The Sesto Fiorentino study: background, methods and preliminary results. Lifetime prevalence of psychiatric disorders in an Italian community sample using clinical interviewers

BACKGROUND: This paper presents lifetime prevalences and estimated risks of DSM-IV psychiatric disorders from a community survey conducted in Sesto Fiorentino, Italy, using psychiatric interviewers with clinical experience and clinical instruments. METHODS: Two thousand five hundred subjects aged 14 or more were randomly selected from the lists of 15 general practitioners (GPs) regardless of whether or not they had consulted the GP. A three-phase design was adopted, with the GPs using the Mini International Neuropsychiatric Interview (MINI) for the first stage. All positive cases at the MINI and a probability sample of 123 negative cases were re-interviewed by psychiatrists or trained residents in psychiatry using the Florence Psychiatric Interview (FPI) at the second stage. During phase III, the subjects were administered the rating scales specific to the pathology detected by the FPI. RESULTS: Two thousand three hundred and sixty-three subjects were interviewed (response rate 94.5%) by their own GP; 623 were found positive for any psychiatric disorder. The psychiatrists could re-interview 605 of these, along with a random sample of 123 negatives. Almost twenty-five percent (24.4%; 15.7% males, 31.7% females) of the population was found positive for any DSM-IV disorder during their lives. The most common diagnosis was major depressive episode, followed by anxiety not otherwise specified. Women had higher rates for most disorders. CONCLUSIONS: The prevalence rates for most of the disorders considered are generally comparable with the range identified by previous studies conducted in other Western countries, even though they were using different methodologies. Exceptions are represented by the high prevalence of residual categories and the lower prevalence of phobias.     

Prevalence, incidence and stability of premenstrual dysphoric disorder in the community

BACKGROUND: Despite an abundance of clinical research on premenstrual and menstrual symptoms, few epidemiological data provide estimates of the prevalence, incidence, co-morbidity, stability and correlates of premenstrual dysphoric disorder (PMDD) in the community. AIMS: To describe the prevalence, incidence, 12 co-morbidity factors and correlates of threshold and subthreshold PMDD in a community sample of young women. METHODS: Findings are based on prospective-longitudinal community survey of 1488 women aged 14-24, who were followed-up over a period of 48 months (follow-up, N = 1,251) as part of the EDSP sample. Diagnostic assessments were based on the Composite International Diagnostic Interview (CIDI) and its 12-month PMDD diagnostic module administered by clinical interviewers. Diagnoses were calculated using DSM-IV algorithms, but daily ratings of symptoms, as required, were not available. RESULTS: The baseline 12-month prevalence of DSM-IV PMDD was 5.8%. Application of the diagnostic exclusion rules with regard to concurrent major depression and dysthymia decreased the rate only slightly (5.3%). An additional 18.6 % were 'near-threshold' cases, mostly because they failed to meet the mandatory impairment criterion. Over the follow-up period only few new PMDD cases were observed: cumulative lifetime incidence was 7.4%. PMDD syndrome was stable across 48 months with < 10% complete remissions among baseline PMDD cases. The 12-month and lifetime co-morbidity rates were high (anxiety disorders 47.4%, mood disorders 22.9%; somatoform 28.4%), only 26.5 % had no other mental disorder. Particularly high odds ratios were found with nicotine dependence and PTSD. In terms of correlates increased rates of 4-weeks impairment days, high use of general health and mental health services, and increased rates of suicide attempts were found. CONCLUSION: In this sample of adolescents and young adults, premenstrual symptoms were widespread. However, DSM-IV PMDD was considerably less prevalent. PMDD is a relatively stable and impairing condition, with high rates of health service utilization, increased suicidality and substantial co-morbidity.     

Prevalence, co-morbidity and correlates of mental disorders in the general population: results from the German Health Interview and Examination Survey (GHS)

BACKGROUND: The German National Health Interview and Examination Survey (GHS) is the first government mandated nationwide study to investigate jointly the prevalence of somatic and mental disorders within one study in the general adult population in Germany. This paper reports results from its Mental Health Supplement (GHS-MHS) on 4-week 12-month, and selected lifetime prevalence of a broad range of DSM-IV mental disorders, their co-morbidity and correlates in the community. METHODS: The sample of the GHS-MHS (n=4181; multistage stratified random sample drawn from population registries; conditional response rate: 87.6%) can be regarded as representative for the German population aged 18-65. Diagnoses are based on fully structured computer assisted clinical interviews (M-CIDI), conducted by clinically trained interviewers. RESULTS: 12-month prevalence for any DSM-IV study disorder is 31% (lifetime: 43%; 4-week: 20%) with anxiety disorders, mood disorders and somatoform syndromes being the most frequent diagnoses. Retrospective age of onset information reveals that most disorders begin early in life. Co-morbidity rates among mental disorders range from 44% to 94%. Correlates of increased rates of mental disorders and co-morbidity were: female gender (except for substance disorders), not being married, low social class, and poor somatic health status. Health care utilization for mental disorders depended on co-morbidity (30% in 'pure', 76% in highly co-morbid cases) and varied from 33% for substance use disorders to 75% for panic disorder. CONCLUSIONS: Results confirm and extend results from other national studies using the same assessment instruments with regard to prevalence, co-morbidity and sociodemographic correlates, covering a broader range of DSM-IV disorders [i.e. somatoform disorders, all anxiety disorders (except PTSD), mental disorders due to substance or general medical factor, eating disorders]. Intervention rates were higher than in previous studies, yet still low overall.     

Threshold and subthreshold bipolar disorders in the Sesto Fiorentino Study

BACKGROUND: The DSM IV lifetime prevalence for bipolar affective disorders is reported to be between 0.4% and 1% in most surveys. DSM IV, however, fails to identify the cases clinically significant described as bipolar spectrum. The few researches that have attempted to evaluate the prevalence of these disorders in the community report lifetime prevalence figures of 5% to 10% for the whole spectrum. METHOD: The data from the Sesto Fiorentino Study, a community survey conducted by clinical interviewers using a typically clinical instrument, have been re-analysed. 2363 people out of the 2500 randomly selected in order to be representatives of the population aged 14 or more living in Sesto Fiorentino (44,000 inhabitants, Central Italy) could be evaluated according to a two-phase design. RESULTS: The lifetime prevalence rates were 0.47% for bipolar I disorder, 0.38% for bipolar II (0.85% for DSM IV bipolar disorders). A much greater number of subjects had clinically significant hypomanic symptoms that failed to fully satisfy the diagnostic criteria, totalling to 4.66% of the population. Compared with depressives without any sign of bipolarity (N=297), these "subthreshold bipolar" cases had significantly greater comorbidity for Generalised Anxiety Disorder, Obsessive-Compulsive Disorders and Anorexia Nervosa, as well as with Obsessive-Compulsive Passive-Aggressive, Paranoid, Borderline personality disorders. Their depressive symptom pattern cases differed from that of the "pure" unipolar cases for a significantly greater frequency of psychic agitation, psychotic symptoms and hyperphagia. LIMITATIONS AND CONCLUSIONS: The main limitation of the study is its retrospective nature, whereas it confirms the clinical relevance of even softer forms of bipolarity on epidemiological grounds.     

Non-disabled cases in a national survey.

BACKGROUND: Lifetime and 12-month prevalence estimates of mental disorders consistently reported in large-scale community surveys have met with deserved scepticism. A crucial variable is the extent to which people who are considered cases are also disabled by their symptoms. In a national population survey, we hypothesized that an administratively significant proportion of persons with anxiety or depressive disorders according to ICD-10 and DSM-IV would report no disability. METHODS: Interviews were sought on a nationally representative sample of people aged 18 and over across Australia. The Composite International Diagnostic Interview on laptop (CIDI-A) was used by professional survey interviewers to identify persons meeting ICD-10 or DSM-IV criteria for anxiety or depressive disorders in the previous 4 weeks, together with self-reported data on associated disability and medical consultations for the same period. RESULTS: In an achieved sample of 10,641 persons (response rate = 78%), no disability in daily life was reported by 28% of persons with an anxiety disorder and 15% with a depressive disorder by ICD-10 criteria; and by 20.4% and 13.9% respectively by DSM-IV. Non-disabled respondents had lower scores on two measures of psychological distress and markedly lower rates for having consulted a doctor for their symptoms. CONCLUSION: The ICD-10 and DSM-IV criteria for anxiety and depressive disorders, when applied to the information on symptoms elicited by the CIDI-A, inadequately discriminate between people who are and are not disabled by their symptoms. There may be a group of highly symptomatic people in the general population who tolerate their symptoms and are not disabled by them.     

A general population comparison of the Composite International Diagnostic Interview (CIDI) and the Schedules for Clinical Assessment in Neuropsychiatry (SCAN)

BACKGROUND: In psychiatric surveys of the general population, there has been considerable discrepancy between diagnoses obtained by fully structured interviews and those established by systematic semi-structured clinical evaluation. The Composite International Diagnostic Interview (CIDI) is an example of the first type of interview widely used in general population surveys. We compared its performance in diagnosing current depressive and anxiety disorders with the Schedules for Clinical Assessment in Neuropsychiatry (SCAN), a semi-structured diagnostic interview administered by clinically trained interviewers. METHODS: Household addresses in Leicestershire, UK, were randomly sampled and 860 adults were screened with the Revised Clinical Interview Schedule. Adults with too few symptoms to fulfil diagnostic criteria for study disorders were excluded to increase the proportion re-interviewed who met such criteria. Repeat diagnostic interviews with the CIDI and SCAN, ordered randomly, were sought from eligible screen positive respondents. Recalibrated CIDI prevalence estimates were derived from the SCAN classification using Bayesian statistics. RESULTS: Concordance ranged between 'poor' and 'fair' across almost all types of study disorders, and for co-morbidity. Concordance was somewhat better for severity of depression and when lower diagnostic thresholds were used for depression. Interview order effects were suggested with lower concordance when CIDI followed SCAN. Recalibration reduced the prevalence of depressive or anxiety disorder from 9.0 to 6.2%. CONCLUSIONS: Community psychiatric surveys using structured diagnostic interview data must be interpreted cautiously. They should include an element of clinical re-appraisal so findings can be adjusted for estimation differences between fully structured and clinical assessments.     

Prevalence and genetic and environmental influences on anxiety disorders in 6-year-old twins

BACKGROUND: Prevalence of childhood anxiety disorders at specific ages and genetic etiological influences on anxiety disorders in young children have been little studied. The present study reports prevalence estimates in a community sample of 6-year-old twins, and patterns of genetic and environmental influences on these early-onset anxiety disorders. METHOD: Using a two-phase design 4,662 twin-pairs were sampled and 854 pairs were assessed in the second phase by maternal-informant diagnostic interview using DSM-IV criteria. RESULTS: The most common conditions were separation anxiety disorder (SAD) [2.8%, 95% confidence interval (CI) 2.1-3.8, for current disorder] and specific phobia (10.8%, 95% CI 8.4-13.6, for current disorder). Behavioral genetic modeling was feasible for these two conditions, applied to two phenotypes: symptom syndrome (regardless of impairment) and the narrower one of diagnostic status (symptom syndrome with associated impairment). The heritability estimate for SAD diagnostic status was high, 73%, with remaining variance attributed to non-shared environment. The heritability estimates for specific phobia were also high, 80% for the symptom syndrome and 60% for diagnostic status, with remaining variance attributed in both cases to non-shared environment. CONCLUSIONS: Compared with previous epidemiological surveys of children and adolescents in wide age-bands, the current estimates suggest that rates of anxiety disorders assessed in young childhood are generally at least as high and perhaps higher compared with those found in older children. The heritability estimates suggest that the genetic effects on these early-onset anxiety disorders are substantial and more significant than environmental effects, whether shared or non-shared.     

Anxiety disorders comorbidity in bipolar I, bipolar II and unipolar major depression: results from a population-based study in Hungary

BACKGROUND: The aim of this study was to analyze the lifetime comorbidity between DSM-III-R anxiety disorders in separate subgroups of patients with major depression, bipolar II and bipolar I disorder in a community sample of a Hungarian population. METHODS: Randomly selected subjects (aged between 18 and 64 years, N=2953) were interviewed by the Diagnostic Interview Schedule (DIS) which generated DSM-III-R diagnoses. RESULTS: The prevalence of generalized anxiety disorder, agoraphobia and simple phobia was the highest among bipolar II patients (20.8, 37.5 and 16.7%, respectively), social phobia was most prevalent in (nonbipolar) major depression (17.6%), while the rate of panic disorder was the same in the (nonbipolar) major depressive and bipolar II subgroups (12.4 and 12.5%, respectively). Bipolar I patients showed a relatively low rate of comorbidity. CONCLUSIONS: The findings support previous results on the particularly high rate of lifetime comorbidity between anxiety disorders and unipolar major depression and particularly bipolar II illness. LIMITATIONS: Underestimation of the prevalence of bipolar II disorder by the diagnostic methodology used, resulting in a small number of bipolar II cases, lack of analysis of data by gender, no data on obsessive-compulsive disorder.     

Twelve-month mental disorders in South Africa: prevalence, service use and demographic correlates in the population-based South African Stress and Health Study

BACKGROUND: South Africa's history and current social conditions suggest that mental disorders are likely to be a major contributor to disease burden, but there has been no national study using standardized assessment tools. METHOD: The South African Stress and Health Study was a nationally representative in-person psychiatric epidemiological survey of 4351 adults (aged 18 years) that was conducted as part of the WHO World Mental Health (WMH) Survey Initiative between January 2002 and June 2004. Twelve-month prevalence and severity of DSM-IV disorders, treatment, and sociodemographic correlates were assessed with Version 3.0 of the WHO Composite International Diagnostic Interview (CIDI 3.0). RESULTS: The 12-month prevalence of any DSM-IV/CIDI disorder was 16.5%, with 26.2% of respondents with disorder classified as severe cases and an additional 31.1% as moderately severe cases. The most common disorders were agoraphobia (4.8%), major depressive disorder (4.9%) and alcohol abuse or dependence (4.5%). Twenty-eight percent of adults with a severe or moderately severe disorder received treatment compared to 24.4% of mild cases. Some 13.8% of persons with no disorder received treatment. Treatment was mostly provided by the general medical sector with few people receiving treatment from mental health providers. CONCLUSIONS: Psychiatric disorders are much higher in South Africa than in Nigeria and there is a high level of unmet need among persons with severe and moderately severe disorders.     

One-month prevalence of depression and other DSM-IV disorders among young adults.

BACKGROUND: We aimed to provide prevalence data on depression and other current mental disorders, impairment, need of psychiatric care and use of mental health services among young adults. METHODS: Based on a semi-structured clinical interview, current DSM-IV disorders, impairment, need of psychiatric care and use of mental health services were evaluated in a sample of 20-24-year-old young urban adults (N = 245), mean age 21.8, screened from a baseline population of 706. One-month prevalence estimates for disorders were calculated by the double sampling method, using various additional criteria to identify cases. RESULTS: One in four young adults (23.8%) suffered from a current mental disorder, the most prevalent being depressive (10.8%), anxiety (6.9%), substance use (6.2%) and personality disorders (6.0%). Prevalence estimates varied substantially according to the use of additional diagnostic criteria. Impairment (GAF < 61) together with DSM-IV symptom criteria produced an overall disorder prevalence of 10.3%, and 5.5% for depression. Prevalences were higher for females than males, except for alcohol abuse and personality disorders. Current co-morbidity was found in 39% of subjects with any disorder, and in more than half of those with depression. One-third of subjects with a current disorder reported an associated contact with psychiatric services and 16% had an ongoing contact. CONCLUSIONS: Our findings support the use of additional criteria to produce clinically relevant prevalence data. Co-morbidity should receive special attention due to its amplification of both need for psychiatric care and severity of impairment. Finally, our results show disturbed young adults to be severely undertreated.     

Psychiatric disorders in burn patients: a follow-up study

BACKGROUND: We report on a prospective study of 45 patients with burn injuries admitted to a major burn unit in the greater Athens area. The study aimed to explore the prevalence of psychological and psychiatric disorders among burn survivors. METHODS: The sample comprised all consecutive cases of adult burn patients in a 6-month period. Personal interviews were conducted by the administration of the Langner scale and the DSM-III-R Structured Clinical Interview. Twelve months later, 30 patients of the baseline sample were reexamined. RESULTS: Psychological impairment was found to be 45.5 and 40% at the baseline and follow-up assessments, respectively. The extent of burns was found to be associated with psychological impairment. The prevalence of psychiatric disorders (any DSM-III nosological entity) reached 46.6% at both baseline and follow-up examinations. Posttraumatic stress disorder was diagnosed in 17.8 and 20.0% of burn survivors at the baseline and the 12-month follow-up assessments, respectively. Logistic regression analysis revealed that face disfigurement was the only burn characteristic significantly associated with the presence of psychiatric morbidity. CONCLUSIONS: The results of the study suggest that the extent of burns is not so important when compared to the possibility of disfigurement from the point of risk of developing a psychiatric disorder.     

Clinical epidemiology of eating disorders: results from the Sesto Fiorentino study

BACKGROUND: It is speculated that clinical samples do not fully reflect the characteristics of eating disorders (EDs) as they are in the general population, especially in their lowest range of severity. The present article reports the prevalence of EDs in a community sample aged >14 years, their clinical and psychopathological features, and their course and outcome on naturalistic grounds. METHODS: The Sesto Fiorentino Study is a three-phase community-based survey where 2,355 out of 2,500 people representative of the population aged >14 years living in Sesto Fiorentino were evaluated by their own general practitioner using the Mini International Neuropsychiatric Interview plus six additional questions. All those who had positive results plus a probability sample of the non-cases were re-interviewed by psychiatrists using the Florence Psychiatric Interview. The subjects who reported ED symptoms were subsequently administered the Eating Disorder Examination (12th edition). RESULTS: Overall, the lifetime prevalence of EDs was 1.21%. More precisely, 0.42% had anorexia nervosa, 0.32% bulimia nervosa, 0.32% binge eating disorder and 0.32% eating disorder not otherwise specified. All the subjects suffering from an ED fulfilled diagnostic criteria for at least another DSM-IV axis I psychiatric disorder. At the moment of the interview, conducted a few years (average 7 years) after the onset of the disorder, 50% had fully recovered from EDs, 26.9% were currently affected by an ED, 23.1% showed a persistent body image disturbance and/or the presence of compensatory behaviours. CONCLUSIONS: Community surveys conducted by clinicians may provide useful additional information on the psychopathological features, natural course and outcome of these disorders on naturalistic grounds.     

Recurrent brief depressive disorder reinvestigated: a community sample of adolescents and young adults

BACKGROUND: This article presents prospective lower bound estimations of findings on prevalence, incidence, clinical correlates, severity markers, co-morbidity and course stability of threshold and subthreshold recurrent brief depressive disorder (RBD) and other mood disorders in a community sample of 3021 adolescents. METHOD: Data were collected at baseline (age 14-17) and at two follow-up interviews within an observation period of 42 months. Diagnostic assessment was based on the Munich Composite International Diagnostic Interview (M-CIDI). RESULTS: Our data suggest that RBD is a prevalent (2.6%) clinical condition among depressive disorders (21.3%) being at least as prevalent as dysthymia (2.3%) in young adults over lifetime. Furthermore, RBD is associated with significant clinical impairment sharing many features with major depressive disorder (MDD). Suicide attempts were reported in 7.8% of RBD patients, which was similar to MDD (11.9%). However, other features, like gender distribution or co-morbidity patterns, differ essentially from MDD. Furthermore, the lifetime co-occurrence of MDD and RBD or combined depression represents a severe psychiatric condition. CONCLUSIONS: This study provides further independent support for RBD as a clinically significant syndrome that could not be significantly explained as a prodrome or residual of major affective disorders.     

Prevalence, 20-month incidence and outcome of unipolar depressive disorders in a community sample of adolescents.

BACKGROUND: This article presents prospective longitudinal findings on prevalence, incidence, patterns of change and stability of depressive disorders in a community sample of 1228 adolescents. METHODS: Data were collected at baseline and follow-up (20 months later) in a representative population sample of 1228 adolescents, aged 14-17 at baseline. Diagnostic assessment was based on the Munich Composite International Diagnostic Interview (M-CIDI). RESULTS: The overall cumulative lifetime incidence of any depressive condition was 20.0% (major depressive disorder (MDD), 12.2%; dysthymia, 3-5%; subthreshold MDD, 6.3%), of which about one-third were incident depressions in the period between baseline and follow-up. Depressive disorders rarely started before the age of 13. Females were about twice as likely as males to develop a depressive disorder. Overall, the 20-month outcome of baseline depression was unfavourable. Dysthymia had the poorest outcome of all, with a complete remission rate of only 33% versus 43% for MDD and 54% for subthreshold MDD. Dysthymia also had the highest number of depressive episodes, and most psychosocial impairment and suicidal behavioural during follow-up. Treatment rates were low (8-23%). Subthreshold MDD associated with considerable impairment had an almost identical course and outcome as threshold MDD. CONCLUSIONS: DSM-IV MDD and dysthymia are rare before the age of 13, but frequent during adolescence, with an estimated lifetime cumulative incidence of 14%. Only a minority of these disorders in adolescence is treated, and more than half of them persist or remit only partly.     

The survey form of SCAN: the feasibility of using experienced lay survey interviewers to administer a semi-structured systematic clinical assessment of psychotic and non-psychotic disorders.

BACKGROUND: The success of large scale surveys depends on well designed questionnaires and the skills of lay interviewers. Discrepancies in prevalence rates between epidemiological surveys and poor agreement between survey interviewer and clinician diagnostic interviews are giving rise to increasing concern among researchers, public health planners and policy developers. New approaches to information collection are called for. The feasibility of training experienced survey interviewers in semi-structured, clinical, diagnostic interviewing has never been investigated systematically across the range of neurotic and psychotic disorders. METHODS: Eight experienced survey interviewers from the Office for National Statistics (ONS) were selected and underwent extended training in a Survey Form of SCAN (SCAN-SF). Sixty-four adults, including a majority of psychiatric in-patients were assessed by ONS interviewers and reinterviewed within a week by SCAN-trained clinicians. Feedback was sought from interviewers and trainers. RESULTS: Trainers found lay interviewers coped at least as well with psychotic as with neurotic symptoms. Concordance for any disorder was 0.74 (95% CI: 0.57 to 0.91); for any specific psychotic disorder 0.63 (0.40 to 0.86); for any specific neurotic disorder 0.63 (0.43 to 0.83). Sensitivity ranged from 0.6 to 0.9 and specificity from 0.8 to 0.9. There was no evidence of rater bias. CONCLUSIONS: These preliminary findings are very promising. However, before the SCAN-SF, administered by carefully trained lay interviewers, can be recommended in large scale surveys, further evaluations of its feasibility and reliability in the general population are needed.     

Prevalence, service use, and demographic correlates of 12-month DSM-IV psychiatric disorders in Mexico: results from the Mexican National Comorbidity Survey

BACKGROUND:This paper describes the 12-month prevalence, severity and demographic correlates of 16 DSM-IV psychiatric disorders and service utilization in the Mexican urban population aged 18-65 years of age. This is representative of 75% of the national adult population.METHOD:The sample design was a strict probability selection scheme. The response rate was 76.6%. The World Mental Health Survey version of the Composite International Diagnostic Interview was installed on laptops and administered by lay interviewers. An international WHO task force carried out its translation into Spanish.RESULTS: The 12-month prevalence of any disorder was 12.1%. The most common disorders were specific phobia (4.0%), major depressive disorder (3.7%) and alcohol abuse or dependence (2.2%). The 12-month prevalence of very severe disorders was 3.7% of which only 24% used any services. Age was the only variable associated with any 12-month disorder, with the younger more likely to report any disorder. Income was associated with severity, with low and low-average incomes more likely to report a 12-month disorder. Females were more likely to report a mood and anxiety disorder, but less likely to report a substance disorder. The group of separated/widowed/divorced was more likely to report a mood and an impulse-control disorder.CONCLUSIONS:The results show that while psychiatric disorders are common in the Mexican population, very severe mental disorders are less common and there is extreme under-utilization of mental health services.     

Twelve-month prevalence, severity, and unmet need for treatment of mental disorders in metropolitan China

BACKGROUND: Psychiatric epidemiological surveys in China have repeatedly found much lower prevalence estimates than in most other parts of the world. METHOD: Face-to-face household interviews of 5201 subjects (2633 in Beijing and 2568 in Shanghai respectively) were conducted from November 2001 to February 2002 using a multistage household probability sampling method. A Chinese version of the World Health Organization Composite International Diagnostic Interview (CIDI) was used for assessment. RESULTS: Twelve-month prevalence of any DSM-IV mental disorder in metropolitan China is estimated to be 7.0%, with major depressive disorder (2.0%), specific phobia (1.9%), and intermittent explosive disorder (1.7%) the most common disorders. Of these, 13.9% are classified as serious, 32.6% moderate, and 53.5% mild. Only 3.4% of respondents with any disorder sought treatment within the previous 12 months. CONCLUSIONS: Although the general pattern of disorders, risk factors, and unmet need for treatment are similar to those in other countries, a low prevalence of mental disorders is found in metropolitan China. Resolving methodological problems that cause downward bias in estimates, such as stigma-related under-reporting and diagnostic incongruity with a somatopsychic mode of symptom presentation may lead to more accurate and probably higher prevalence estimates in future epidemiological studies. As a low prevalence still translates into an enormous number of people in China, measures are urgently needed to address the huge unmet need for treatment of mental disorders.     

Prevalence of three bulimia syndromes in the general population

Prevalence of bulimia was estimated from a cross-sectional general population survey of 1498 adults, using the Diagnostic Interview Schedule (DIS) administered by trained lay interviewers. Lifetime prevalence of the DSM-III syndrome in adults aged 18-64 was 1.0% and this was concentrated in young women: in women aged 18-44 lifetime prevalence was 2.6%, and 1.0% currently had the disorder. Based on clinicians' reinterviews of random respondents and identified and marginal cases, the prevalence of current disorder using criteria for draft DSM-III-R bulimia was 0.5%, for DSM-III it was 0.2%, and for Russell's Criteria bulimia nervosa 0.0%. A strong cohort effect was found, with higher lifetime prevalence among younger women, which is consistent with a growing incidence of the disorder among young women in recent years. Although elements of the syndromes were so common as to suggest that dysfunctional attitudes to eating and disturbed behaviour surrounding eating are widespread, there was little evidence of the bulimia syndrome having become an epidemic on the scale suggested by early reports.     

DSM-IV generalized anxiety disorder in the Australian National Survey of Mental Health and Well-Being

BACKGROUND: This paper reports population data on DSM-IV generalized anxiety disorder from the Australian National Survey of Mental Health and Well-Being. METHODS: The data were obtained from a nationwide household survey of adults using a stratified multi-stage sampling process. A response rate of 78.1% resulted in 10,641 persons being interviewed. Diagnoses were made using the Composite International Diagnostic Interview. The interview was computerized and conducted by trained lay interviewers. RESULTS: Prevalence in the total sample was 2.8% for 1-month GAD and 36% for 12-month GAD. Persons over 55 years of age were less likely to have GAD than those in the younger age groups. Logistic regression analysis also showed that a diagnosis of GAD was significantly associated with being of younger to middle age, being separated divorced or widowed, not having tertiary qualifications or being unemployed. Co-morbidity with another affective, anxiety, substance use or personality disorders was common, affecting 68% of the sample with 1-month DSM-IV GAD. GAD was associated with significant disablement, and 57% of the sample with DSM-IV GAD had consulted a health professional for a mental health problem in the prior 12 months. CONCLUSIONS: The survey provides population data on DSM-IV GAD and its correlates. GAD is a common disorder that is accompanied by significant morbidity and high rates of co-morbidity with affective and anxiety disorders, and is associated with marital status, education, employment status, but not sex. Changes to DSM-IV diagnostic criteria did not appear to affect the prevalence rate compared to previous population surveys.     

Prevalence of psychiatric disorders in an Italian town: low prevalence confirmed with two different interviews

BACKGROUND: In Italy, few studies on the prevalence of psychiatric disorders have considered all of the most common disorders and very few have adopted the most common tools, that is, the Composite International Diagnostic Interview (CIDI) and the Present State Examination (PSE). The objective of the present study was to estimate the prevalence of psychiatric disorders and its correlates in the town of Jesi, Italy, using the PSE and CIDI, administered 7 years apart. METHODS: The two surveys were conducted among adults in Jesi (central Italy), using the PSE in 1993 and the CIDI in 2000. Participants were randomly chosen from the patient lists of general practitioners. RESULTS: The one-month prevalence of persons with a psychiatric disorder was 7.3% (95% CI: 4.4-11.6) in 1993 and 6.0% (95% CI: 3.5-9.5) in 2000. The lifetime and 1-year prevalence rates were 21.0 and 8.2%, respectively. The most common disorders were depressive and anxiety disorders. Mood and anxiety disorders were more common among women and unmarried persons. CONCLUSIONS: The prevalence is lower than that in most other areas of the world yet consistent with estimates for Italian populations reported by studies using the same (or similar) tools.