A comparison of DSM-5 and DSM-IV agoraphobia in the World Mental Health Surveys.

BACKGROUND: The Diagnostic and Statistical Manual of Mental Disorders, version 5 (DSM-5) definition of agoraphobia (AG) as an independent diagnostic entity makes it timely to re-examine the epidemiology of AG. Study objective was to present representative data on the characteristics of individuals who meet DSM-IV criteria for AG (AG without a history of panic disorder [PD] and PD with AG) but not DSM-5 criteria, DSM-5 but not DSM-IV criteria, or both sets of criteria. METHODS: Population-based surveys from the World Mental Health Survey Initiative including adult respondents (n = 136,357) from 27 countries across the world. The Composite International Diagnostic Interview was used to assess AG and other disorders. RESULTS: Lifetime and 12-month prevalence estimates of DSM-5 AG (1.5% and 1.0%) were comparable to DSM-IV (1.4% and 0.9%). Of respondents meeting criteria in either system, 57.1% met criteria in both, while 24.2% met criteria for DSM-5 only and 18.8% for DSM-IV only. Severe role impairment due to AG was reported by a lower proportion of respondents who met criteria only for DSM-IV AG (30.4%) than those with both DSM-5 and DSM-IV AG (44.0%; χ 21 = 4.7; P = 0.031). The proportion of cases with any comorbidity was lower among respondents who met criteria only for DSM-IV AG (78.7%) than those who met both sets (92.9%; χ 21 = 14.5; P < 0.001). CONCLUSIONS: This first large survey shows that, compared to the DSM-IV, the DSM-5 identifies a substantial group of new cases with AG, while the prevalence rate remains stable at 1.5%. Severity and comorbidity are higher in individuals meeting DSM-5 AG criteria compared with individuals meeting DSM-IV AG criteria only.

Associations between DSM-IV mental disorders and diabetes mellitus: a role for impulse control disorders and depression.

AIMS/HYPOTHESIS: No studies have evaluated whether the frequently observed associations between depression and diabetes could reflect the presence of comorbid psychiatric conditions and their associations with diabetes. We therefore examined the associations between a wide range of pre-existing Diagnostic Statistical Manual, 4th edition (DSM-IV) mental disorders with self-reported diagnosis of diabetes. METHODS: We performed a series of cross-sectional face-to-face household surveys of community-dwelling adults (n = 52,095) in 19 countries. The World Health Organization Composite International Diagnostic Interview retrospectively assessed lifetime prevalence and age at onset of 16 DSM-IV mental disorders. Diabetes was indicated by self-report of physician's diagnosis together with its timing. We analysed the associations between all mental disorders and diabetes, without and with comorbidity adjustment. RESULTS: We identified 2,580 cases of adult-onset diabetes mellitus (21 years +). Although all 16 DSM-IV disorders were associated with diabetes diagnosis in bivariate models, only depression (OR 1.3; 95% CI 1.1, 1.5), intermittent explosive disorder (OR 1.6; 95% CI 1.1, 2.1), binge eating disorder (OR 2.6; 95% CI 1.7, 4.0) and bulimia nervosa (OR 2.1; 95% CI 1.3, 3.4) remained after comorbidity adjustment. CONCLUSIONS/INTERPRETATION: Depression and impulse control disorders (eating disorders in particular) were significantly associated with diabetes diagnosis after comorbidity adjustment. These findings support the focus on depression as having a role in diabetes onset, but suggest that this focus may be extended towards impulse control disorders. Acknowledging the comorbidity of mental disorders is important in determining the associations between mental disorders and subsequent diabetes.

Cumulative traumas and risk thresholds: 12-month PTSD in the World Mental Health (WMH) surveys.

BACKGROUND: Clinical research suggests that posttraumatic stress disorder (PTSD) patients exposed to multiple traumatic events (TEs) rather than a single TE have increased morbidity and dysfunction. Although epidemiological surveys in the United States and Europe also document high rates of multiple TE exposure, no population-based cross-national data have examined this issue. METHODS: Data were analyzed from 20 population surveys in the World Health Organization World Mental Health Survey Initiative (n = 51,295 aged 18+). The Composite International Diagnostic Interview (3.0) assessed 12-month PTSD and other common DSM-IV disorders. Respondents with 12-month PTSD were assessed for single versus multiple TEs implicated in their symptoms. Associations were examined with age of onset (AOO), functional impairment, comorbidity, and PTSD symptom counts. RESULTS: 19.8% of respondents with 12-month PTSD reported that their symptoms were associated with multiple TEs. Cases who associated their PTSD with four or more TEs had greater functional impairment, an earlier AOO, longer duration, higher comorbidity with mood and anxiety disorders, elevated hyperarousal symptoms, higher proportional exposures to partner physical abuse and other types of physical assault, and lower proportional exposure to unexpected death of a loved one than cases with fewer associated TEs. CONCLUSIONS: A risk threshold was observed in this large-scale cross-national database wherein cases who associated their PTSD with four or more TEs presented a more "complex" clinical picture with substantially greater functional impairment and greater morbidity than other cases of PTSD. PTSD cases associated with four or more TEs may merit specific and targeted intervention strategies.

Irritable mood in adult major depressive disorder: results from the world mental health surveys.

BACKGROUND: Although irritability is a core symptom of DSM-IV major depressive disorder (MDD) for youth but not adults, clinical studies find comparable rates of irritability between nonbipolar depressed adults and youth. Including irritability as a core symptom of adult MDD would allow detection of depression-equivalent syndromes with primary irritability hypothesized to be more common among males than females. We carried out a preliminary examination of this issue using cross-national community-based survey data from 21 countries in the World Mental Health (WMH) Surveys (n = 110,729). METHODS: The assessment of MDD in the WHO Composite International Diagnostic Interview includes one question about persistent irritability. We examined two expansions of the definition of MDD involving this question: (1) cases with dysphoria and/or anhedonia and exactly four of nine Criterion A symptoms plus irritability; and (2) cases with two or more weeks of irritability plus four or more other Criterion A MDD symptoms in the absence of dysphoria or anhedonia. RESULTS: Adding irritability as a tenth Criterion A symptom increased lifetime prevalence by 0.4% (from 11.2 to 11.6%). Adding episodes of persistent irritability increased prevalence by an additional 0.2%. Proportional prevalence increases were significantly higher, but nonetheless small, among males compared to females. Rates of severe role impairment were significantly lower among respondents with this irritable depression who did not meet conventional DSM-IV criteria than those with DSM-IV MDD. CONCLUSION: Although limited by the superficial assessment in this single question on irritability, results do not support expanding adult MDD criteria to include irritable mood.

Associations between DSM-IV mental disorders and onset of self-reported peptic ulcer in the World Mental Health Surveys.

OBJECTIVE: Recent research demonstrating concurrent associations between mental disorders and peptic ulcers has renewed interest in links between psychological factors and ulcers. However, little is known about associations between temporally prior mental disorders and subsequent ulcer onset. Nor has the potentially confounding role of childhood adversities been explored. The objective of this study was to examine associations between a wide range of temporally prior DSM-IV mental disorders and subsequent onset of ulcer, without and with adjustment for mental disorder comorbidity and childhood adversities. METHODS: Face-to-face household surveys conducted in 19 countries (n=52,095; person years=2,096,486). The Composite International Diagnostic Interview retrospectively assessed lifetime prevalence and age at onset of 16 DSM-IV mental disorders. Peptic ulcer onset was assessed in the same interview by self-report of physician's diagnosis and year of diagnosis. Survival analyses estimated associations between first onset of mental disorders and subsequent ulcer onset. RESULTS: After comorbidity and sociodemographic adjustment, depression, social phobia, specific phobia, post-traumatic stress disorder, intermittent explosive disorder, alcohol and drug abuse disorders were significantly associated with ulcer onset (ORs 1.3-1.6). Increasing number of lifetime mental disorders was associated with ulcer onset in a dose-response fashion. These associations were only slightly attenuated by adjustment for childhood adversities. CONCLUSIONS: A wide range of mental disorders were linked with the self-report of subsequent peptic ulcer onset. These associations require confirmation in prospective designs, but are suggestive of a role for mental disorders in contributing to ulcer vulnerability, possibly through abnormalities in the physiological stress response associated with mental disorders.

Associations between DSM-IV mental disorders and subsequent heart disease onset: beyond depression.

BACKGROUND: Prior studies on the depression-heart disease association have not usually used diagnostic measures of depression, or taken other mental disorders into consideration. As a result, it is not clear whether the association between depression and heart disease onset reflects a specific association, or the comorbidity between depression and other mental disorders. Additionally, the relative magnitude of associations of a range of mental disorders with heart disease onset is unknown. METHODS: Face-to-face household surveys were conducted in 19 countries (n=52,095; person years=2,141,194). The Composite International Diagnostic Interview retrospectively assessed lifetime prevalence and age at onset of 16 DSM-IV mental disorders. Heart disease was indicated by self-report of physician's diagnosis, or self-report of heart attack, together with their timing (year). Survival analyses estimated associations between first onset of mental disorders and subsequent heart disease onset. RESULTS: After comorbidity adjustment, depression, panic disorder, specific phobia, post-traumatic stress disorder and alcohol use disorders were associated with heart disease onset (ORs 1.3-1.6). Increasing number of mental disorders was associated with heart disease in a dose-response fashion. Mood disorders and alcohol abuse were more strongly associated with earlier onset than later onset heart disease. Associations did not vary by gender. CONCLUSIONS: Depression, anxiety and alcohol use disorders were significantly associated with heart disease onset; depression was the weakest predictor. If confirmed in future prospective studies, the breadth of psychopathology's links with heart disease onset has substantial clinical and public health implications.

Disability mediates the impact of common conditions on perceived health.

BACKGROUND: We examined the extent to which disability mediates the observed associations of common mental and physical conditions with perceived health. METHODS AND FINDINGS: WHO World Mental Health (WMH) Surveys carried out in 22 countries worldwide (n = 51,344 respondents, 72.0% response rate). We assessed nine common mental conditions with the WHO Composite International Diagnostic Interview (CIDI), and ten chronic physical with a checklist. A visual analog scale (VAS) score (0, worst to 100, best) measured perceived health in the previous 30 days. Disability was assessed using a modified WHO Disability Assessment Schedule (WHODAS), including: cognition, mobility, self-care, getting along, role functioning (life activities), family burden, stigma, and discrimination. Path analysis was used to estimate total effects of conditions on perceived health VAS and their separate direct and indirect (through the WHODAS dimensions) effects. Twelve-month prevalence was 14.4% for any mental and 51.4% for any physical condition. 31.7% of respondents reported difficulties in role functioning, 11.4% in mobility, 8.3% in stigma, 8.1% in family burden and 6.9% in cognition. Other difficulties were much less common. Mean VAS score was 81.0 (SD = 0.1). Decrements in VAS scores were highest for neurological conditions (9.8), depression (8.2) and bipolar disorder (8.1). Across conditions, 36.8% (IQR: 31.2-51.5%) of the total decrement in perceived health associated with the condition were mediated by WHODAS disabilities (significant for 17 of 19 conditions). Role functioning was the dominant mediator for both mental and physical conditions. Stigma and family burden were also important mediators for mental conditions, and mobility for physical conditions. CONCLUSIONS: More than a third of the decrement in perceived health associated with common conditions is mediated by disability. Although the decrement is similar for physical and mental conditions, the pattern of mediation is different. Research is needed on the benefits for perceived health of targeted interventions aimed at particular disability dimensions.

[The gateway to illegal substance use in Colombia: violations of the gateway rule]. / Puerta de Entrada al Consumo de Sustancias Ilegales en Colombia: Infracciones a la Norma de Inicio.

OBJECTIVE: Establishing the frequency of gateway illegal substance use with alcohol or nicotine being violated amongst Colombian adults in the general population. METHODS: A descriptive study was carried out on adults from the general Colombian population. Gateway frequencies were determined for illegal substance use regarding substances other than alcohol or nicotine. RESULTS: A total of 4,426 adults participated in this research. A group of 127 people (3.3%) reported that they had started illegal substance use before using alcohol or nicotine; 2.3% of them had used other illegal substance before using cannabis, 0,6 % had smoked cannabis before using alcohol or nicotine and 0,4 % had used other illegal substances before using alcohol or nicotine. CONCLUSIONS: A small group of people who use illegal substances in Colombia start with substances different to alcohol or nicotine. The factors associated with gateway use of illegal substances (regarding substance other than alcohol or nicotine) should be investigated.

Puerta de Entrada al Consumo de Sustancias Ilegales en Colombia: Infracciones a la Norma de Inicio / The gateway to illegal substance use in Colombia: violations of the gateway rule

Objetivo Establecer la frecuencia de la infracción a la norma del inicio de sustancias ilegales con el uso de alcohol o nicotina en adultos colombianos de la población general. Métodos Se realizó un estudio descriptivo con adultos de la población general de Colombia. Se determinaron las frecuencias de inicio de consumo de sustancias ilegales con sustancias distintas a alcohol o nicotina. Resultados En un total de 4 426 adultos participaron en la investigación y se observó que 127 personas (3,3 por ciento) iniciaron el consumo de sustancias ilegales con el uso de sustancias diferentes a alcohol o nicotina: 2,3 por ciento otra sustancia ilegal antes que marihuana; 0,6 por ciento marihuana antes que alcohol o nicotina; y 0,4 por ciento otra sustancia ilegal antes que alcohol o nicotina. Conclusiones Un número reducido de consumidores de sustancias ilegales en Colombia inicia con sustancias distintas a alcohol o nicotina. Es necesario investigar los factores asociados con este inicio.

Objective Establishing the frequency of gateway illegal substance use with alcohol or nicotine being violated amongst Colombian adults in the general population. Methods A descriptive study was carried out on adults from the general Colombian population. Gateway frequencies were determined for illegal substance use regarding substances other than alcohol or nicotine. Results A total of 4,426 adults participated in this research. A group of 127 people (3.3 percent) reported that they had started illegal substance use before using alcohol or nicotine; 2.3 percent of them had used other illegal substance before using cannabis, 0,6 percent had smoked cannabis before using alcohol or nicotine and 0,4 percent had used other illegal substances before using alcohol or nicotine. Conclusions A small group of people who use illegal substances in Colombia start with substances different to alcohol or nicotine. The factors associated with gateway use of illegal substances (regarding substance other than alcohol or nicotine) should be investigated.

Prevalencia, severidad y nesecidad no satisfechas del tratamiento de los trastornos de ansiedad, relacionados con sustancias, del estado de ánimo y del control de los impulsos en adultos según el Estudio Nacional de Salud Mental, Colombia, 2003 / Prevalence, severity and unsatisfied needs, usually find during treatments for anxiety related to the abuse of substances, their mental health, as well as, the control of impulses in adults according to The National Study on Mental Health, Colombia 2003

CONTEXTO: Poco se conoce acerca de la severidad y los correlatos de trastornos mentales sin tratamiento en Colombia. OBJETIVO: Estimar la prevalencia, la severidad y el tratamiento de los trastornos de ansiedad, relacionados con sustancias, del estado de ánimo y del control de los impulsos en adultos según el Estudio Nacional de Salud Mental (ENSM) Colombia 2003. El análisis se realizó a partir de la base de datos aprobada por la Organización Mundial de la Salud (OMS) y la Universidad de Harvard para el ENSM. METODOLOGÍA: Entrevistas cara a cara en hogares de 60 municipios de Colombia representativos del país. Participaron un total de 4.544 adultos. Se empleó como instrumento el CIDI-OMS. Resultados: La prevalencia de tener durante el transcurso de la vida cualquier trastorno CIDI-OMS/ DSM-IV es del 40.1 por ciento, siendo los trastornos de ansiedad los más altos durante la vida (19.5 por ciento) y en los últimos 12 meses (9.9 por ciento). Los trastornos de ansiedad tienen la mediana más temprana de edad de inicio a los nueve años. Los trastornos mentales graves están asociados a una discapacidad importante en los papeles y funcionalidad de los adultos colombianos, con un promedio de 27.9 días por año. CONCLUSIONES: Una reubicación del tratamiento acompañado de una política en salud mental podría disminuir substancialmente la dificultad de las necesidades no satisfechas de tratamiento para trastornos graves. Se pone en consideración la necesidad de proveer a los casos moderados y leves un tratamiento, especialmente si están en riesgo de evolucionar hacia trastornos más graves. [Posada JA, Trevisi C. Prevalencia, severidad y necesidades no satisfechas del tratamiento de los trastornos de ansiedad, relacionados con sustancias, del estado de ánimo y del control de los impulsos en adultos según el Estudio Nacional de Salud Mental, Colombia, 2003. MedUNAB 2004; 7:65-72]

Prevalence, severity and unsatisfied needs, usually find during treatments for anxiety related to the abuse of substances, their mental health, as well as, the control of impulses in adults according to The National Study on Mental Health, Colombia 2003. BACKGROUND: In our Country, Colombia, little is known about the severity of mental disorders without any treatment. OBJECTIVE: To estimate the prevalence, severity and treatment of anxiety disorders related to substances, mental health and control of impulses among adults, according to the ENSM Colombia, 2003. The analysis was done from a data base approved by WHO and Harvard University for the World Questionnaire for Mental Health. METHODOLOGY: We, personally, interviewed homes from 60 towns in Colombia. 4544 people responded the questionnaire. CIDI-WHO instrument was fol-lowed. Results: The prevalence, in Colombia, for having any metal disorder (CIDI-WHO / DSM IV) during life is 40.1%, being anxiety disorders the highest, reaching a 19.5% during their lives, and a 9.9% will be during the last 12 months. Anxiety also have the earliest presentation in life, about the 9th decade. Among Colombians the serious mental disorders are associated with a great disability and a poor functional status. This accounts for an average of 27.9 lost days per year. CONCLUSIONS: It is mandatory to design new political strategies directed to obtain a satisfactory mental health, by means of new treatments, in order to diminish the unsatisfied needs in the management of serious mental disorders. We stress the fact of the need to intervene, by means of a treatment the light to moderate cases, especially if they are at risk to become a serious disorder

Las técnicas de evaluación psicométrica en salud mental y psiquiatría / Psychometric evaluation techniques in mental health and psychiatry

El presente artículo describe de manera general qué es la psicometría, las áreas que cubre y algunas aplicaciones prácticas en el trabajo clínico psiquiatrico, además de establecer puentes entre la actividad psiquiatrica y los aportes de las evaluaciones psicométricas.Compara las evaluaciones psicométricas con las entrevistas psiquiatricas. Finalmente, presenta los principales instrumentos de evaluación psiquiatrica diseñados por la Organización Mundial de la Salud...

The article revises in general way what the psychometry is, the covered areas, and some practical applications in the clinical psychiatric practice. It also provides bridges between psychiatric practice and the help given by psycometric evaluations. The differences between psychometric evaluations and the psychiatric interview are discussed. Finally, the most important instruments of psychiatric evaluation designed by Word Health Organizaction are presented...

Prevalencia de trastornos mentales y uso de servicios: resultados preliminares del Estudio nacional de salud mental. Colombia, 2003 / Prevalence of Mental Disorders and use of Services: Preliminary Results from of the National Study of Mental Health, Colombia, 2003

Este estudio forma parte de la Encuesta mundial de salud mental (EMSM), de la Organización Mundial de la Salud (OMS) y describe la prevalencia de trastornos mentales, las variaciones en la distribución geográfica de los trastornos, los correlatos sociodemográficos y la utilización de servicios en la población urbana adulta. El Estudio nacional de salud mental Colombia 2003 (ENSM) se basa en un diseño probabilístico, multietápico y estratificado para cinco regiones del país, cuya población blanco fue la población no institucionalizada, que tiene un hogar fijo, de 18 a 65 años de edad y que vive en áreas urbanas. La tasa de respuesta ponderada fue de 87,7%. El instrumento utilizado es la versión computarizada de la Entrevista diagnóstica internacional compuesta (versión certificada 15), que proporciona diagnósticos de acuerdo con el DSMIV y la CIE-10. Alrededor del 56% de la muestra fueron mujeres, el 37% tenían entre 18 y 29 años, de las cuales el 26% reportó únicamente estudios primarios y el 45%, estudios secundarios. El 40,1% de la población reportó haber tenido alguna vez en su vida uno o más de los 23 trastornos basados en el DSM-IV, el 16,0% de la muestra evidenció trastornos mentales en los últimos doce meses y el 7,4% presentó alguno en los últimos treinta días. Los trastornos más frecuentemente reportados alguna vez en la vida fueron los de ansiedad (19,3%), seguido por los trastornos del estado de ánimo (15,0%) y los trastornos por uso de sustancias (10,6%). El 4,9% de la población estudiada ha intentado suicidarse alguna vez en la vida y el 1,3% lo ha intentado en los últimos treinta días. Sólo una de cada diez personas con un trastorno mental y sólo una de cada cinco con dos o más trastornos mentales dijo recibir servicios de cualquier tipo en el último año. Esto representa un reto para el sistema de salud y demuestra la necesidad de enfocar atención y recursos hacia el tratamiento oportuno de enfermedades mentales.

This study comprises part of the World Mental Health Survey (WMH) of the World Health Organization (WHO) and describes the prevalence of mental disorders, variations in the geographic distribution of disorders, the sociodemographic correlates and the utilization of services in the adult urban population. The Estudio Nacional de Salud Mental Colombia 2003 (ENSM) is based on a probabilistic, multistage and stratified sampling design within 5 regions of Colombia. The target population was urban non-institutionalized inhabitants of permanent dwellings, between the ages of 18 to 65 years. The response rate was 87.7%. The instrument used for this study was a computerized version of the Composite International Diagnostic Interview (CIDI) (registered version 15) that provides diagnoses in agreement with the Statistical Manual of Mental Disorders-IV and the International Classification of Disease, edition 10. Fiftysix percent of the sample was female, 37% was between the ages of 18 and 29 years old, and 26% had only a primary education while 45% had secondary education. Lifetime prevalence rates were calculated at 40.1% for any of the 23 DSM-IV disorders included in the CIDI, 16% for the past 12 months, and 7.4% for the past 30 days. Anxiety disorders were most frequently reported (19.3% lifetime prevalence rates) followed by affective disorders (15.0%) and substance use disorders (10.6%). Lifetime rates for suicide attempts for the overall sample were calculated at 4.9% with 1.3% reported suicide attempts in the past 30 days. The data indicates that only one out of every 10 individuals with one mental disorder and only one out of every five with two or more mental disorders receives any type of treatment. This represents a challenge to the system of health care and demonstrates the need to focus our attention and resources toward the treatment of mental disorders.

Encuesta nacional de servicios de atención al menor maltratado en hospitales de Colombia / National survey of attention services to battered child in hospitals of Colombia

El presente estudio pretende dar información sobre las condiciones de los servicios de atención al maltrato infantil en 100 hospitales de todo el país. La información utilizada fue recopilada del estudio denominada: maltrato y buen trato a menores, un perfil de Colombia, realizado por el Centro Nacional de Consultoría (CNC), para el Instituto Colombiano de Bienestar Familiar (ICBF), bajo la asesoría del autor. En general, 18 por ciento de los menores fueron reportados como sospechosos de sufrir maltrato y 3 por ciento recibieron diagnóstico clínico de maltrato. Entre los menores con maltrato clínicamente confirmado, el maltrato físico, la negligencia física y el maltrato emocional fueron las más frecuentemente reportado. El 62 por ciento de los hospitales no tenían protocolos para la atención de estos casos, 41 por ciento no tenían un adecuado apoyo logístico y el 48 por ciento no tenían equipos interdisciplinario para este menester. Solo 22 por ciento de los niños tuvieron acceso a una atención adecuada y 9 por ciento tuvieron una solución definitiva al problema