This paper presents an overview of the World Mental Health (WMH) Survey Initiative version of the World Health Organization (WHO) Composite International Diagnostic Interview (CIDI) and a discussion of the methodological research on which the development of the instrument was based. The WMH-CIDI includes a screening module and 40 sections that focus on diagnoses (22 sections), functioning (four sections), treatment (two sections), risk factors (four sections), socio-demographic correlates (seven sections), and methodological factors (two sections). Innovations compared to earlier versions of the CIDI include expansion of the diagnostic sections, a focus on 12-month as well as lifetime disorders in the same interview, detailed assessment of clinical severity, and inclusion of information on treatment, risk factors, and consequences. A computer-assisted version of the interview is available along with a direct data entry software system that can be used to keypunch responses to the paper-and-pencil version of the interview. Computer programs that generate diagnoses are also available based on both ICD-10 and DSM-IV criteria. Elaborate CD-ROM-based training materials are available to teach interviewers how to administer the interview as well as to teach supervisors how to monitor the quality of data collection.

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The World Mental Health (WMH) Survey Initiative Version of the World Health Organization (WHO) Composite International Diagnostic Interview (CIDI).

Emotion and Adaptation

Risky families are characterized by conflict and aggression and by relationships that are cold, unsupportive, and neglectful. These family characteristics create vulnerabilities and/or interact with genetically based vulnerabilities in offspring that produce disruptions in psychosocial functioning (specifically emotion processing and social competence), disruptions in stress-responsive biological regulatory systems, including sympathetic-adrenomedullary and hypothalamic-pituitary-adrenocortical functioning, and poor health behaviors, especially substance abuse. This integrated biobehavioral profile leads to consequent accumulating risk for mental health disorders, major chronic diseases, and early mortality. We conclude that childhood family environments represent vital links for understanding mental and physical health across the life span.

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Risky Families: Family Social Environments and the Mental and Physical Health of Offspring

Subjective well-being (SWB) is evaluation of life in terms of satisfaction and balance between positive and negative affect; psychological well-being (PWB) entails perception of engagement with existential challenges of life. The authors hypothesized that these research streams are conceptually related but empirically distinct and that combinations of them relate differentially to sociodemographics and personality. Data are from a national sample of 3,032 Americans aged 25–74. Factor analyses confirmed the related-but-distinct status of SWB and PWB. The probability of optimal well-being (high SWB and PWB) increased as age, education, extraversion, and conscientiousness increased and as neuroticism decreased. Compared with adults with higher SWB than PWB, adults with higher PWB than SWB were younger, had more education, and showed more openness to experience. Research on well-being has flourished in recent decades (Diener, Suh, Lucas, & Smith, 1999; Kahneman, Diener, & Schwarz, 1999), with increasing recognition of the different streams of inquiry guiding this broad domain. Ryan and Deci’s (2001) integrative review organized the field of well-being into two broad traditions: one dealing with happiness (hedonic well-being), and one dealing with human potential (eudaimonic well-being; Ryan & Deci, 2001; see also Waterman, 1993). In the present study, we draw and extend these distinctions, which we refer to as traditions of research on subjective well-being (SWB) and psychological well-being (PWB). We use these terms to underscore the fact that studies of SWB have repeatedly included not only affective indicators of happiness (hedonic well-being) but also cognitive assessments of life satisfaction. In addition, some aspects of PWB (e.g., personal growth, purpose in life) but not others (e.g., positive relations with others, self-acceptance) reflect the self-fulfillment meanings of eudaimonic well-being. As described below, SWB and PWB are also the overarching phrases most frequently used in studies that constitute these traditions, both of which are fundamentally concerned with subjective accounts of well-being. Our specific empirical aims are to examine whether indicators of SWB and PWB constitute taxonomically distinct reflections of well-being in a national sample of U.S. adults. Although both approaches assess well-being, they address different features of what it means to be well: SWB involves more global evaluations of affect and life quality, whereas PWB examines perceived thriving vis-a `-vis the existential challenges of life (e.g., pursuing meaningful goals, growing and developing as a person, establishing quality ties to others). We further test the hypothesis that these distinct varieties of well-being are contoured by the broad categories of sociodemographic and personality factors. Specifically, we investigate the role of location in the life course (i.e., age) and position in the socioeconomic hierarchy (e.g., educational status) as well as personality traits in accounting for different profiles of well-being. To put the inquiry in historical context, we provide a brief summary of each tradition.

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Optimizing well-being: the empirical encounter of two traditions.

Improved methods of assessment and research design have established a robust and causal association between stressful life events and major depressive episodes. The chapter reviews these developments briefly and attempts to identify gaps in the field and new directions in recent research. There are notable shortcomings in several important topics: measurement and evaluation of chronic stress and depression; exploration of potentially different processes of stress and depression associated with first-onset versus recurrent episodes; possible gender differences in exposure and reactivity to stressors; testing kindling/sensitization processes; longitudinal tests of diathesis-stress models; and understanding biological stress processes associated with naturally occurring stress and depressive outcomes. There is growing interest in moving away from unidirectional models of the stress-depression association, toward recognition of the effects of contexts and personal characteristics on the occurrence of stressors, and on the likelihood of progressive and dynamic relationships between stress and depression over time-including effects of childhood and lifetime stress exposure on later reactivity to stress.

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Stress and Depression

Background: Data are presented on the general population prevalences, correlates, comorbidities, and impairments associated with DSM-III-R phobias. Methods: Analysis is based on the National Comorbidity Survey. Phobias were assessed with a revised version of the Composite International Diagnostic Interview. Results: Lifetime (and 30-day) prevalence estimates are 6.7% (and 2.3%) for agoraphobia, 11.3% (and 5.5%) for simple phobia, and 13.3% (and 4.5%) for social phobia. Increasing lifetime prevalences are found in recent cohorts. Earlier median ages at illness onset are found for simple (15 years of age) and social (16 years of age) phobias than for agoraphobia (29 years of age). Phobias are highly comorbid. Most comorbid simple and social phobias are temporally primary, while most comorbid agoraphobia is temporally secondary. Comorbid phobias are generally more severe than pure phobias. Despite evidence of role impairment in phobia, only a minority of individuals with phobia ever seek professional treatment. Conclusions: Phobias are common, increasingly prevalent, often associated with serious role impairment, and usually go untreated. Focused research is needed to investigate barriers to help seeking.

https://jamanetwork.com/HttpHandlers/ArticlePdfHandler.ashx?journal=psych&articleId=497537&pdfFileName=archpsyc_53_2_009.pdf

Agoraphobia, Simple Phobia, and Social Phobia in the National Comorbidity Survey

The long-term relationships between various forms of childhood adversity and adult episodes of major depression are explored in a representative household survey of the United States adult (age 25+) population. Seven of the eight childhood adversities considered are significantly associated with recent (12-month) episodes of depression. These effects are largely indirect consequences of some childhood adversities leading to a life history of depression and prior depression leading to new episodes. Only three of the eight childhood adversities directly affect recent onset or recurrence. The paper closes with a discussion of implications for future research on the long-term effects of childhood adversities.

https://www.cambridge.org/core/services/aop-cambridge-core/content/view/S0033291700025460

Childhood adversities and adult depression: basic patterns of association in a US national survey

OBJECTIVE The goal of this study was to determine the prevalence of DSM-III-R panic disorder and to describe its correlates. METHOD The study was part of the National Comorbidity Survey, the first psychiatric epidemiologic survey of the entire U.S. population and the first to use DSM-III-R criteria for diagnosis. The 8,098 survey respondents, aged 15-54 years, were given the Composite International Diagnostic Interview. For this report, the data on panic were analyzed, and from them the prevalence of panic disorder and related experiences in the U.S. population was estimated. RESULTS About 15% of the survey respondents reported the occurrence of a panic attack over their lifetimes, and 3% reported a panic attack in the preceding month. About 1% met the DSM-III-R criteria for panic disorder in the month preceding the interview. Panic attacks and panic disorder had a bimodal age distribution and were associated with female sex and lower educational achievement. Fifty percent of the survey respondents with panic disorder reported no symptoms of agoraphobia. The pattern of prevalence of correlated sociodemographic factors was similar for persons with panic attacks, panic disorder, and panic disorder with agoraphobia. CONCLUSIONS There appears to be no obvious threshold for the diagnosis of panic disorder. Panic disorder and agoraphobia, although highly comorbid, also occur separately.

Panic and panic disorder in the United States

BACKGROUND Data on eight specific fears representing DSM-III-R simple phobia were analysed to evaluate: (a) their prevalence and (b) the validity of subtypes of specific phobia defined by DSM-IV.

METHOD A modified version of the Composite International Diagnostic Interview was administered to a probability sample of 8098 community respondents. Correlates of responses to questions concerning these fears were analysed.

RESULTS The most prevalent specific fears were of animals among women, and of heights among men. Slight evidence was found for specific phobia subtypes. Number of fears, independent of type, powerfully predicted impairment, comorbidity, illness course, demographic features, and family psychopathology.

CONCLUSION Number of specific fears may mark a general predisposition to psychopathology. More detailed information is needed to resolve the question of specific phobia subtypes.

Specific fears and phobias. Epidemiology and classification.

Although previous research has shown that childhood adversity has long-term effects on adult depression, little is known about the causal pathways involved in these effects. In this report data from a two-wave longitudinal survey of the U.S. household population are used to study these pathways as they affect the association between childhood family violence and adult recurrence of depression. We focus on recurrence of depression because most episodes of clinically significant depression in adulthood occur to persons with a history of depression. We find that chronic interpersonal stress in adulthood mediates the effect of childhood family violence on recurrence of depression, and that childhood family violence modifies the effect of chronic adult interpersonal stress on recurrence of depression. Furthermore, in the absence of chronic adult interpersonal stress there is no association between childhood family violence and adult recurrence of depression.

William Magee

Papers

Agoraphobia, Simple Phobia, and Social Phobia in the National Comorbidity Survey

Childhood adversities and adult depression: basic patterns of association in a US national survey

Panic and panic disorder in the United States

Specific fears and phobias. Epidemiology and classification.

Childhood family violence and adult recurrent depression