Showing papers by "Ellen E. Walters published in 2006"
TL;DR: Efforts are needed to increase the detection and treatment of adult ADHD and research is needed to determine whether effective treatment would reduce the onset, persistence, and severity of disorders that co-occur with adult ADHD.
Abstract: Objective: Despite growing interest in adult attention deficit hyperactivity disorder (ADHD), little is known about its prevalence or correlates. Method: A screen for adult ADHD was included in a probability subsample (N=3,199) of 18–44-year-old respondents in the National Comorbidity Survey Replication, a nationally representative household survey that used a lay-administered diagnostic interview to assess a wide range of DSM-IV disorders. Blinded clinical follow-up interviews of adult ADHD were carried out with 154 respondents, oversampling those with positive screen results. Multiple imputation was used to estimate prevalence and correlates of clinician-assessed adult ADHD. Results: The estimated prevalence of current adult ADHD was 4.4%. Significant correlates included being male, previously married, unemployed, and non-Hispanic white. Adult ADHD was highly comorbid with many other DSM-IV disorders assessed in the survey and was associated with substantial role impairment. The majority of cases were u...
3,280 citations
TL;DR: Although the major societal burden of panic is caused by PD and PA-AG, isolated PAs also have high prevalence and meaningful role impairment, and 4 subgroups are significantly comorbid with other lifetime DSM-IV disorders.
Abstract: Context Only limited information exists about the epidemiology of DSM-IV panic attacks (PAs) and panic disorder (PD). Objective To present nationally representative data about the epidemiology of PAs and PD with or without agoraphobia (AG) on the basis of the US National Comorbidity Survey Replication findings. Design and Setting Nationally representative face-to-face household survey conducted using the fully structured World Health Organization Composite International Diagnostic Interview. Participants English-speaking respondents (N=9282) 18 years or older. Main Outcome Measures Respondents who met DSM-IV lifetime criteria for PAs and PD with and without AG. Results Lifetime prevalence estimates are 22.7% for isolated panic without AG (PA only), 0.8% for PA with AG without PD (PA-AG), 3.7% for PD without AG (PD only), and 1.1% for PD with AG (PD-AG). Persistence, lifetime number of attacks, and number of years with attacks increase monotonically across these 4 subgroups. All 4 subgroups are significantly comorbid with other lifetime DSM-IV disorders, with the highest odds for PD-AG and the lowest for PA only. Scores on the Panic Disorder Severity Scale are also highest for PD-AG (86.3% moderate or severe) and lowest for PA only (6.7% moderate or severe). Agoraphobia is associated with substantial severity, impairment, and comorbidity. Lifetime treatment is high (from 96.1% for PD-AG to 61.1% for PA only), but 12-month treatment meeting published treatment guidelines is low (from 54.9% for PD-AG to 18.2% for PA only). Conclusion Although the major societal burden of panic is caused by PD and PA-AG, isolated PAs also have high prevalence and meaningful role impairment.
657 citations
TL;DR: Intermittent explosive disorder is a much more common condition than previously recognized and makes IED a promising target for early detection, outreach, and treatment.
Abstract: CONTEXT: Little is known about the epidemiology of intermittent explosive disorder (IED). OBJECTIVE: To present nationally representative data on the prevalence and correlates of DSM-IV IED. DESIGN: The World Health Organization Composite International Diagnostic Interview was used to assess DSM-IV anxiety disorders, mood disorders, substance use disorders, and impulse control disorders. SETTING: The National Comorbidity Survey Replication, a face-to-face household survey carried out in 2001-2003. PARTICIPANTS: A nationally representative sample of 9282 people 18 years and older. MAIN OUTCOME MEASURE: Diagnoses of DSM-IV IED. RESULTS: Lifetime and 12-month prevalence estimates of DSM-IV IED were 7.3% and 3.9%, with a mean 43 lifetime attacks resulting in 1359 dollars in property damage. Intermittent explosive disorder-related injuries occurred 180 times per 100 lifetime cases. Mean age at onset was 14 years. Sociodemographic correlates were uniformly weak. Intermittent explosive disorder was significantly comorbid with most DSM-IV mood, anxiety, and substance disorders. Although the majority of people with IED (60.3%) obtained professional treatment for emotional or substance problems at some time in their life, only 28.8% ever received treatment for their anger, while only 11.7% of 12-month cases received treatment for their anger in the 12 months before interview. CONCLUSIONS: Intermittent explosive disorder is a much more common condition than previously recognized. The early age at onset, significant associations with comorbid mental disorders that have later ages at onset, and low proportion of cases in treatment all make IED a promising target for early detection, outreach, and treatment. Road rage, temper outbursts that involve throwing or breaking objects, and some types of intimate partner violence can sometimes be associated with IED. Language: en
309 citations
TL;DR: Results of the first epidemiological study of adult separation anxiety disorder, to the authors’ knowledge, and its relationship to childhood separation anxiety Disorder are presented.
Abstract: Objective: Despite its inclusion in DSM-IV, little is known about the prevalence or correlates of adult separation anxiety disorder or its relationship to the childhood disorder. Results of the first epidemiological study of adult separation anxiety disorder, to the authors’ knowledge, and its relationship to childhood separation anxiety disorder are presented. Method: Data were from the National Comorbidity Survey Replication (NCS-R), a nationally representative survey of U.S. households. A fully structured, lay-administered diagnostic interview assessed a wide range of DSM-IV disorders, including separation anxiety disorder. No independent clinical validation was obtained of the assessment. Results: Lifetime prevalence estimates of childhood and adult separation anxiety disorders were 4.1% and 6.6%, respectively. Approximately one-third of the respondents who were classified as childhood cases (36.1%) had an illness that persisted into adulthood, although the majority classified as adult cases (77.5%) h...
230 citations
TL;DR: A short, preliminary risk index based on retrospectively reported responses to fully structured questions is strongly correlated with 12-month suicide attempts among ideators, with a high concentration of attempts among high-risk ideators.
Abstract: Background. Clinical judgments about the likelihood of suicide attempt would be aided by an index of risk factors that could be quickly assessed in diverse settings. We sought to develop such a risk index for 12-month suicide attempts among suicide ideators. Method. The National Comorbidity Survey Replication (NCS-R), a household survey of adults aged 18+, assessed the 12-month occurrence of suicide ideation, plans and attempts in a subsample of 5692 respondents. Retrospectively assessed correlates include history of prior suicidality, socio- demographics, parental psychopathology and 12-month DSM-IV disorders. Results. Twelve-month prevalence estimates of suicide ideation, plans and attempts are 2 . 6, 0 . 7 and 0 . 4% respectively. Although ideators with a plan are more likely to make an attempt (31 . 9%) than those without a plan (9 . 6 %), 43 % of attempts were described as unplanned. History of prior attempts is the strongest correlate of 12-month attempts. Other significant correlates include shorter duration of ideation, presence of a suicide plan, and several sociodemographic and parental psychopathology variables. Twelve-month disorders are not powerful correlates. A four-category summary index of correlates is strongly related to attempts among ideators (area under the receiver operator characteristic curve (AUC)=0 . 88). The distribution (conditional probability of attempt) of the risk index is : 19 . 0 % very low (0 . 0%), 51 . 1 % low (3 . 5 %), 16 . 2% intermediate (21 . 3 %), and 13 . 7% high (78 . 1%). Two-thirds (67 . 1 %) of attempts were made by ideators in the high-risk category. Conclusions. A short, preliminary risk index based on retrospectively reported responses to fully structured questions is strongly correlated with 12-month suicide attempts among ideators, with a high concentration of attempts among high-risk ideators.
226 citations
TL;DR: Large unmet needs for mental health services among those with psychiatric disorders are found in Mexico.
Abstract: Objective: This study described the rate and adequacy of mental health service use among participants in the Mexico National Comorbidity Survey and the correlates of any 12-month treatment and of adequate treatment. Method: The authors conducted face-to-face household surveys of a probability sample of individuals ages 18 to 65 years in the noninstitutionalized population living in urban areas of Mexico from 2001 to 2002. The use of mental health services and 12-month DSM-IV disorders was assessed with the World Mental Health version of the World Health Organization Composite International Diagnostic Interview. The rates and correlates of any service use and the adequacy of treatment were identified in logistic regression analyses, taking into account the complex sample design and weighting process. Results: The data reported here were based on 2,362 interviews. Fewer than one in five respondents with any psychiatric disorder during the last 12 months used any service during the prior year. The rates of service use by those with mood disorders were somewhat higher. About one in every two respondents who used services received minimally adequate care. Conclusions: The authors found large unmet needs for mental health services among those with psychiatric disorders. Those with mental illness and those who deliver or seek to improve mental health care in Mexico face enormous challenges.
63 citations