Six-month prevalence of psychiatric disorders in three communities 1980 to 1982

Six-month prevalence rates for selected DSM-III psychiatric disorders are reported based on community surveys in New Haven, Conn, Baltimore, and St Louis. As part of the Epidemiologic Catchment Area program, data were gathered on more than 9,000 adults, employing the Diagnostic Interview Schedule to collect information to make a diagnosis. The most common disorders found were phobias, alcohol abuse and/or dependence, dysthymia, and major depression. The most common diagnoses for women were phobias and major depression, whereas for men, the most predominant disorder was alcohol abuse and/or dependence. Rates of psychiatric disorders dropped sharply after age 45 years.     

Frequency of DSM-III personality disorders in patients with panic disorder: comparison with psychiatric and normal control subjects

Three clinical populations--panic disorder (n = 88), randomly selected outpatients (n = 82), and normal control subjects (n = 40)--were compared on three standardized DSM-III personality disorder instruments, the Structured Interview for DSM-III Personality Disorders (SIDP), the Millon Clinical Multiaxial Inventory (MCMI), and the Personality Diagnostic Questionnaire (PDQ). Significant differences were consistently found in presence of "any" personality disorder and DSM-III Cluster C (there were always more disorders in the outpatients). Logistic regression analysis revealed the important determinants predicting personality disorders, and therefore of differences between groups, were state depression, age, lifetime history of alcohol abuse, and presence of panic disorder.     

Lifetime and 6-month prevalence of abuse and dependence of alcohol in the Munich follow-up study

Summary This paper reports lifetime and 6-month prevalence rates of alcohol abuse and dependence in West Germany. Assessment instruments are a modified German version of the Diagnostic Interview Schedule (DIS), a fully standardized interview for the assessment of selected DSM-III diagnoses and the Munich Alcoholism Test (MALT). According to the DIS/DSM-III criteria, 13.0% of the adult general population (aged 25–64 years) were found to fulfill the lifetime criteria for alcohol abuse, alcohol dependence, or both; however, only 1.3% of all men and 0.9% of the women interviewed received a current DSM-III diagnosis of alcohol abuse or dependence. There was good consensus between current DSM-III diagnoses with current clinical ICD-diagnoses, but poor concordance with lifetime diagnoses. Symptoms of alcoholism, onset and severity, comorbidity with other DIS/DSM-III disorders as well as some selected risk factors are reported. The results are primarily compared with the results of the US-Epidemiological Catchment Area Program (ECA).     

Comparison of lifetime psychiatric diagnoses in Premenstrual Syndrome Clinic and community samples

The purpose of this investigation was to obtain information about lifetime psychiatric diagnoses of women seeking treatment for premenstrual syndrome. The National Institute for Mental Health Diagnostic Interview Schedule (DIS) was administered to 223 women attending a premenstrual syndrome clinic. Rates of symptoms and psychiatric disorders were then compared with DIS data collected from an Epidemiologic Catchment Area (ECA) program community sample of 923 women in the same age group from the same geographic location. Women in the Premenstrual Syndrome Clinic sample met DIS/DSM-III criteria for dysthymia, phobia, obsessive-compulsive disorder, alcohol abuse/dependence, and drug abuse/dependence with a greater frequency than did women from the community sample. There appears to be much overlap between the symptoms for which women seek help from a specialty premenstrual syndrome clinic and symptoms related to several specific affective, anxiety, and substance abuse disorders. Further investigation is needed to determine whether premenstrual syndrome is strongly associated with DSM-III psychiatric diagnoses or whether current psychiatric classification systems are inadequate for differentiation.     

Inhalant use, abuse, and dependence among adolescent patients: commonly comorbid problems

OBJECTIVE: Little is known about adolescents with DSM-IV-defined inhalant abuse and dependence. The aim of this study was to compare comorbidity among (1) adolescents with inhalant use disorders, (2) adolescents who reported using inhalants without inhalant use disorder, and (3) other adolescent patients drawn from an adolescent drug and alcohol treatment program. METHOD: The authors examined 847 admissions of patients who had completed structured diagnostic assessments. The three groups were compared for noninhalant substance use disorders, posttraumatic stress disorder, conduct disorder, major depression, previous suicide attempts, and physical/sexual abuse and neglect. RESULTS: Adolescents with inhalant abuse or dependence (group 1; n = 28) were significantly more likely to meet lifetime criteria for abuse or dependence on alcohol, hallucinogens, nicotine, cocaine, and amphetamines, to have had major depression, and to have attempted suicide compared with other adolescent patients who reported never using inhalants (group 3); adolescents with inhalant use disorders also reported significantly more abuse and neglect. Adolescents with inhalant abuse or dependence (group 1) did not differ significantly on any measure compared with adolescents who reported using inhalants without an inhalant use disorder (group 2). CONCLUSIONS: Adolescent patients with a history of inhalant use, abuse, or dependence entering treatment should be carefully screened for noninhalant substance use disorders, major depression, suicidality, and abuse and neglect.     

Axis I phenomenology of borderline personality disorder

The Axis I phenomenology of 50 outpatients meeting both Diagnostic Interview for Borderlines (DIB) and DSM-III criteria for Borderline Personality Disorder (BPD), 29 outpatients meeting DSM-III criteria for Antisocial Personality Disorder (APD), and 26 outpatients meeting DSM-III criteria for Dsythymic Disorder as well as DSM-III criteria for some other type of Axis II disorder (dysthymic OPD) was assessed blind to clinical diagnosis using the Structured Clinical Interview for DSM-III (SCID). Borderlines were significantly more likely than antisocial controls to have met DSM-III criteria for an affective disorder, particularly Dysthymic Disorder, and an anxiety disorder. They were also significantly more likely than dysthymic OPD controls but significantly less likely than antisocial controls to have met DSM-III criteria for alcohol abuse/dependence and drug abuse/dependence. The authors conclude that: (1) the link between BPD and unipolar affective disorders is less specific than previously suggested, and (2) there is a link between BPD and impulse disorders that may be of equal, if not greater, importance.     

Prevalence of major depressive disorder in Nigerian college students with alcohol-related problems

OBJECTIVES: The study aimed to estimate the prevalence of major depressive disorder (MDD) among Nigerian college students with alcohol-related problems (ARP) and compare the estimated prevalence with their counterparts without ARP. METHOD: A cross-sectional survey of a representative sample of students (n=2658) in six colleges in Osun state, Western Nigeria. The students were independently assessed for ARP and MDD with the Mini International Neuropsychiatric Interview (MINI). RESULTS: The current (2 weeks) prevalence of MDD in college students with alcohol dependence is 23.8%; alcohol abuse 17.2% and hazardous use 12.4%. Compared with total abstainers, major depressive disorder is significantly more likely to be associated with diagnosis of alcohol dependence (OR 3.14, 95% CI 1.42-6.96), alcohol abuse (OR 2.27, 95% CI 1.38-3.72) and hazardous use (OR 1.64, 95% CI 1.12-2.38), but less associated with alcohol users without ARP (OR 0.93, 95% CI 0.69-1.25). CONCLUSION: Nigerian college students with ARP are significantly more at risk of depressive disorders than those without ARP. Early recognition and treatment of depression are important considerations when planning preventive strategies for alcohol-related problems in college students.     

The incidence of specific DIS/DSM-III mental disorders: data from the NIMH Epidemiologic Catchment Area Program

Incidence data are presented for the 7 most frequent specific categories of mental disorder available in the NIMH Epidemiologic Catchment Area (ECA) program (major depressive disorder; panic disorder; phobic disorder; obsessive-compulsive disorder; drug abuse/dependence; alcohol abuse/dependence; cognitive impairment). The DSM-III case definitions in the ECA Program are according to the implementation of the Diagnostic Interview Schedule (DIS). Rates of incidence are presented specific for age, sex, and site, and pooled smoothed curves for the relationship of age to incidence, specific for sex are shown. The 7 disorders have distinctly different relationships to sex and age of onset.     

Cigarette Smoking and Psychiatric Disorder in a Community Sample

We examined the lifetime prevalence of psychiatric disorders in cigarette smokers and nonsmokers in a non-patient sample. First-degree relatives of psychiatric patients (n = 697) and normal controls (n = 360) were interviewed with the Diagnostic Interview Schedule and the Structured Interview for DSM-III Personality Disorders. Using these interviews we diagnosed the major mental (Axis I) disorders and personality (Axis II) disorders. A cigarette smoker was defined as someone who smoked daily for a month or more at some time in their lives. We found that smokers more frequently had a lifetime history of major depression, alcohol and drug abuse/dependence, agoraphobia, unstable/acting out and anxious/fearful personality disorders. In a logistic regression analysis, the only significant variables independently associated with smoking status were the alcohol and drug use disorders. Age was an important modifying variable—the smoking-illness relationship was robust in the youngest age cohort and negligible in the oldest cohort. We conclude that cigarette smokers have increased rates of mood, anxiety, substance use, and personality disorders. However, after controlling for the comorbidity among the disorders only alcohol and drug abuse/dependence were independently associated with smoking. Young smokers had particularly high rates of substance use disorders. This age effect may reflect the impact of a quarter century of health education.     

Christchurch Psychiatric Epidemiology Study, Part I: Methodology and lifetime prevalence for specific psychiatric disorders

In 1986 the Christchurch Psychiatric Epidemiology Study obtained interviews with a probability sample of 1498 adults aged 18 to 64 years. The Diagnostic Interview Schedule (DIS) was used to enable DSM-III diagnoses to be made. This paper describes the methodology of the study and reports the lifetime prevalence of specific psychiatric disorders. The highest lifetime prevalences found were for generalised anxiety (31%), alcohol abuse/dependence (19%) and major depressive episode (13%). Men had higher rates of substance abuse whereas women had higher rates of affective disorders and most anxiety disorders. Compared with results from the Epidemiologic Catchment Area Program, Puerto Rico and Edmonton, Christchurch has the highest rates for major depression and is among the highest for alcohol abuse/dependence.     

Prospective analysis of the relation between DSM-III anxiety disorders and alcohol use disorders.

OBJECTIVE: Cross-sectional studies show a robust association between anxiety disorders and alcohol use disorders (comorbidity); however, this methodology does not allow for the testing of causal models. The authors attempted to overcome this limitation by examining comorbid relationships prospectively. METHOD: Male and female college students were assessed as freshmen (year 1), and then again at years 4 and 7, for selected 12-month anxiety disorders (generalized anxiety disorder, agoraphobia, and social phobia or panic) diagnosed according to the National Institute of Mental Health Diagnostic Interview Schedule (DIS) and DSM-III and for 12-month DIS/DSM-III alcohol use disorders (alcohol dependence alone and alcohol abuse or dependence). RESULTS: Cross-sectionally, the odds of having either an anxiety disorder or an alcohol use disorder were two- to fivefold greater when the other condition was present. Prospectively, the odds of developing a new alcohol dependence diagnosis at year 7 increased from 3.5 to five times for those diagnosed with an anxiety disorder at years 1 or 4. Conversely, the odds of developing a new anxiety disorder at year 7 increased by about four times for those diagnosed with alcohol dependence at years 1 or 4. When alcohol abuse and dependence were combined, the pattern of findings was similar, albeit weaker. Multivariate path models provide similar results and highlight the reciprocal influence of alcohol use disorders and anxiety disorders. CONCLUSIONS: Alcohol use disorders (especially alcohol dependence) and anxiety disorders demonstrate a reciprocal causal relationship over time, with anxiety disorders leading to alcohol dependence and vice versa.     

Risk of heavy drinking and alcohol use disorders in social phobia: a prospective analysis

OBJECTIVE: The risks of heavy drinking and alcohol abuse/dependence were prospectively assessed among individuals with DSM-III social phobia and individuals with subclinical social phobia (irrational fear of social situations without significant impairment or avoidance). METHOD: The baseline interview for the Baltimore site of the Epidemiologic Catchment Area program was completed in 1981. Between 1993 and 1996 the original cohort was traced. Among the 1,161 individuals who did not have episodes of heavy drinking or current or prior alcohol abuse/dependence at baseline, logistic regression was used to assess the association of social phobia and subclinical social phobia with incident alcohol abuse/dependence and incident episodic heavy drinking. RESULTS: Among the 33 individuals with a DSM-III diagnosis of social phobia at baseline, only one developed heavy drinking by follow-up, and none developed alcohol abuse or dependence. Among the 84 individuals with a history of subclinical social phobia, the cumulative incidence rates of heavy drinking and alcohol abuse/dependence were 119 per 1,000 and 95 per 1,000, respectively. After adjustment for sex, age, race, education level, marital status, age at first alcohol intoxication, and history of other psychiatric or illicit drug use disorder, the estimated relative risk for heavy drinking among respondents with subclinical social phobia was 2.41, and the estimated relative risk for alcohol abuse/dependence was 2.30, relative to respondents without social phobia or subclinical social fears. CONCLUSIONS: The data may improve our understanding of the relationship of social phobia and risk for alcohol conditions, which may have important implications for preventive measures.     

Two-year recall of lifetime diagnoses in offspring at high and low risk for major depression. The stability of offspring reports

Stability of recall of DSM-III diagnoses was assessed at two interviews 2 years apart in a sample of 150 offspring, aged 6 to 23 years, at high and low risk for major depression. Stability of recall was good for major depression with the use of DSM-III criteria and fair for major depression with the use of "strict" criteria (based on 4 weeks' duration of illness and an impairment in a major social role). Stability of recall was good for substance abuse and conduct disorder. Stability of recall was generally poor for anxiety disorder, regardless of subtype. For all major disorders except anxiety disorder, the difference in reported age at onset between the two interviews was small (less than 1 year) and not statistically significant. The most important correlates of stability of reports of major depression were previous psychiatric treatment and dysthymia and poor social functioning at the initial interview. This is the first study to evaluate long-term recall of DSM-III lifetime diagnoses in a nonreferred sample of children, adolescents, and young adults.     

Predictors of high rates of suicidal ideation among drug users

Several studies have attempted to understand the link among substance abuse, depression, and suicidal ideation (SI). Assessment of this link is important to develop specific interventions for persons in substance abuse treatment. This association was tested among 990 drug users in and out of treatment with significant criminal justice histories from two National Institute on Drug Abuse studies. The Diagnostic Interview Schedule and Substance Abuse Module assessed DSM-III-R depression, number of depression criteria met, antisocial personality disorder (ASPD), and substance use disorders. Compared with men, women were twice as likely to report depression (24% vs. 12%), whereas men were nearly twice as likely to report ASPD (42% vs. 24%). High rates of SI were found, with women more likely than men to report thoughts of death (50% vs. 31%), wanting to die (39% vs. 21%), thoughts of committing suicide (47% vs. 33%), or attempting suicide (33% vs. 11%); 63% of women and 47% of men reported at least one of these suicidal thoughts or behaviors. Male and female ideators were more likely than nonideators to report depressed mood and to meet criteria for depression, ASPD, and alcohol use disorders. Male ideators were more likely than male nonideators to meet criteria for cocaine use disorders. Using logistic regression, SI among men was predicted by alcohol use disorder (OR = 1.60), ASPD (OR = 1.59), and number of depression criteria (OR = 9.38 for five criteria). Among women, SI was predicted by older age, marital status, alcohol use disorder (OR = 2.77), and number of depression criteria (OR = 9.12 for five criteria). These original findings point out the need to discuss suicidal thoughts among depressed drug users for early treatment and prevention.     

Christchurch Psychiatric Epidemiology Study, Part II: Six month and other period prevalences of specific psychiatric disorders

The Christchurch Psychiatric Epidemiology Study determined the occurrence (over 2 weeks, 1 month, 6 months, 12 months and life-time) of a number of specific DIS/DSM-III psychiatric diagnoses in the Christchurch urban area. Data were collected on 1498 randomly selected adults, aged between 18 and 64 years. The Diagnostic Interview Schedule (DIS) was used to collect information to make a DSM-III diagnosis. The six month prevalence rates of disorder are presented and compared with available results from the NIMH Epidemiological Catchment Area Program, Puerto Rico and Edmonton. Other period prevalences for the total sample are also presented. Christchurch is shown to have higher six month prevalence rates for major depression and alcohol abuse/dependence than other sites which have utilised the DIS in community surveys.     

Factors associated with repeat suicide attempts among adolescents

OBJECTIVE: To determine potential risk factors associated with repeat suicide attempts among adolescents. METHOD: Retrospective medical record review of all patients aged 13-20 years who presented to the emergency department at an inner city tertiary hospital after attempted suicide between 1994 and 1996. Subjects were identified using the International Classification of Diseases (ICD-9) codes E950.0 to E959.9 for attempted suicide. Study variables included demographic parameters, chronic medical conditions/illnesses, psychiatric and substance abuse disorders, history of sexual abuse and previous and subsequent suicide attempts. Variables univariately associated with repetition at p < 0.25 were entered into a multiple regression analysis. RESULTS: Eighty seven per cent of patients presented with a drug overdose. Seventy-six per cent of all subjects attempted suicide in the context of a dispute or relationship break-up. At least one psychiatric disorder was present in 76% of subjects at the index attempt. The most frequently diagnosed disorders were depression (45.5%) and drug (34%) and alcohol abuse (27%). Variables predicting repetition within 12 months were drug (OR = 3.891, p = 0.02) and alcohol abuse (OR = 3.56, p = 0.05), non-affective psychotic disorders (OR = 3.81, p = 0.04), and chronic medical conditions/illness (OR = 3.29, p = 0.03). A history of sexual abuse was almost significant (OR = 3.03, p = 0.06). CONCLUSIONS: Adolescents most likely to re-attempt suicide with 12 months present with either substance abuse, non-affective psychotic disorders, chronic medical conditions, or a history of sexual abuse. All adolescents with a possible suicide attempt should receive a comprehensive mental health and psychosocial assessment. Closer scrutiny of the role of chronic illnesses and sexual abuse in both future research and clinical management is urged. A broad based, multidisciplinary intervention approach is recommended.     

Preadolescent alcohol abuse and dependence

The authors document 10 cases of children who met the criteria for a DSM-III axis I diagnosis of alcohol abuse or dependence by the age of 13. They present one case report to demonstrate the family history of affective disorder, especially bipolar disorder, and alcoholism that characterized these 10 patients. Most of the children with bipolar disorder responded well to psychotropics. The authors suggest that there may be a relationship between early-onset alcohol abuse and the development of major affective disorders in adolescence.     

Lifetime prevalence of specific mental disorders among people born in Iceland in 1931

The lifetime prevalence rates are presented for mental disorders in a random sample of people born in Iceland in 1931, interviewed at the age of 55-57 years. The diagnoses are made according to DSM-III, on the basis of the National Institute of Mental Health's diagnostic Interview Schedule (NIMH-DIS) used by trained lay interviewers. The most common diagnoses were alcohol abuse and dependence, generalized anxiety disorder, phobic disorders, dysthymic disorder and major depressive episode. Disorders more common in men were antisocial personality, alcohol abuse and alcohol dependence. Disorders more common among women were major depressive episode and generalized anxiety disorder. Alcohol abuse was more prevalent among those living in rural areas, but dependence was more prevalent in the urban area, where panic disorder is also more frequent. Widowed, separated and divorced people had most of the highest prevalences: tobacco-use disorder, alcohol abuse and dependence, dysthymia and generalized anxiety disorder. Except for a very high rate of alcohol abuse and dependence and a low rate of substance abuse disorders, the prevalence rates are similar to those obtained in North American studies using the NIMH-DIS as a survey instrument. The DSM-III criteria for alcohol abuse or dependence may be less applicable to Iceland than to North America, because of differences in what is culturally regarded as acceptable use of alcohol.     

MAPI personality correlates of comorbid substance abuse among adolescent psychiatric inpatients

This study investigated MAPI scale patterns among adolescent psychiatric inpatients along a dimension of substance abuse deviancy; no substance abuse; alcohol abuse only; alcohol and marijuana abuse only; other substance abuse plus alcohol and/or marijuana abuse. The findings showed the most notable distinction involved the issue of non-alcoholic substance abuse. Psychiatric inpatients who abuse alcohol were little different from patients with no substance abuse diagnosis. Conversely, those patients who abuses the more culturally deviant non-alcoholic substance were markedly different than non-substance abusing or alcohol-only abusing patients in several respects; highly negativistic attitudes toward family, authority and conformity; personality styles marked by aggressiveness and labile negativism and low conscientiousness; behavioral trait of impulsivity; poor sense of academic confidence. Only these non-alcoholic substance abusing psychiatric patients may require a distinctively different treatment plan than the protocol for uncomplicated psychiatric disorder.