World Health Organization Composite International Diagnostic Research Articles

Psychotic experiences among informal caregivers: findings from 48 low- and middle-income countries.

PurposeInformal caregivers may be at high risk for psychotic experiences (PE) due to caregiving related stress, sleep issues, or other potential mechanisms, but this has not been previously investigated in the general adult population. Thus, we examined the association between caregiving and PE, and its mediators, in a large sample of adults from 48 low- and middle-income countries (LMICs).MethodsCross-sectional, community-based data from the World Health Organization (WHO) World Health Survey were analyzed. Informal caregivers referred to those who provided help to a relative or friend (adult or child) in the past year, because this person has a long-term physical or mental illness or disability, or is getting old and weak. PE were assessed using the WHO Composite International Diagnostic Interview psychosis screen. Multivariable logistic regression and mediation analyses were conducted.ResultsData on 224,842 individuals were analyzed. The mean (SD) age was 38.3 (16.0) years (range 18–120 years) and 50.7% were females. After adjustment for age, sex, and country, in the overall sample, caregiving was associated with 1.67 (95%CI = 1.56–1.79) times higher odds for PE. Sleep/energy explained the largest proportion of the association between caregiving and PE (13.9%), followed by pain/discomfort (11.5%), perceived stress (7.6%), depression (6.2%), and cognition (3.5%).ConclusionCaregivers in LMICs are at higher risk of PE. Future studies are warranted to gain a further understanding of the underlying mechanisms, and to assess whether addressing the identified mediators can lead to lower risk for PE among caregivers.Supplementary InformationThe online version contains supplementary material available at 10.1007/s00127-022-02312-z.

Twelve-month mental health service use in six countries of the Americas: A regional report from the World Mental Health Surveys.

To provide cross-national data for selected countries of the Americas on service utilization for psychiatric and substance use disorders, the distribution of these services among treatment sectors, treatment adequacy and factors associated with mental health treatment and adequacy of treatment. Data come from data collected from 6710 adults with 12 month mental disorder surveys across seven surveys in six countries in North (USA), Central (Mexico) and South (Argentina, Brazil, Colombia, Peru) America who were interviewed 2001-2015 as part of the World Health Organization (WHO) World Mental Health (WMH) Surveys. DSM-IV diagnoses were made with the WHO Composite International Diagnostic Interview (CIDI). Interviews also assessed service utilization by the treatment sector, adequacy of treatment received and socio-demographic correlates of treatment. Little over one in four of respondents with any 12 month DSM-IV/CIDI disorder received any treatment. Although the vast majority (87.1%) of this treatment was minimally adequate, only 35.3% of cases received treatment that met acceptable quality guidelines. Indicators of social-advantage (high education and income) were associated with higher rates of service use and adequacy, but a number of other correlates varied across survey sites. These results shed light on an enormous public health problem involving under-treatment of common mental disorders, although the problem is most extreme among people with social disadvantage. Promoting services that are more accessible, especially for those with few resources, is urgently needed.

Association of Urbanicity With Psychosis in Low- and Middle-Income Countries

Urban residence is one of the most well-established risk factors for psychotic disorder, but most evidence comes from a small group of high-income countries. To determine whether urban living is associated with greater odds for psychosis in low- and middle-income countries (LMICs). This international population-based study used cross-sectional survey data collected as part of the World Health Organization (WHO) World Health Survey from May 2, 2002, through December 31, 2004. Participants included nationally representative general population probability samples of adults (≥18 years) residing in 42 LMICs (N = 215 682). Data were analyzed from November 20 through December 5, 2017. Urban vs nonurban residence, determined by the WHO based on national data. Psychotic experiences, assessed using the WHO Composite International Diagnostic Interview psychosis screen, and self-reported lifetime history of a diagnosis of a psychotic disorder. Among the 215 682 participants (50.8% women and 49.2% men; mean [SD] age, 37.9 [15.7] years), urban residence was not associated with psychotic experiences (odds ratio [OR], 0.99; 95% CI, 0.89-1.11) or psychotic disorder (OR, 0.89; 95% CI, 0.76-1.06). Results of all pooled analyses and meta-analyses of within-country effects approached a null effect, with an overall OR of 0.97 (95% CI, 0.87-1.07), OR for low-income countries of 0.98 (95% CI, 0.82-1.15), and OR for middle-income countries of 0.96 (95% CI, 0.84-1.09) for psychotic experiences and an overall OR of 0.92 (95% CI, 0.73-1.16), OR for low-income countries of 0.92 (95% CI, 0.66-1.27), and OR for middle-income countries of 0.92 (95% CI, 0.67-1.27) for psychotic disorder. Our results provide evidence that urbanicity, a well-established risk factor for psychosis, may not be associated with elevated odds for psychosis in developing countries. This finding may provide better understanding of the mechanisms by which urban living may contribute to psychosis risk in high-income countries, because urban-rural patterns of cannabis use, racial discrimination, and socioeconomic disparities may vary between developing and developed nations.

Clinical significance of psychotic experiences in the context of sleep disturbance or substance use.

Psychotic experiences (PE) are commonly reported in the general population, where they are associated with elevated clinical need and functional impairment. Research studies typically exclude PE that occur in the context of sleep or substance use (PE-SS), based on the assumption that they are normative within these contexts. This is the first study to formally test clinical and functional outcomes associated with PE that occur in the context of sleep or substance use. Data from the Collaborative Psychiatric Epidemiology Surveys (n = 11 776) were used to assess the associations between both PE and PE-SS and a broad range of outcomes, including psychiatric co-morbidity, suicidal behavior, mental health treatment utilization and World Health Organization (WHO) domains of function, using logistic regression analyses. Lifetime PE and PE-SS were mutually exclusive categories, assessed using the WHO Composite International Diagnostic Interview psychosis screen. PE were associated with all 10 clinical and functional outcomes. Similarly, respondents reporting PE-SS had greater clinical need and impaired function relative to controls, which was significant for seven of the 10 outcome variables. When directly compared, the PE and PE-SS groups differed only in their associations with role function (greater impairment for PE) and self-care (greater impairment for PE-SS). PE-SS were associated with a broad range of clinical and functional outcomes in this large general population sample. These associations were similar to those found for PE. Future studies should investigate relative differences between sleep- and substance-induced PE.

Lifetime Prevalence of Common Mental Disorders in Qatar: Using WHO Composite International Diagnostic Interview (WHO-CIDI)

Background : Mental Disorders, particularly Depression, are recognised as one of the biggest burden of disease worldwide. Two of the top three burdens of disease in Qatar are mental health related. Yet, this is scarcity of lifetime prevalence data available to understand the impact in this country. Aim : This study uses the WHO Composite International Diagnostic Interview (WHO-CIDI), to measure the lifetime prevalence of the most presenting mental disorders in the adult Qatari population, aged 18-65, and examine their symptom patterns and co-morbidity. Design : This is a cross sectional study conducted during the period from April 2010 to October 2011. Setting : Five Primary Health Care (PHC) Centres distributed around the country. Subjects : A total of 1,500 Qatari subjects aged 18 to 65 years were approached; 1,063 (70.8%) gave consent and participated in this study. Methods : Four field supervisors from Qatar were trained and certified as trainers by IDRAAC, the education and training centre responsible for the Arabic translation and validation of CIDI. Variations in Arabic dialect were reported to IDRAAC for verification and approval. In line with the World Health Organization (WHO) World Mental Health (WMH) Survey Initiative, a nationally representative psychiatric epidemiological survey was carried out in Qatar. Prevalence and severity of ICD-10 disorders were assessed with the WHO Composite International Diagnostic Interview (CIDI, Version 3.0). Results : Of the studied 1063 subjects, 50.1% were males and 49.9% were females. Most of the respondents were in the age group 18-34 years (46.1%), followed by 35-49 years (34.1%), then 50-65 years (19.8%). The most common ICD-10 disorders were specific generalized anxiety disorders (20.4)%, and major depression (19.1%), with a higher prevalence in women. 20.6% of the sample had chronic physical conditions. There were high levels of statistically significant differences between age groups and gender regarding Generalized Anxiety Disorders, Social phobia, specific phobia, major depression, and personality disorders screen. Women performed significantly worse as assessed by the 30 day functioning screen (p < 0.001). Conclusion : The findings of this study in lifetime prevalence of mental disorders in Qatar are comparable with international figures. Women were more likely than men to have mental illness. Overall, Generalized Anxiety Disorders; Social phobia, specific phobia, major depression, and personality disorders were the commonest disorders.

One-year test-retest reliability of a Japanese web-based version of the WHO Composite International Diagnostic Interview (CIDI) for major depression in a working population

The purpose of this study was to investigate the one-year test-retest reliability and the demographic correlates of a self-administered web-based depression section of the World Health Organization-Composite International Diagnostic Interview (WHO-CIDI) in a working population. Overall, 1060 out of all employees (N = 1279) from a manufacturing company in Japan responded to two web-based surveys of depression of the WHO-CIDI within a one-year interval in 2009 and 2010. The concordance between lifetime diagnoses of major depressive disorder on two occasions was calculated as percent agreement (%), Gwet's AC1 , and Yule's Q indicators were compared by gender, age, education, and marital status. For the total sample, percent agreement was 94%, AC1 was 0.93, and Yule's Q was 0.82. The concordance rate was low (0.15) among those who were diagnosed at either time or both times. The concordance differed significantly across education and marital status. While the agreement indicators were relatively high, consistent with previous reports based on face-to-face interviews conducted within a shorter interval, the low stability of positive cases may challenge the accuracy of lifetime diagnosis of major depressive disorder using a web version of the WHO-CIDI. Education and marital status might affect the test-retest reliability. Copyright © 2014 John Wiley & Sons, Ltd.

The Prevalence and Correlates of Binge Eating Disorder in the World Health Organization World Mental Health Surveys

Little population-based data exist outside the United States on the epidemiology of binge eating disorder (BED). Cross-national BED data are presented here and compared with bulimia nervosa (BN) data in the World Health Organization (WHO) World Mental Health Surveys. Community surveys with 24,124 respondents (ages 18+) across 14 mostly upper-middle and high-income countries assessed lifetime and 12-month DSM-IV mental disorders with the WHO Composite International Diagnostic Interview. Physical disorders were assessed with a chronic conditions checklist. Country-specific lifetime prevalence estimates are consistently (median; interquartile range) higher for BED (1.4%; .8-1.9%) than BN (.8%; .4-1.0%). Median age of onset is in the late teens to early 20s for both disorders but slightly younger for BN. Persistence is slightly higher for BN (6.5 years; 2.2-15.4) than BED (4.3 years; 1.0-11.7). Lifetime risk of both disorders is elevated for women and recent cohorts. Retrospective reports suggest that comorbid DSM-IV disorders predict subsequent onset of BN somewhat more strongly than BED and that BN predicts subsequent comorbid disorders somewhat more strongly than does BED. Significant comorbidities with physical conditions are due almost entirely to BN and to a somewhat lesser degree BED predicting subsequent onset of these conditions. Role impairments are similar for BN and BED. Fewer than half of lifetime BN or BED cases receive treatment. Binge eating disorder represents a public health problem at least equal to BN. Low treatment rates highlight the clinical importance of questioning patients about eating problems even when not included among presenting complaints.

Early-Life Mental Disorders and Adult Household Income in the World Mental Health Surveys

Better information on the human capital costs of early-onset mental disorders could increase sensitivity of policy makers to the value of expanding initiatives for early detection and treatment. Data are presented on one important aspect of these costs: the associations of early-onset mental disorders with adult household income. Data come from the World Health Organization (WHO) World Mental Health Surveys in 11 high-income, five upper-middle income, and six low/lower-middle income countries. Information about 15 lifetime DSM-IV mental disorders as of age of completing education, retrospectively assessed with the WHO Composite International Diagnostic Interview, was used to predict current household income among respondents aged 18 to 64 (n = 37,741) controlling for level of education. Gross associations were decomposed to evaluate mediating effects through major components of household income. Early-onset mental disorders are associated with significantly reduced household income in high and upper-middle income countries but not low/lower-middle income countries, with associations consistently stronger among women than men. Total associations are largely due to low personal earnings (increased unemployment, decreased earnings among the employed) and spouse earnings (decreased probabilities of marriage and, if married, spouse employment and low earnings of employed spouses). Individual-level effect sizes are equivalent to 16% to 33% of median within-country household income, and population-level effect sizes are in the range 1.0% to 1.4% of gross household income. Early mental disorders are associated with substantial decrements in income net of education at both individual and societal levels. Policy makers should take these associations into consideration in making health care research and treatment resource allocation decisions.

Comparison of Self-reported Cognitive Difficulties in a National Sample of Long-Term Cancer Survivors and Cancer-Naive Controls

Evidence that long-term cancer survivors (LTCS) experience greater cognitive dysfunction than individuals without cancer is mixed. This analysis of a population-based sample of United States residents compares self-reported cognitive difficulties in LTCS and cancer naïve controls (CNC), controlling for psychiatric disorders. National Comorbidity Survey-Replication (NCS-R) interviews were conducted in a nationally-representative sample of 9282 people, of whom 5692 were assessed for cancer history. Long-term survivors of adult cancers were defined as individuals who were at least 18 years old at time of diagnosis; greater than 5 years following diagnosis; and with cancer reportedly in remission or cured. Cognitive dysfunction queries included two screening questions and five items drawn than the World Health Organization (WHO) Disability Assessment Schedule 2.0. Psychiatric disorders were identified using the WHO's Composite International Diagnostic Interview. Odds ratios and 95% confidence intervals were obtained from multivariable logistic regression models fit to evaluate the relationship between cancer status (LTCS versus CNC) and cognitive symptoms. Of NCS-R participants, 225 met criteria for LTCS and 3953 for CNC. Long-term cancer survivors and CNC screened positive for cognitive symptoms at a rate of 19.5% and 20.8%, respectively, for the first screen and 16.0% and 16.4%, respectively, for the second. Adjusting for demographic and psychiatric variables, LTCS did not carry increased odds of experiencing cognitive symptoms [(OR) 1.00 (95% CI, .59 to 1.68); (OR) .95 (95 %CI, .57 to 1.59)]. Self-reported cognitive symptoms are common among LTCS and CNC. LTCS do not report cognitive symptoms with greater frequency.

The prevalence and comorbidity of social anxiety disorder among United States Latinos: a retrospective analysis of data from 2 national surveys.

Social anxiety disorder (SAD) is increasingly being recognized as a prevalent, unremitting, and highly comorbid disorder, yet studies focusing on this disorder among US Latinos and immigrant populations are not available. This article evaluates ethnic differences in the prevalence and comorbidity of SAD as well as the clinical and demographic characteristics associated with SAD. Cultural and contextual factors associated with risk of SAD are also examined within the Latino population more specifically. Data are analyzed from the National Latino and Asian American Study and the National Comorbidity Survey-Replication. Both studies utilized the World Health Organization-Composite International Diagnostic Interview, which estimates the prevalence of lifetime and 12-month psychiatric disorders according to DSM-IV criteria. Latinos reported a lower lifetime and 12-month SAD prevalence and a later age at onset than US-born non-Latino whites. On the other hand, Latinos diagnosed with 12-month SAD reported higher impairment across home, work, and relationship domains than their non-Latino white counterparts. Relative to non-Latino whites, Latinos who entered the United States after the age of 21 years were less likely to have lifetime SAD comorbidity with drug abuse and dependence and more likely to report lifetime SAD comorbidity with agoraphobia. The pattern of risk and associated characteristics of SAD varies for Latinos as compared to non-Latino whites. This is reflected by differences between these 2 groups across SAD prevalence, onset, impairment, and comorbidity. The particularly high comorbidity found with agoraphobia among Latinos who arrive in the United States as adults suggests that cultural factors and timing of immigration play a role in the manifestation and course of anxiety disorders. Interventions designed to decrease the levels of impairment associated with SAD are needed as well as efforts to target Latinos suffering from this disorder, specifically.

Twelve-Month Prevalence of and Risk Factors for Suicide Attempts in the World Health Organization World Mental Health Surveys

Although suicide is a leading cause of death worldwide, clinicians and researchers lack a data-driven method to assess the risk of suicide attempts. This study reports the results of an analysis of a large cross-national epidemiologic survey database that estimates the 12-month prevalence of suicidal behaviors, identifies risk factors for suicide attempts, and combines these factors to create a risk index for 12-month suicide attempts separately for developed and developing countries. Data come from the World Health Organization (WHO) World Mental Health (WMH) Surveys (conducted 2001-2007), in which 108,705 adults from 21 countries were interviewed using the WHO Composite International Diagnostic Interview. The survey assessed suicidal behaviors and potential risk factors across multiple domains, including sociodemographic characteristics, parent psychopathology, childhood adversities, DSM-IV disorders, and history of suicidal behavior. Twelve-month prevalence estimates of suicide ideation, plans, and attempts are 2.0%, 0.6%, and 0.3%, respectively, for developed countries and 2.1%, 0.7%, and 0.4%, respectively, for developing countries. Risk factors for suicidal behaviors in both developed and developing countries include female sex, younger age, lower education and income, unmarried status, unemployment, parent psychopathology, childhood adversities, and presence of diverse 12-month DSM-IV mental disorders. Combining risk factors from multiple domains produced risk indices that accurately predicted 12-month suicide attempts in both developed and developing countries (area under the receiver operating characteristic curve = 0.74-0.80). Suicidal behaviors occur at similar rates in both developed and developing countries. Risk indices assessing multiple domains can predict suicide attempts with fairly good accuracy and may be useful in aiding clinicians in the prediction of these behaviors.

Screening for serious mental illness in the general population with the K6 screening scale: results from the WHO World Mental Health (WMH) survey initiative

Data are reported on the background and performance of the K6 screening scale for serious mental illness (SMI) in the World Health Organization (WHO) World Mental Health (WMH) surveys. The K6 is a six-item scale developed to provide a brief valid screen for Diagnostic and Statistical Manual of Mental Disorders 4th edition (DSM-IV) SMI based on the criteria in the US ADAMHA Reorganization Act. Although methodological studies have documented good K6 validity in a number of countries, optimal scoring rules have never been proposed. Such rules are presented here based on analysis of K6 data in nationally or regionally representative WMH surveys in 14 countries (combined N = 41,770 respondents). Twelve-month prevalence of DSM-IV SMI was assessed with the fully-structured WHO Composite International Diagnostic Interview. Nested logistic regression analysis was used to generate estimates of the predicted probability of SMI for each respondent from K6 scores, taking into consideration the possibility of variable concordance as a function of respondent age, gender, education, and country. Concordance, assessed by calculating the area under the receiver operating characteristic curve, was generally substantial (median 0.83; range 0.76-0.89; inter-quartile range 0.81-0.85). Based on this result, optimal scaling rules are presented for use by investigators working with the K6 scale in the countries studied.

Associations between Abortion, Mental Disorders, and Suicidal Behaviour in a Nationally Representative Sample

Most previous studies that have investigated the relation between abortion and mental illness have presented mixed findings. We examined the relation between abortion, mental disorders, and suicidality using a US nationally representative sample. Data came from the National Comorbidity Survey Replication (n = 3310 women, aged 18 years and older). The World Health Organization-Composite International Diagnostic Interview was used to assess mental disorders based on the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria and lifetime abortion in women. Multiple logistic regression analyses were employed to examine associations between abortion and lifetime mood, anxiety, substance use, eating, and disruptive behaviour disorders, as well as suicidal ideation and suicide attempts. We calculated the percentage of respondents whose mental disorder came after the first abortion. The role of violence was also explored. Population attributable fractions were calculated for significant associations between abortion and mental disorders. After adjusting for sociodemographics, abortion was associated with an increased likelihood of several mental disorders--mood disorders (adjusted odds ratio [AOR] ranging from 1.75 to 1.91), anxiety disorders (AOR ranging from 1.87 to 1.91), substance use disorders (AOR ranging from 3.14 to 4.99), as well as suicidal ideation and suicide attempts (AOR ranging from 1.97 to 2.18). Adjusting for violence weakened some of these associations. For all disorders examined, less than one-half of women reported that their mental disorder had begun after the first abortion. Population attributable fractions ranged from 5.8% (suicidal ideation) to 24.7% (drug abuse). Our study confirms a strong association between abortion and mental disorders. Possible mechanisms of this relation are discussed.

Strong Link to Suicide Found for Anxiety, Conduct Disorders

Strong Link to Suicide Found for Anxiety, Conduct Disorders

New women-specific diagnostic modules: the Composite International Diagnostic Interview for Women (CIDI-VENUS)

The World Health Organization-Composite International Diagnostic Interview (WHO-CIDI) is a highly structured interview for the assessment of mental disorders, based on the definitions and criteria of the fourth edition of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). Over the past decade it has become evident that the CIDI does not sufficiently address the assessment needs of women. Women are affected by most mental disorders, particularly mood and anxiety disorders, approximately twice as frequently as men. Women-specific disorders, such as Premenstrual Syndrome (PMS), Premenstrual Dysphoric Disorder (PMDD), psychiatric disorders during pregnancy and postpartum as well as during the perimenopause, menopause and beyond are not addressed by the standard CIDI diagnostic modules. In addition, the CIDI in its current form does not address the potential effect that female reproductive milestones may have on diagnosis, treatment and prevention of mental disorders in women. Our aim was to develop a new women specific platform (CIDI-VENUS; CIDI-V) to be embedded in the existing CIDI that will address the above mentioned current deficiencies. Guided by a team of experts in the field of Women's Mental Health from Canada and Germany the following modules were developed: 1) A complete menstrual history and comprehensive contraceptive history with a link to the Premenstrual Symptoms Screening Tool (PSST). 2) A complete perinatal history of pregnancies, miscarriages, terminations, still births, death of a child, with details of current pregnancy including gestation and expected date of confinement, labour history and breastfeeding, history of tobacco, alcohol, and other substance use including prescription drugs during pregnancy and postpartum, a section on specific phobias and on recurrent obsessive/compulsive thoughts/behaviours (OCD) related to the baby with a link to the Perinatal Obsessive-Compulsive Scale (POCS), as well as a link to the Edinburgh Postnatal Depression Scale (EPDS). 3). A detailed history of use of hormone therapy (e.g. pills, patches, implants, etc.) with a focus on (peri-) menopausal women, differentiating between physical and psychological symptoms with a link to the Menopause Visual Analogue Scales (M-VAS) and to the Greene Climacteric Scale. 4) An iterative module concluding each CIDI section to specify the course of mental disorders during the reproductive stages and menopausal transition. While retaining core diagnostic sections and diagnostic algorithms, the CIDI-V is enriched by women-specific diagnostic modules, providing a wealth of clinically relevant information about women's mental health, not available anywhere else in our current psychiatric diagnostic instruments.

Prevalence of and risk factors for suicide‐related outcomes in the World Health Organization World Mental Health Surveys Japan

Suicide is a major public health concern in Japan but little is known about the prevalence of and risk factors for suicidal ideation, plans, and attempts. The aim of the present study was to clarify the prevalence of and risk factors for important suicide-related outcomes. Important suicide-related outcomes and risk factors were assessed in face-to-face interviews with 2436 adult respondents in seven areas as part of the World Health Organization (WHO) World Mental Health Survey Initiative. Mental disorders were assessed with the WHO Composite International Diagnostic Interview (CIDI). The lifetime prevalence estimates of suicidal ideation, plans, and attempts were 10.9%, 2.1%, and 1.9%, respectively. Risk of suicide plans and attempts was highest when suicidal ideation occurred at an early age and within the first year of ideation. In middle-aged individuals, the period after first employment and the presence of mental disorders were risk factors. Risk of suicide plans and attempts is highest when suicidal ideation occurred at an earlier age and within the first year of ideation. Mental disorders are as predictive of the suicide-related outcomes examined here, and comorbidity is an important predictor.

Psychiatric Epidemiology

mentaldisorders in a nationally representative US sample. 2 These studies established the methods ofmodern psychiatric epidemiology in the United States, including the use of reliable lay-administered structured diagnostic assessment tools to ascertain standardized diagnosticcriteria,3–4 the comparison of clinical interviews with lay interviews to evaluate diagnosticvalidity,5–7 and the application of sampling strategies to identify nationally representativesamples. Combined with earlier and richly informative international studies in psychiatricepidemiology,8–10 the ECA, NCS, and related surveys demonstrated that mental disorderswere highly prevalent in the general population and placed mental illness squarely on thenation's and the world's public health agenda.11These studies have also changed how we view psychopathology. Most mental illnesses, forexample, begin far earlier in life than was previously believed. In addition, findings such asthe frequency of comorbidity among the major diagnostic entities have led to systematic studiesof their boundaries and renewed questions about categorical vs dimensional approaches toclassification. Nonetheless, many critical issues were not addressed by earlier studies. Whilethe overall 12-month prevalence of any mental illness was reported to be in the range of 30%,significant questions about the disability associated with these syndromes remain. How severeare the disorders reported to be present in 30% of the population? What is the economic andpublic health impact of these conditions? How long is the delay between onset and diagnosis?And to what extent have we made progress in providing appropriate evidence-based treatmentsto those who are ill?The 4 articles from the National Comorbidity Survey Replication (NCS-R) published in thisissue of the ARCHIVES address each of these questions.12–15 The NCS-R uses theinternational World Health Organization-Composite International Diagnostic Interview(WHO-CIDI),6 a fully structured lay-administered interview, to generate

The World Health Organization adult ADHD self-report scale (ASRS): a short screening scale for use in the general population

A self-report screening scale of adult attention-deficit/hyperactivity disorder (ADHD), the World Health Organization (WHO) Adult ADHD Self-Report Scale (ASRS) was developed in conjunction with revision of the WHO Composite International Diagnostic Interview (CIDI). The current report presents data on concordance of the ASRS and of a short-form ASRS screener with blind clinical diagnoses in a community sample. The ASRS includes 18 questions about frequency of recent DSM-IV Criterion A symptoms of adult ADHD. The ASRS screener consists of six out of these 18 questions that were selected based on stepwise logistic regression to optimize concordance with the clinical classification. ASRS responses were compared to blind clinical ratings of DSM-IV adult ADHD in a sample of 154 respondents who previously participated in the US National Comorbidity Survey Replication (NCS-R), oversampling those who reported childhood ADHD and adult persistence. Each ASRS symptom measure was significantly related to the comparable clinical symptom rating, but varied substantially in concordance (Cohen's kappa in the range 0.16-0.81). Optimal scoring to predict clinical syndrome classifications was to sum unweighted dichotomous responses across all 18 ASRS questions. However, because of the wide variation in symptom-level concordance, the unweighted six-question ASRS screener outperformed the unweighted 18-question ASRS in sensitivity (68.7% v. 56.3%), specificity (99.5% v. 98.3%), total classification accuracy (97.9% v. 96.2%), and kappa (0.76 v. 0.58). Clinical calibration in larger samples might show that a weighted version of the 18-question ASRS outperforms the six-question ASRS screener. Until that time, however, the unweighted screener should be preferred to the full ASRS, both in community surveys and in clinical outreach and case-finding initiatives.

Prevalence, Severity, and Unmet Need for Treatment of Mental Disorders in the World Health Organization World Mental Health Surveys

Little is known about the extent or severity of untreated mental disorders, especially in less-developed countries. To estimate prevalence, severity, and treatment of Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) mental disorders in 14 countries (6 less developed, 8 developed) in the World Health Organization (WHO) World Mental Health (WMH) Survey Initiative. Face-to-face household surveys of 60 463 community adults conducted from 2001-2003 in 14 countries in the Americas, Europe, the Middle East, Africa, and Asia. The DSM-IV disorders, severity, and treatment were assessed with the WMH version of the WHO Composite International Diagnostic Interview (WMH-CIDI), a fully structured, lay-administered psychiatric diagnostic interview. The prevalence of having any WMH-CIDI/DSM-IV disorder in the prior year varied widely, from 4.3% in Shanghai to 26.4% in the United States, with an interquartile range (IQR) of 9.1%-16.9%. Between 33.1% (Colombia) and 80.9% (Nigeria) of 12-month cases were mild (IQR, 40.2%-53.3%). Serious disorders were associated with substantial role disability. Although disorder severity was correlated with probability of treatment in almost all countries, 35.5% to 50.3% of serious cases in developed countries and 76.3% to 85.4% in less-developed countries received no treatment in the 12 months before the interview. Due to the high prevalence of mild and subthreshold cases, the number of those who received treatment far exceeds the number of untreated serious cases in every country. Reallocation of treatment resources could substantially decrease the problem of unmet need for treatment of mental disorders among serious cases. Structural barriers exist to this reallocation. Careful consideration needs to be given to the value of treating some mild cases, especially those at risk for progressing to more serious disorders.