Context Little is known about lifetime prevalence or age of onset of DSM-IV disorders. Objective To estimate lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the recently completed National Comorbidity Survey Replication. Design and Setting Nationally representative face-to-face household survey conducted between February 2001 and April 2003 using the fully structured World Health Organization World Mental Health Survey version of the Composite International Diagnostic Interview. Participants Nine thousand two hundred eighty-two English-speaking respondents aged 18 years and older. Main Outcome Measures Lifetime DSM-IV anxiety, mood, impulse-control, and substance use disorders. Results Lifetime prevalence estimates are as follows: anxiety disorders, 28.8%; mood disorders, 20.8%; impulse-control disorders, 24.8%; substance use disorders, 14.6%; any disorder, 46.4%. Median age of onset is much earlier for anxiety (11 years) and impulse-control (11 years) disorders than for substance use (20 years) and mood (30 years) disorders. Half of all lifetime cases start by age 14 years and three fourths by age 24 years. Later onsets are mostly of comorbid conditions, with estimated lifetime risk of any disorder at age 75 years (50.8%) only slightly higher than observed lifetime prevalence (46.4%). Lifetime prevalence estimates are higher in recent cohorts than in earlier cohorts and have fairly stable intercohort differences across the life course that vary in substantively plausible ways among sociodemographic subgroups. Conclusions About half of Americans will meet the criteria for a DSM-IV disorder sometime in their life, with first onset usually in childhood or adolescence. Interventions aimed at prevention or early treatment need to focus on youth.

https://www.ph.ucla.edu/epi/faculty/detels/PH150/Kessler_DSMIV_AGP2009.pdf

Lifetime Prevalence and Age-of-Onset Distributions of DSM-IV Disorders in the National Comorbidity Survey Replication

Background Little is known about the general population prevalence or severity of DSM-IV mental disorders. Objective To estimate 12-month prevalence, severity, and comorbidity of DSM-IV anxiety, mood, impulse control, and substance disorders in the recently completed US National Comorbidity Survey Replication. Design and Setting Nationally representative face-to-face household survey conducted between February 2001 and April 2003 using a fully structured diagnostic interview, the World Health Organization World Mental Health Survey Initiative version of the Composite International Diagnostic Interview. Participants Nine thousand two hundred eighty-two English-speaking respondents 18 years and older. Main Outcome Measures Twelve-month DSM-IV disorders. Results Twelve-month prevalence estimates were anxiety, 18.1%; mood, 9.5%; impulse control, 8.9%; substance, 3.8%; and any disorder, 26.2%. Of 12-month cases, 22.3% were classified as serious; 37.3%, moderate; and 40.4%, mild. Fifty-five percent carried only a single diagnosis; 22%, 2 diagnoses; and 23%, 3 or more diagnoses. Latent class analysis detected 7 multivariate disorder classes, including 3 highly comorbid classes representing 7% of the population. Conclusion Although mental disorders are widespread, serious cases are concentrated among a relatively small proportion of cases with high comorbidity.

/pdf/prevalence-severity-and-comorbidity-of-12-month-dsm-iv-54fahxwd1s.pdf

Prevalence, Severity, and Comorbidity of 12-Month DSM-IV Disorders in the National Comorbidity Survey Replication

世界経済・社会統計 = World development indicators

Despite the concern that has been expressed about potential method biases, and the pervasiveness of research settings with the potential to produce them, there is disagreement about whether they really are a problem for researchers in the behavioral sciences. Therefore, the purpose of this review is to explore the current state of knowledge about method biases. First, we explore the meaning of the terms “method” and “method bias” and then we examine whether method biases influence all measures equally. Next, we review the evidence of the effects that method biases have on individual measures and on the covariation between different constructs. Following this, we evaluate the procedural and statistical remedies that have been used to control method biases and provide recommendations for minimizing method bias.

Sources of Method Bias in Social Science Research and Recommendations on How to Control It

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.

/pdf/the-epidemiology-of-major-depressive-disorder-results-from-2kfxdgis3p.pdf

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

Recent treatment of mental disorders in the World Mental Health Survey Initiative

Context: A Health Canada and Food and Drug Administration (FDA) Advisory has warned thatatypical antipsychotic medications (APMs) increase mortality in older patients. Objective: To assess the short-term mortality in a population-based cohort of all BritishColumbia seniors who initiated conventional vs. atypical APMs. Design. Cohort study. Setting. Population-based linked health care utilization data of all British Columbia residents 65years and older from 1996 through 2004. Patients. Senior BC residents who were initiated on antipsychotic medications and had norecorded cancer diagnosis. Intervention . Conventional APMs vs. atypical APMs. Main Outcome Measures: All cause mortality. Results: 12,882 seniors initiated conventional APM therapy and 24,359 atypical APMs. Withinthe first 180 days of use, 1,822 patients (14.1%) who initiated treatment with conventional APMsdied, compared with 2,337 patients (9.6%) who initiated treatment with atypical APMs(unadjusted mortality ratio = 1.47; 95% confidence interval: 1.39 – 1.56). Multivariableadjustment resulted in a 180-day mortality ratio (MR) of 1.32 (1.23-1.42). The increase inmortality was highest in users of haloperidol (MR = 2.14; 95% CI: 1.86 to 2.45) but lower forloxapine (MR = 1.29; 95% CI: 1.19 to 1.40).The greatest mortality increase occurred with use ofhigher (> median) conventional APM dosages (MR=1.67; 1.50-1.86) and during the first 40 daysafter initiation (MR=1.60; 1.42-1.80). Results were confirmed in propensity score analyses andinstrumental variables estimation adjusting for unmeasured confounders.

Comparative Safety of Conventional and Atypical Antipsychotic Medications: Risk of Death in British Columbia Seniors

Purpose of review Psychopharmacoepidemiology has grown from its origins investigating unanticipated hazards from psychiatric drugs and now includes a wide array of studies. This review covers recent developments in the field including the current sources of data being used, examples of studies published in the past year, and potential directions for the future. Recent findings Investigators now have several important sources of psychopharmacoepidemiological data at their disposal, each with its own unique strengths and limitations. With them, psychopharmacoepidemiologists have recently identified potential adverse metabolic, electrophysiological, and cancer outcomes associated with the use of antipsychotic medications. Underrecognized benefits have also been found, such as the protective effect of clozapine on suicidality, a finding recently confirmed in the InterSePT trial. Investigations have also documented the marked expansion over the past decade in the use of psychotropic medications for disorders such as depression and attention deficit hyperactivity disorder. However, sobering results have shown that in spite of these secular increases the quality of care is often poor. For this reason, psychopharmacoepidemiological studies continue to shed light on modifiable determinants of suboptimal prescribing and patient non-adherence. Interventions to enhance the use of psychiatric medications have recently been shown to be effective and cost-effective for an ever wider set of disorders, populations, and outcomes, giving new grounds for optimism. Summary Psychiatric medications are increasingly effective, costly, and widely consumed. Psychopharmacoepidemiological studies can be of central importance in ensuring that the use of these medications is safe, appropriate, and optimal.

Recent developments in psychopharmacoepidemiology

Remote care management for older adult populations with elevated prevalence of depression or anxiety and comorbid chronic medical illness: A systematic review.

Philip S. Wang

Papers

Recent treatment of mental disorders in the World Mental Health Survey Initiative

Comparative Safety of Conventional and Atypical Antipsychotic Medications: Risk of Death in British Columbia Seniors

Recent developments in psychopharmacoepidemiology

Remote care management for older adult populations with elevated prevalence of depression or anxiety and comorbid chronic medical illness: A systematic review.

The Social Epidemiology of Mental Disorder