and women during the transition from employment to retirement is limited. This study sought to explore the relationship between retirement and mental health across older adulthood, whilst considering age and known risk factors for mental disorders. Data were from the 1997 National Survey of Mental Health and Well-being, a cross-sectional survey of 10,641 Australian adults. The prevalence of depression and anxiety disorders was analysed in the sub-sample of men ( n = 1928 ) and women ( n = 2261 ) aged 45–74 years. Mental health was assessed using the Composite International Diagnostic Instrument. Additional measures were used to assess respondents’ physical health, demographic and personal characteristics. The prevalence of common mental disorders diminished across increasing age groups of men and women. Women aged 55–59, 65–69, and 70–74 had significantly lower rates of mental disorders than those aged 45–49. In contrast, only men aged 65–69 and 70–74 demonstrated significantly lower prevalence compared with men aged 45–49. Amongst younger men, retirees were significantly more likely to have a common mental disorder relative to men still in the labour force; however, this was not the case for retired men of, or nearing, the traditional retirement age of 65. Men and women with poor physical health were also more likely to have a diagnosable mental disorder. The findings of this study indicate that, for men, the relationship between retirement and mental health varies with age. The poorer mental health of men who retire early is not explained by usual risk factors. Given current policy changes in many countries to curtail early retirement, these findings highlight the need to consider mental health, and its influencing factors, when encouraging continued employment amongst older adults.

Does Resilience Protect Minorities From Mental Illness?

Does Resilience Protect Minorities From Mental Illness?

An International Study of the Effect of Physical Ill Health on Psychiatric Recovery in Primary Care

The aim of this study was to determine the association between physical morbidity and recovery from psychiatric illness in primary care. A total of 1252 psychiatric cases were recruited using a 2-stage design from 5447 subjects presenting for primary care in 14 countries. Cases were assessed at the time of screening and 1 year subsequently. Information on physical, psychiatric, and social status was obtained using the Composite International Diagnostic Instrument adapted for use in primary care (CIDI-PHC) and the Groningen Social Disability Schedule (GSDS). Assessments of psychiatric morbidity were also obtained from the patients' family practitioners. Medically explained somatic symptoms were strongly related to psychiatric outcome 1 year later. Whereas just over one half of patients (614 of 1078) with 4 or less medically explained symptoms had recovered from a psychiatric disorder, the percentage recovery fell to 38% (67 of 174) in those with 5 or more medically explained symptoms. Patients with 5 or more medically explained symptoms had a 70% increase in risk of remaining a psychiatric case 1 year later after controlling for demographics, country, initial severity of psychiatric disorder, medically unexplained somatic symptoms, and social disability. Physical ill health is independently associated with psychologic outcome 1 year after a patient has been seen. The needs of these patients should receive greater attention.

Prevalence and age of onset for drug use in seven international sites: results from the international consortium of psychiatric epidemiology

This study compares lifetime prevalence and age of first use (onset) for alcohol, cannabis, and other drugs in six international sites. Data from seven epidemiologic field surveys that used compatible instruments and study designs were compiled for cross-site analyses by the International Consortium of Psychiatric Epidemiology (ICPE). The world health organization's composite international diagnostic instrument (WHO-CIDI) and additional items were used to ascertain drug use in each site. Lifetime use rates were estimated for alcohol, cannabis, and other illicit drugs. Survival analyses were used to estimate age of onset. Study settings and main results: use of alcohol twelve or more times ranged in descending order from the Netherlands (86.3%), United States (71.7%), Ontario, Canada (71.6%); São Paulo, Brazil (66.1%), Munich, Germany (64.9%), Fresno, California (USA) (51.9%), to Mexico City (43.2%). Use of cannabis five or more times in a lifetime ranged from 28.8 in the United States to 1.7% in Mexico City, and other drugs ranged from United States (19.4%) to Mexico City (1.7%). Age of first use was similar across study sites. This study demonstrates the fundamental uniformity of onset patterns by age as contrasted with wide variations in lifetime prevalences across sites. Study findings suggest that drug use patterns may change among emigrating populations from low consumption nations as a consequence of international resettlement in nations with higher rates. Methodological limitations of the study along with recommendations for future international comparative research are discussed.

Effects of time in the United States and Indian ethnicity on DSM-III-R psychiatric disorders among Mexican Americans in California.

The study examines the effects of time in the United States and Indian ethnicity on prevalence of 12 DSM-III-R psychiatric disorders among Mexican Americans in California. In Fresno County, primarily an agricultural area, 3012 participants of Mexican origin (18 to 59 years) were selected under a cluster sampling design and interviewed using a version of the World Health Organization's Composite International Diagnostic Instrument (WHO-CIDI). Lifetime prevalence of any psychiatric disorder was 46.4% for Indians and 32.9% for non-Indians. Alcohol dependence was the most prevalent disorder (Indians = 17.4%, non-Indians = 10.7%). Indians had significantly higher risk of affective disorders (adjusted OR = 2.9) and drug abuse/dependence (adjusted OR = 2.6) compared with non-Indians. Time in the United States was associated with higher risk of lifetime affective disorders and drug abuse/dependence. This effect was more pronounced among Indians. Mexican immigrants are ethnically heterogenous and Indians appear to be more vulnerable to negative effects of exposure to U.S. society.

The Christchurch prisons psychiatric epidemiology study: methodology and prevalence rates for psychiatric disorders

AbstractAn investigation into psychiatric morbidity in the prisons in Christchurch, New Zealand is described. There are no previously published epidemiology studies concerning New Zealand prison inmates. A total of 225 inmates were approached to take part in the study representing a census of female inmates and remanded males and a randomly selected cohort of 125 sentenced males. Interviewers administered the Composite International Diagnostic Instrument – Automated (CIDI‐A), a structured interview that generated both DSM‐III‐R and ICD 10 diagnoses. Interviews were completed on 183 inmates. Results reveal high lifetime and current prevalence rates for drug and alcohol abuse and dependence as well as high current and lifetime prevalence rates for affective disorders. Schizophrenia had a lifetime prevalence rate of 5% in the sentenced male population. Comparison with community epidemiological figures for psychiatric disorder reveal elevated lifetime and current prevalence rates among prison inmates for all major psychiatric diagnoses except generalized anxiety disorder. Implications for future treatment and service planning in forensic psychiatry are discussed with particular reference to a national epidemiology study of major psychiatric disorder in New Zealand prisons. Copyright © 1999 Whurr Publishers Ltd.

Illicit drug use among Mexicans and Mexican Americans in California: the effects of gender and acculturation.

To examine the effects of gender and acculturation on illicit drug use among the Mexican-origin population in California. The 3012 subjects between 18 and 59 years of age were selected under a stratified, multi-stage cluster sampling method. Fresno County in California is primarily agricultural, with only one metropolitan area. Over 30% of the total population of 764,800, are Hispanics, of Mexican origin. A modified version of the World Health Organization's Composite International Diagnostic Instrument (WHO-CIDI) was used to ascertain drug use. Respondents were considered drug users if they had ever used marijuana, cocaine, hallucinogens, heroin or inhalants. Acculturation was measured with a Likert scale, assessing English vs. Spanish language preference. Other covariates of interest were nativity and place of residence. Men had higher rates of use than women for every drug (men = 46.3%, women = 23.2%). Urban rates were higher than rural rates, for both women (urban = 32.8% vs. rural = 16.6%) and men (urban = 57.0% vs. rural = 36.8%). In logistic regression models, men were more likely than women to have ever used illicit drugs or inhalants (adjusted OR = 4.8), cocaine (adjusted OR = 5.3) or marijuana (OR = 4.3). However, the combined effect of United States nativity and acculturation, on drug use, was greater among women (adjusted OR = 29.3) than among men (adjusted OR = 7.4). The effect of acculturation was stronger among urban, than among town or rural residents. Acculturation and United States nativity are risk factors for illicit drug use among Mexican origin men and women. However, women have increased vulnerability compared with men. Findings reinforce the need for culturally based public health interventions.