Consequences of the use of different classification systems: a comparison of the DSM-III-R and the ICD-10 for depression

This paper examines the consequences of applying two different psychiatric classification systems, DSM-III-R and ICD-10. Focusing on depression, the prevalence rates, the sociodemographic, personality and family history determinants and the consequences (quality of life, use of care, need for care) are compared. Data are from the Netherlands Mental Health Survey and Incidence Study (NEMESIS), a general population study among people 18–64 years of age. Depression was assessed by the Composite International Diagnostic Interview (CIDI). According to DSM-III-R, 15.7% of the population has suffered from depression at one point or another in their lives. For ICD-10, this percentage was 20.3%. The differences in prevalence rates appear to stem primarily from differences in the inclusion criteria. The DSMIII-R identifies a subset of more severe depressive categories and thereby produces lower prevalence rates, higher rates of comorbidity and stronger correlations between depression and its determinants and consequences. Copyright © 1999 Whurr Publishers Ltd.     

Prevalence of mood disorders in the rural population of Udmurtia

A sample of 855 rural adult inhabitants of Udmurtia was interviewed by means of the Composite International Diagnostic Interview (CIDI) in order to investigate the incidence and prevalence of mood disorders. Depression affected 30.5% of the population according to ICD-10, and 22% according to DSM-III-R over a 12-month period. Depressive disorders were more common in women (40.5%) than in men (17.4%), and in subjects who were widowed (68.8%), divorced (55.6%) or had poor family relationships. Depression was not related to ethnicity, educational level, income or living conditions. Depression showed a high level of comorbidity with social phobia in Udmurts and with persistent somatoform pain disorder in Russian women. The annual incidence of depressive episode was 7.5%, and the highest risk of depression was among younger women and older men.     

Child and adolescent psychiatric disorders in a public service over seventy years

The entire sample of N=45554 patients attending the child and adolescent psychiatric service of the Canton of Zurich, Switzerland between 1921 and 1990 was analyzed with regard to age, sex, and diagnoses. Data were based on annual reports of the institution for the period between 1921 and 1978. From 1979 onwards, electronically stored data on each patient were available. ICD-9 diagnoses were applied between 1979 and 1987. The ICD-10 system was introduced in 1988. The total administrative prevalence rate varied between 0.15 and 0.40 percent with an increasing trend over time. On the average, boys outnumbered girls by a sex ratio of 2:1. The age distribution showed peaks at 8 to 9 years and during adolescence. The distributions of the most common diagnoses showed remarkable differences over time. It is assumed that changes in diagnostic categories rather than changes in true prevalence rates play a major role in the latter trend.     

Predictors of first incidence of DSM-III-R psychiatric disorders in the general population: findings from the Netherlands Mental Health Survey and Incidence Study

OBJECTIVE: To investigate determinants of 12-month first incidence of DSM-III-R mood disorder (MD), anxiety disorder (AD) and substance use disorder (SUD) in the general population. METHOD: Data are from the Netherlands Mental Health Survey and Incidence Study (NEMESIS), a prospective epidemiologic study in which a representative sample of 7076 adults aged 18-64 years were interviewed with the Composite International Diagnostic Interview. New cases diagnosed 12 months after baseline were compared with never diagnosed controls on sociodemographic and psychosocial variables. RESULTS: Multivariate, the only demographic variable associated with incidence of MD was female gender. The strongest predictors were negative life events and ongoing difficulties. High level of neuroticism was also associated. Incidence of AD was likewise predicted by female gender. Negative life events and ongoing difficulties were also significant predictors, though weaker than for MD. Incidence of SUD was more common among males, young adults, people not living with a partner and those experiencing positive life events. CONCLUSION: Incident MD and AD were predicted more strongly by life events, and SUD more strongly by demographic factors.     

Prevalence of psychiatric disorders in children and adolescents with and without intellectual disability

Background There have been very few population‐based studies of the prevalence of psychiatric disorders among children and adolescents with and without intellectual disability (ID). Methods Secondary analysis of the 1999 Office for National Statistics survey of the Mental Health of Children and Adolescents in Great Britain was performed. This survey collected information on a multistage, stratified, random sample of 10 438 children between 5 and 15 years of age across 475 postcode sectors in England, Scotland and Wales. Results The prevalence of any diagnosed ICD‐10 disorder, conduct disorder, anxiety disorder, hyperkinesis and pervasive developmental disorders were significantly greater among children with ID than among their non‐ID peers. There were no statistically significant differences between children with and without ID with regard to the prevalence of depressive disorders, eating disorders or psychosis. Factors associated with an increased risk of psychopathology among children and adolescents with ID included age, gender, social deprivation, family composition, number of potentially stressful life events, the mental health of the child's primary carer, family functioning and child management practices. Conclusions Children and adolescents with ID are at significantly increased risk of certain forms of psychiatric disorder. Careful consideration of the social and economic adversity facing such families will be necessary to ensure that support services are responsive to both the needs of child as well as the needs of the family in which they are living.     

Epidemiology of DSM-III-R major depression and minor depression among adolescents and young adults in the national comorbidity survey

Data on the prevalences, comorbidities, and cohort effects of DSM-III-R major depression (MD) and minor depression (mD) are reported for the nationally representative sample of n = 1,769 adolescents and young adults who participated in the National Comorbidity Survey. Lifetime prevalences are 15.3% (MD) and 9.9% (mD), while 30-day prevalences are 5.8% (MD) and 2.1% (mD). Most cases reported recurrent episodes (73.9% of those with MD and 69.2% with mD) and significant role impairment, including attempted suicide among 21.9% of those with MD. The majority of lifetime cases (76.7% of those with MD and 69.3% with mD) reported other comorbid lifetime NCS/DSM-III-R disorders. Depression was temporally secondary in the majority of these cases. Number of prior disorders was more important than type of disorders in predicting subsequent depression, raising the possibility that secondary depression is a nonspecific severity marker for earlier disorders. A cohort effect for both MD and mD was documented that persisted even for episodes lasting a year or longer. Increasing prevalences of prior comorbid disorders were found to play an important part in explaining the cohort effect for depression. Depression and Anxiety 7:3–14, 1998. © 1998 Wiley-Liss, Inc.     

Trends in psychiatric hospitalization in Denmark: a 10-year register-based investigation.

Information about all admissions to psychiatric hospitals and departments in Denmark in 1977, 1982 and 1987 and about all resident patients on census days in the same years were extracted from the central psychiatric register. The number of available beds decreased by 43% from 1977 to 1987. The admission rates decreased for all diagnostic groups but schizophrenia, which increased. The group of younger schizophrenic men declined in size, which is alarming if mentally ill homeless people are considered. The census study shows a decrease in all diagnostic groups, most pronounced in the elderly age groups. Patients with neuroses disappear from the available beds in the mental hospitals and departments. The changes in the psychiatric service system from mostly hospitalization to outpatient treatment and community psychiatric treatment require a comprehensive personal registration of treatment regardless of the administrative affiliations of these services.     

Incidence of cardiovascular diseases and type-2-diabetes mellitus in patients with psychiatric disorders

Abstract

Objective: To assess the incidence of cardiovascular diseases (CVD) and type-2-diabetes in patients with psychiatric disorders.

Methods: A population-based study was conducted using the Swedish national health registries. Patients were identified from the Electronic Medical Records (EMR) in 20 primary care centers and were categorized in four diagnosis cohorts according to their first psychiatric diagnosis: bipolar disorder, schizophrenia, major depressive disorder, or other mood disorder. A control cohort of patients with no psychiatric disorders followed in the same primary care centers was also identified. Incident CVD and type-2-diabetes were defined as the presence of a diagnosis of CVD or diabetes during the follow-up period in patients without prior event.

Results: The age and sex standardized incidence rate of CVD was 13.5 per 1000 patient-year in the patients with any psychiatric disorder versus 6.3 per 1000 patient-year in the controls. A similar trend was observed for incident diabetes (5.7 versus 3.4 per 1000 patient-year, respectively). The bipolar disorder and the schizophrenia cohorts showed the highest standardized incidence rates.

Conclusion: Incidence of CVD and to a lesser extent type-2-diabetes was particularly high in patients with psychiatric disorders. This carries strong clinical implications for the prevention of CVD and type-2-diabetes in these patients.     

Gender and age-specific first incidence of DSM-III-R psychiatric disorders in the general population

Background Prospective studies in the general population are needed to identify risk factors for mental disorders. Samples of sufficient size are needed, but large-scale studies that assess the incidence of psychopathology are rare. Aims The aim of this study was to investigate the 12-month first incidence rates (IR) by age and gender for 15 specified DSM-III-R disorders in the general population. Methods The study was based on a representative sample (N = 5618) of the Dutch population aged 18–64. Results The IR for any disorder was 5.68 per 100 person-years at risk (men 4.45, women 6.94). IRs for both men and women were highest in the youngest age category. The most common 12-month incident disorders in men were alcohol abuse (IR = 4.09) and major depression (1.72). In women, the most common incident disorders were major depression (IR = 3.90) and simple phobia (3.17). Conclusions The results show the rarity of first-onset of mental disorders. IRs vary strongly between the different life phases, as well as between men and women. This suggests potential target areas for age-specific and gender-specific prevention. Accepted: 19 March 2002     

Early life experiences and psychiatric disorders: An adoptee study

The aim of this study was to investigate whether there is any correlation between negative experiences in early infancy and the later occurrence of psychiatric disorders. The subjects in this study were a cohort of 2,215 adoptees born 1930–1949. Information about the probands' early experiences has been obtained from the files of the Child Welfare Office, which include age at time of placement in the adoptive home and type of care before placement. 136 of the probands had been treated in a psychiatric department or mental hospital. From the case records a uniform classification of diagnoses was made. The analyses have been carried out in two steps; first as repeated univariate analyses and secondly as series of discriminant function analyses. Reactive neurotic depression was significantly correlated with placement at the age of 6–12 months, but with this sole exception there was no support for the hypothesis of a correlation between psychiatric disorders and early experiences.     

Prognosis of postpartum psychiatric disorders in a Turkish sample

Objective

The postpartum period represents a time of increased risk for psychiatric disorders. Postpartum depression is especially very common. Many aetiological risk factors have been reported for postpartum psychiatric disorders. The purpose of this study was to evaluate the postpartum psychiatric disorders in a Turkish sample and discuss their course.

Methods

The files of 6000 inpatients who were admitted to Gazi University School of Medicine Psychiatry Department were evaluated retrospectively, and 67 patients were chosen whose psychiatric illness had began puerperally. These patients were grouped according to age of onset of the illness, number of episodes and the type of these episodes, their postpartum psychiatric diagnoses and illness prognosis.

Results

Of 6000 patients, 67 (1.11%) were diagnosed as having a postpartum psychiatric disorder: 56.7% (n=38) were diagnosed as having a postpartum psychotic disorder, while 35.8% (n=24) as having an affective disorder. Forty-seven patients (70.1%) received a diagnosis of major psychiatric disorder during their follow-up.

Conclusion

These results show that postpartum diagnoses may show a chronic course and cause a life-time psychiatric illness and therefore patients should be monitored carefully for psychotic symptoms even after the acute period is over.     

“Patterns of comorbidity” among DSM-III-R and ICD-10 personality disorders as observed with a new inventory for the assessment of personality disorders

Although DSM-III-R and ICD-10 suggest the assignment of multiple personality diagnoses, a high degree of overlap may be an indicator of insufficiently distinct and too inclusive types of personality. We studied this problem with a new inventory in an unselected clinical sample. The Aachen List of Items for the Registration of Personality Disorders (AMPS) integrates the different types of disordered personality according to DSM-III-R, ICD-10, and four subaffective categories, which largely follow the typologies of Kracpelin, K. Schneider, and Kretschmer. The prevalence rate of each personality disorder was calculated in a consecutive group of 231 patients. Patterns of comorbidity were computed using odds ratios. More than one personality disorder was found in 41% according to DSM-III-R. ICD-10 showed a significantly higher degree of overlap. Interesting comorbidity patterns are discussed in comparison with several North American studies. Results indicate that clear-cut categorical personality diagnoses are not likely to be set up.     

Prevalence of somatoform disorders in a psychiatric population: an Italian nationwide survey

The survey involved 50 centres comprising both hospital and community psychiatric care services throughout Italy. Overall, 2620 patients were recruited, and of those 2002 (76%) completed the Somatoform Disorders Schedule (SDS), a CIDI-derived interview. The NOS somatoform disorders (SDs) diagnosis appeared to be the most common (60%) (and they showed the highest number of co-morbid diagnoses), followed by pain disorders (8%). The prevalence of undifferentiated somatoform and hypochondriactal disorders was 1.6%: older age groups showed a tendency towards higher rates of the latter. In general, the study found that a significant percentage of patients with SDs are referred to psychiatric services, but mainly because of other psychopathological problems: in fact, somatic complaints are cross-sectionally present in different psychiatric nosological categories. This study also emphasizes some limitations of the current classification of SDs. Received: 9 August 1996 / Accepted: 14 July 1998     

Relationship between mood related disorders and quality of life in a population of Dutch adult psychiatric outpatients

Our objective was to investigate explicitly the relationship between mood-related disorders (MRDs) and quality of life (QOL), while trying to overcome the limitations of earlier research. QOL scores of psychiatric outpatients with MRDs were compared with QOL scores of outpatients without MRD and a sample of the general Dutch population (GDP). QOL was assessed with the World Health Organization Quality of Life assessment instrument, long version (WHOQOL-100), and depressive symptoms were assessed with the Symptom Checklist-90 (SCL-90). Outpatients with MRD had lower scores on all aspects of the WHOQOL-100 compared with the GDP. Compared with outpatients without MRD, the outpatients with MRD scored lower on most aspects of the WHOQOL-100. Within the group with MRDs, patients with major depressive disorder (MDD) had lower QOL scores compared with patients with dysthymic disorder or adjustment disorder with depressed mood. Severity of MRD and MDD was negatively related to QOL. Comorbid personality disorders worsened QOL. Within the group with MRDs, common variance between depressive symptoms and QOL did not exceed 25%. MRDs are negatively related with QOL. Severity of MRD and comorbidity of personality disorders decrease QOL further. MRDs affect all domains and facets of QOL. The relationship found between MRDs and QOL was not caused by an overlap between the concepts depressive symptoms and QOL, shown by the relative small common variance between (depressive) symptoms and QOL.     

Prevalence of psychiatric disorders in a Brazilian birth cohort of 11-year-olds

Objective  

To estimate the prevalence of psychiatric disorders in preadolescents aged 11–12 years from a birth cohort in a southern Brazilian city.