Showing papers by "Ellen E. Walters published in 2003"

The epidemiology of major depressive disorder: results from the National Comorbidity Survey Replication (NCS-R).

Abstract: ContextUncertainties exist about prevalence and correlates of major depressive disorder (MDD).ObjectiveTo present nationally representative data on prevalence and correlates of MDD by Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria, and on study patterns and correlates of treatment and treatment adequacy from the recently completed National Comorbidity Survey Replication (NCS-R).DesignFace-to-face household survey conducted from February 2001 to December 2002.SettingThe 48 contiguous United States.ParticipantsHousehold residents ages 18 years or older (N = 9090) who responded to the NCS-R survey.Main Outcome MeasuresPrevalence and correlates of MDD using the World Health Organization's (WHO) Composite International Diagnostic Interview (CIDI), 12-month severity with the Quick Inventory of Depressive Symptomatology Self-Report (QIDS-SR), the Sheehan Disability Scale (SDS), and the WHO disability assessment scale (WHO-DAS). Clinical reinterviews used the Structured Clinical Interview for DSM-IV.ResultsThe prevalence of CIDI MDD for lifetime was 16.2% (95% confidence interval [CI], 15.1-17.3) (32.6-35.1 million US adults) and for 12-month was 6.6% (95% CI, 5.9-7.3) (13.1-14.2 million US adults). Virtually all CIDI 12-month cases were independently classified as clinically significant using the QIDS-SR, with 10.4% mild, 38.6% moderate, 38.0% severe, and 12.9% very severe. Mean episode duration was 16 weeks (95% CI, 15.1-17.3). Role impairment as measured by SDS was substantial as indicated by 59.3% of 12-month cases with severe or very severe role impairment. Most lifetime (72.1%) and 12-month (78.5%) cases had comorbid CIDI/DSM-IV disorders, with MDD only rarely primary. Although 51.6% (95% CI, 46.1-57.2) of 12-month cases received health care treatment for MDD, treatment was adequate in only 41.9% (95% CI, 35.9-47.9) of these cases, resulting in 21.7% (95% CI, 18.1-25.2) of 12-month MDD being adequately treated. Sociodemographic correlates of treatment were far less numerous than those of prevalence.ConclusionsMajor depressive disorder is a common disorder, widely distributed in the population, and usually associated with substantial symptom severity and role impairment. While the recent increase in treatment is encouraging, inadequate treatment is a serious concern. Emphasis on screening and expansion of treatment needs to be accompanied by a parallel emphasis on treatment quality improvement.

Screening for Serious Mental Illness in the General Population

Abstract: Background Public Law 102-321 established a block grant for adults with "serious mental illness" (SMI) and required the Substance Abuse and Mental Health Services Administration (SAMHSA) to develop a method to estimate the prevalence of SMI. Methods Three SMI screening scales were developed for possible use in the SAMHSA National Household Survey on Drug Abuse: the Composite International Diagnostic Interview Short-Form (CIDI-SF) scale, the K10/K6 nonspecific distress scales, and the World Health Organization Disability Assessment Schedule (WHO-DAS). An enriched convenience sample of 155 respondents was administered all screening scales followed by the 12-month Structured Clinical Interview for DSM-IV and the Global Assessment of Functioning (GAF). We defined SMI as any 12-month DSM-IV disorder, other than a substance use disorder, with a GAF score of less than 60. Results All screening scales were significantly related to SMI. However, neither the CIDI-SF nor the WHO-DAS improved prediction significantly over the K10 or K6 scales. The area under the receiver operating characteristic curve of SMI was 0.854 for K10 and 0.865 for K6. The most efficient screening scale, K6, had a sensitivity (SE) of 0.36 (0.08) and a specificity of 0.96 (0.02) in predicting SMI. Conclusions The brevity and accuracy of the K6 and K10 scales make them attractive screens for SMI. Routine inclusion of either scale in clinical studies would create an important, and heretofore missing, crosswalk between community and clinical epidemiology.

The National Comorbidity Survey

Abstract: 164 Rosenthal et al (1984) defined seasonal affective disorder (SAD) as a syndrome characterised by recurrent depressions that occur annually at the same time each year. Later, Rosenthal and co-workers developed the Seasonal Pattern Assessment Questionnaire (SPAQ) for the assessment of SAD (Rosenthal, 1987). Rosen et al (1990), using the SPAQ, found the prevalence of SAD to be 7.40/0, and of sub-syndromal SAD 10.70/0 in a sample of 1234 persons interviewed by mailed questionnaire in New York, Maryland and Florida. Other community studies report prevalences of between 2.2 and 10% (Booker, 1992; Weicki, 1992; Partonen, 1993; Schlager, 1993; Ozaki, 1995).

Mild Disorders Should Not Be Eliminated From the DSM-V

Abstract: Background: High prevalence estimates in epidemiological surveys have led to concerns that the DSM system is overly inclusive and that mild cases should be excluded from future DSM editions. Objective: To demonstrate that the DSM-III-R disorders in the baseline National Comorbidity Survey (NCS) can be placed on a severity gradient that has a dose-response relationship with outcomes assessed a decade later in the NCS follow-up survey (NCS-2) and that no inflection point exists at the mild severity level. Methods: The NCS was a nationally representative household survey of DSM-III-R disorders in the 3-year time span 1990-1992. The NCS-2 is a follow-up survey of 4375 NCS respondents (76.6% conditional response rate) reinterviewed in 2000 through 2002. The NCS-2 outcomes include hospitalization for mental health or substance disorders, work disability due to these disorders, suicide attempts, and serious mental illness. Results:Twelve-month NCS/DSM-III-Rdisorders were disaggregatedinto3.2%severe,3.2%serious,8.7%moderate, and 16.0% mild case categories. All 4 case categorieswereassociatedwithstatisticallysignificantly(P.05, 2-sided tests) elevated risk of the NCS-2 outcomes comparedwithbaselinenoncases,withoddsratiosofanyoutcome ranging monotonically from 2.4 (95% confidence interval, 1.6-3.4) to 15.1 (95% confidence interval, 10.022.9)formildtoseverecases.Oddsratioscomparingmild to moderate cases were generally nonsignificant. Conclusions: There is a graded relationship between mental illness severity and later clinical outcomes. Retention of mild cases in the DSM is important to represent the fact that mental disorders (like physical disorders)varyinseverity.Decisionsabouttreatingmildcases should be based on cost-effectiveness not current severity. Cost-effectiveness analysis should include recognition that treatment of mild cases might prevent a substantial proportion of future serious cases. Arch Gen Psychiatry. 2003;60:1117-1122

The Prevalence Of Treated And Untreated Mental Disorders In Five Countries

Abstract: We analyzed survey data from Canada, Chile, Germany, the Netherlands, and the United States to study the prevalence and treatment of mental and substance abuse disorders. Total past-year prevalence...

The Prevalence Of Treated And Untreated Mental Disorders In Five Countries The work of an international consortium finds sizable populations whose mental conditions are not being treated.

Abstract: PROLOGUE: The U.S. surgeon general and the World Health Organization (WHO) have both released studies in the past few years with alarming estimates of the prevalence of mental disorders, the burden these conditions create, and high rates of undertreatment. Assessing the policy implications of these findings is difficult, however, in part because the surveys on which prevalence estimates are based cannot capture degrees of severity with great precision. The following paper uses data from five countries to focus on the problem of undertreatment of severe mental illnesses. Serious cases are a relatively small proportion of all mental disorders, and “the probability of receiving treatment is strongly related to illness severity in each country,” according to this multinational team of researchers. Rob Bijl is head of the Department of Crime Prevention and Sanctions in the Research and Documentation Center of the Ministry of Justice in the Netherlands. Ron de Graaf is a physician and a senior researcher at the Netherlands Institute of Mental Health and Addiction. Eva Hiripi is a statistician and a senior analyst in the Department of Health Care Policy, Harvard Medical School; Ron Kessler is a professor in that department; and Ellen Walters is a senior biostatistician there. Robert Kohn is a psychiatrist and an assistant professor in the Department of Psychiatry and Human Behavior at Brown University (U.S.). David Offord is a psychiatrist and professor emeritus of psychiatry at McMaster University in Toronto. He also directs the Canadian Centre for Studies of Children at Risk. Bedirhan Ustun is a psychiatrist and head of the WHO Classification, Assessment, Surveys, and Terminology Unit in Geneva. Benjamin Vicente is a psychiatrist and a professor in the Department of Psychiatry and Mental Health at the Universidad de Concepcion in Chile. Wilma Vollebergh is a psychiatrist and head of the Research Program on Developmental Psychiatry at the National Institute on Mental Health and Addiction in the Netherlands. Hans-Ulrich Wittchen is a psychologist and a professor of psychology at the Technical University of Dresden, Germany, and professor of clinical psychology at the Max Planck Institute of Psychiatry in Munich.