4.0 Article

Mild disorders should not be eliminated from the DSM-V

Journal

ARCHIVES OF GENERAL PSYCHIATRY
Volume 60, Issue 11, Pages 1117-1122

Publisher

AMER MEDICAL ASSOC
DOI: 10.1001/archpsyc.60.11.1117

Keywords

-

Categories

Funding

  1. NATIONAL INSTITUTE OF MENTAL HEALTH [R01MH046376, R01MH052861, R01MH049098] Funding Source: NIH RePORTER
  2. NATIONAL INSTITUTE ON DRUG ABUSE [R01DA012058] Funding Source: NIH RePORTER
  3. NIDA NIH HHS [DA 12058] Funding Source: Medline
  4. NIMH NIH HHS [MH 49098, MH 00507, MH 46376, MH 52861] Funding Source: Medline

Ask authors/readers for more resources

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-R disorders were disaggregated into 3.2% severe, 3.2% serious, 8.7% moderate, and 16.0% mild case categories. All 4 case categories were associated with statistically significantly (P<.05, 2-sided tests) elevated risk of the NCS-2 outcomes compared with baseline noncases, with odds ratios of any outcome ranging monotonically from 2.4 (95% confidence interval, 1.6-3.4) to 15.1 (95% confidence interval, 10.0-22.9) for mild to severe cases. Odds ratios comparing mild 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) vary in severity. Decisions about treating mild cases 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.

Authors

I am an author on this paper
Click your name to claim this paper and add it to your profile.

Reviews

Primary Rating

4.0
Not enough ratings

Secondary Ratings

Novelty
-
Significance
-
Scientific rigor
-
Rate this paper

Recommended

No Data Available
No Data Available