 |
 |

Mild Disorders Should Not Be Eliminated From the DSM-V
Ronald C. Kessler, PhD;
Kathleen R. Merikangas, PhD;
Patricia Berglund, MBA;
William W. Eaton, PhD;
Doreen S. Koretz, PhD;
Ellen E. Walters, MS
Arch Gen Psychiatry. 2003;60:1117-1122.
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.
From the Department of Health Care Policy, Harvard Medical School, Boston, Mass (Dr Kessler and Ms Walters); the Intramural Research Program (Dr Merikangas) and the Division of Mental Disorders, Behavioral Research, and AIDS (Dr Koretz), National Institute of Mental Health, Bethesda, Md; the Institute for Social Research, University of Michigan, Ann Arbor (Ms Berglund); and the Department of Mental Hygiene, The Johns Hopkins School of Public Health, Baltimore, Md (Dr Eaton).
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
 |
Serious Psychological Distress Among Parenting and Nonparenting Adults
Herman-Stahl et al.
Am. J. Public Health 2007;97:2222-2229.
ABSTRACT
| FULL TEXT
Exposure to Hurricane-Related Stressors and Mental Illness After Hurricane Katrina
Galea et al.
Arch Gen Psychiatry 2007;64:1427-1434.
ABSTRACT
| FULL TEXT
Understanding Mental Health Treatment in Persons Without Mental Diagnoses: Results From the National Comorbidity Survey Replication
Druss et al.
Arch Gen Psychiatry 2007;64:1196-1203.
ABSTRACT
| FULL TEXT
Deployment-related stress and trauma in Dutch soldiers returning from Iraq: Prospective study
ENGELHARD et al.
Br. J. Psychiatry 2007;191:140-145.
ABSTRACT
| FULL TEXT
Declining Transition Rate in Ultra High Risk (Prodromal) Services: Dilution or Reduction of Risk?
Yung et al.
Schizophr Bull 2007;33:673-681.
ABSTRACT
| FULL TEXT
Socio-economic position and common mental disorders: Longitudinal study in the general population in the UK
Skapinakis et al.
Br. J. Psychiatry 2006;189:109-117.
ABSTRACT
| FULL TEXT
"Major" Depressive Disorder, Coronary Heart Disease, and the DSM-IV Threshold Problem
Ketterer et al.
Psychosomatics 2006;47:50-55.
ABSTRACT
| FULL TEXT
Use of Mental Health Care and Substance Abuse Treatment Among Adults With Co-occurring Disorders
Harris and Edlund
Psychiatr. Serv. 2005;56:954-959.
ABSTRACT
| FULL TEXT
Perceived Unmet Need for Mental Health Treatment and Barriers to Care Among Patients With Panic Disorder
Craske et al.
Psychiatr. Serv. 2005;56:988-994.
ABSTRACT
| FULL TEXT
Prevalence and Treatment of Mental Disorders, 1990 to 2003
Kessler et al.
NEJM 2005;352:2515-2523.
ABSTRACT
| FULL TEXT
The Clinical Impact of Negative Psychological States: Expanding the Spectrum of Risk for Coronary Artery Disease
Kubzansky et al.
Psychosom. Med. 2005;67:S10-S14.
ABSTRACT
| FULL TEXT
Recent Studies of the Biology and Treatment of Depression
Schatzberg
Focus 2005;3:14-24.
ABSTRACT
| FULL TEXT
Exploration of DSM-IV Criteria in Primary Care Patients With Medically Unexplained Symptoms
Smith et al.
Psychosom. Med. 2005;67:123-129.
ABSTRACT
| FULL TEXT
For DSM-V, It's the "Disorder Threshold," Stupid
Regier et al.
Arch Gen Psychiatry 2004;61:1051-1051.
FULL TEXT
Prevalence, Severity, and Unmet Need for Treatment of Mental Disorders in the World Health Organization World Mental Health Surveys
The WHO World Mental Health Survey Consortium
JAMA 2004;291:2581-2590.
ABSTRACT
| FULL TEXT
Pentagon Employees After September 11, 2001
Grieger et al.
Psychiatr. Serv. 2004;55:320-320.
FULL TEXT
|