Donald S. Rae

Criterion Validity of the NIMH Diagnostic Interview Schedule for Children Version 2.3 (DISC-2.3)

OBJECTIVE To examine the criterion validity of the NIMH Diagnostic Interview Schedule for Children (DISC) Version 2.3 in the NIMH Methods for the Epidemiology of Child and Adolescent Mental Disorders (MECA) Study, using a design that permitted several comparisons of DISC-generated diagnoses with diagnoses based on clinician symptom ratings. METHOD Two hundred forty-seven youths were selected from the 1,285 parent-youth pairs that constituted the four-site MECA sample. Subjects who screened positive for any of the five diagnostic areas under investigation in the validity study (attention-deficit hyperactivity disorder, oppositional defiant disorder, conduct disorder, depressive disorder, and the major anxiety disorders) were recruited, as well as a comparable number of screen negatives. Clinicians reinterviewed separately both the youth and the primary caregiver using the DISC followed by a clinical-style interview, and then they rated the presence of symptoms and impairment. Computer algorithms combined this information into diagnoses using comparable rules for both DISC and clinical rating diagnoses. RESULTS In general, the DISC showed moderate to good validity across a number of diagnoses. CONCLUSIONS Results suggest some specific diagnostic areas in which further revision of the DISC is warranted. Three main sources of variability in DISC-clinician diagnostic agreement were evident over and above that due to the instrument itself, including (1) the informant used, (2) the algorithm applied in synthesizing symptom reports, and (3) the design of the validity comparison.

One‐month prevalence of mental disorders in the United States and sociodemographic characteristics: the Epidemiologic Catchment Area study

The associations between the one‐month prevalence rates of mental disorders and sociodemographic characteristics were investigated for 18571 people interviewed in the first‐wave community samples of all 5 sites in the US National Institute of Mental Health (NIMH) Epidemiologic Catchment Area program. Men were found to have a significantly higher rate of cognitive impairment than women after controlling for the effects of age, race or ethnicity, marital status and socioeconomic status. Marital status was one of the most powerful correlates of mental disorder risk: the odds of separated or divorced people having any NIMH Diagnostic Interview Schedule disorder were twice that of married people after controlling for age, gender, race or ethnicity and socioeconomic status. The odds of those in the lowest socioeconomic status group having any Diagnostic Interview Schedule disorder was about 2.5 times that of those in the highest socioeconomic status group, controlling for age, gender, race or ethnicity and marital status. For all disorders except cognitive impairment, race or ethnicity did not remain statistically significant after controlling for age, gender, marital status and socioeconomic status.

Depressive and Disruptive Disorders and Mental Health Service Utilization in Children and Adolescents

OBJECTIVE To examine the relationship of depressive and disruptive disorders with patterns of mental health services utilization in a community sample of children and adolescents. METHOD Data were from the NIMH Methods for the Epidemiology of Child and Adolescent Mental Disorders (MECA) Study. The sample consisted of 1,285 child (ages 9-17 years) and parent/guardian pairs. Data included child psychopathology (assessed by the Diagnostic Interview Schedule for Children), impairment, child need and use of mental health services, and family socioeconomic status. RESULTS After adjusting for potential confounding factors, disruptive disorder was significantly associated with childrens use of mental health services, but depressive disorder was not. For school-based services, no difference was found between the 2 types of disorders. Parents perceived greater need for mental health services for children with disruptive disorders than for those with depression. Conversely, depression was more related to childrens perception of mental health service need than was disruptive disorder. CONCLUSIONS The findings highlight the need for more effective ways to identify and refer depressed children to mental health professionals, the importance of improving school-based services to meet childrens needs, and the necessity to better educate parents and teachers regarding the identification of psychiatric disorders, especially depression.

The epidemiology of anxiety disorders: The epidemiologic catchment area (ECA) experience

According to the Epidemiologic Catchment Area (ECA) study--one of the largest investigations of the prevalence of mental disorders ever conducted--anxiety disorders affect more than 7% of adults in the United States. Women, individuals under age 45, those who are separated or divorced, and those in low socioeconomic groups all have a higher rate of anxiety than individuals in other groups. This article will present prevalence rates of anxiety disorders based on data from the five ECA sites--New Haven, Conn; Baltimore, Md; St Louis, Mo; Durham, NC; and Los Angeles, Ca.

Gender differences in phobias: Results of the ECA community survey☆

Abstract Analyses of gender differences in phobias are presented based on Wave 1 of the five-site ECA community survey. A total of 18,572 respondents, aged 18 and over, were questioned about 15 phobic symptoms, yielding diagnoses based on DSM-III criteria for agoraphobia, social phobia, and simple phobia. Women had significantly higher prevalence rates of agoraphobia and simple phobia, but no gender differences were found for social phobia, the least prevalent of the phobic disorders. The most common phobias for both men and women involved “spiders, bugs, mice and snakes,” and “heights.” The largest differences between men and women were found on the agoraphobic symptoms of “going out of the house alone” and “being alone,” and on two simple phobia items, the fear of “any harmless or dangerous animal,” and “storms.” No sex differences were found in age of onset, reporting a fear on the phobic level, telling a doctor about symptoms, or recall of past symptomatology. Mean age of onset was significantly older for agoraphobia than for social or simple phobia, although all phobias evidenced onset at an early age.

Concordance Between Parent Reports of Children's Mental Health Services and Service Records: The Services Assessment for Children and Adolescents (SACA)

The concordance between parent reports of childrens mental health services and medical and administrative service records were assessed in a field test of the Services Assessment for Children and Adolescents (SACA) interview instrument. Service use reports from primary caregivers, usually mothers, for their childs emotional or behavioral problems were compared against inpatient, outpatient, and school records in St. Louis, one of the pilot sites for the Multi-Site Study of Service Use, Need, Outcomes and Costs in Child and Adolescent Populations (UNOCCAP). A global “any use” service variable, comprised of inpatient, outpatient, and school reports, yielded an overall service use concordance kappa of .76 between parent reports and records. Parent reports of inpatient hospitalization services using the SACA yielded the highest agreement with medical records, with kappa statistics of 1.00 for use of any inpatient hospital care and for medication use. Parent reports of specific inpatient services concurred with medical records more moderately, yielding kappas from .50 to .66. Reports of any outpatient mental health services yielded variable rates of agreement, with kappas ranging from .67 for any use of outpatient care, to .66 for medication use, to negligible kappas for specific treatments. Parent reports of school services were weakly related to records for most services, except for moderate agreement (.48) on placement in special classrooms for emotional or behavioral problems. Family burden or impact discriminated more powerfully than other variables between respondents who concurred with records and those who did not.

Mental health service use by Americans with severe mental illnesses.

Background: The aim of this study was to determine the patterns and determinants of service use in severely mentally ill persons drawn from the National Institute of Mental Health Epidemiological Catchment Area (ECA) program, a community-based epidemiologic survey. This information provides a baseline against which to track ongoing changes in the US mental health service system. Methods: Severe mental illness (SMI) was defined according to US Senate Appropriations Committee guidelines. Comparisons were made with persons who had a mental disorder that did not meet these criteria (non-SMI). Sociodemographic factors, and 1-year volume and intensity of mental or addictive services use were determined. Differences between those who used services and those who did not were examined using logistic regression. Results: Persons with SMI differed from persons with non-SMI in most sociodemographic characteristics. A higher proportion of persons with SMI used ambulatory services, but the mean number of visits per person did not differ from the non-SMI population. Persons with SMI comprised the bulk of hospital inpatients admitted during a 1-year period. Several significant sociodemographic determinants of service use were found, with different patterns for general medical and specialty service use, pointing out potential barriers to care. Conclusions: As health care reform measures continue to be debated, attention to the service needs of the severely mentally ill is of crucial importance. Pre-managed care (pre-1993) baseline service use benchmarks will be essential to assess the impact of managed care on access to care, particularly for the severely mentally ill. Periodic collection of epidemiologic data on prevalence and service use would thus greatly facilitate service planning and addressing barriers to receiving mental health services in this population.

Phobia: prevalence and risk factors

SummaryThis article is the presentation of the main phobia data from the Epidemiologic Catchment Area (ECA) program, with a sample size ofn=18,571. Work on this article was initiated in 1981 at the beginning of the ECA study, but publication has been delayed a decade. Phobias are determined from information from the Diagnostic Interview Schedule (DIS), classified according to DSM III. Phobias are found to be the most common psychiatric disorder in the community, more common than major depression or alcohol abuse or dependence in the month prior to interview. The one month prevalence is between 4.0 and 11.1%, with the estimated prevalence in the United States being 6.2%. There were nine community surveys of the prevalence of phobia that pre-dated the ECA studies, which found a wide range of prevalence rates from 1.2% to 26.1%. By far the strongest risk factor associated with phobias is the presence of another psychiatric disorder. Prevalence rates of simple phobia and agoraphobia are found in the ECA studies to be significantly higher in women; social phobia, which is less prevalent, has no significant sex difference. The prevalence rates are higher in younger age groups, and in those with low socioeconomic status (SES). The onset of phobias occurs primarily in the childhood or teenage years, and they tend to be chronic conditions. Less than a quarter of phobics receive treatment.

Concordance between two measures of depression in the Hispanic Health and Nutrition Examination Survey

SummaryA concordance analysis between the Center for Epidemiologic Studies Depression Scale (CES-D) and the National Institute of Mental Health (NIMH) Diagnostic Interview Schedule (DIS) for current major depression was conducted using data from Cuban Americans and Puerto Rican respondents to the Hispanic Health and Nutrition Examination Survey (HHANES). Overall agreement between the two depression measures was relatively high, which suggested that the CES-D might be appropriate as a first-stage screening instrument for community-based surveys of clinical depression. Female gender and indicators of social class (education, income, poverty index, and employment) were related to low specificity and low agreement. The estimated cutoff points of the CES-D that best predicted DIS current major depression were different between the two ethnic groups; 17 for Cuban Americans, and 20 for Puerto Ricans. A receiver operating characteristics (ROC) curve analysis revealed that the traditional method of defining CES-D cases by summing the scores for each item was superior to counting only the persistent symptoms, that is, those present nearly everyday.

Prevalence of Mental Illness in Germany and the United States: Comparison of the Upper Bavarian Study and the Epidemiologic Catchment Area Program

The objective of the present study was to compare data on the prevalence of mental illness in Germany and the United States. For this purpose, data from the Upper Bavarian Study (UBS) and the Epidemiologic Catchment Area (ECA) are presented and compared. In both studies, personal interviews were administered to a sample of community residents. The UBS sample consisted of 1,847 persons aged > or = 18 years, and the ECA study consisted of 24,371 household members aged > or = 18 years in five sites; 1,876 persons from the ECA sample lived in rural sites, and they were used for comparison with the (rural) UBS sample. The diagnostic classification (according to DSM-III) obtained by clinical interviewers in the UBS and by lay interviewers in the ECA was used. The total 6-month prevalence for any axis I Diagnostic Interview Schedule mental disorder (corrected for sample stratifications and adjusted for age) was 18.5% in the (rural) UBS, 18.0% in the total ECA sample (five sites), and 13.4% in the rural sites of the ECA. High morbidity rates for substance use disorders (UBS, 5.8%; ECA rural sites, 3.4%) and affective disorders (UBS, 6.8%; ECA rural sites, 4.1%) were observed in both studies. The 6-month prevalence rates for alcohol use disorders (3.1% considered marked or severe) were 5.1% in the UBS and 2.9% in the ECA rural sites. Concerning anxiety disorders (UBS, 1.6%; ECA rural sites, 6.7%) there was a substantial difference between the studies, which mainly resulted from a higher prevalence of phobia in the ECA program. There were higher rates of dysthymia (3.8% considered marked or severe) in the UBS (5.4%) than in the ECA rural sites (2.6%), whereas the rate of major depression was somewhat lower in UBS (1.4%) as compared with the ECA rural sites (2.4%). Alcohol use disorder was the most frequent category of mental disorder for men in both studies; for women, affective disorder and phobia (in the ECA) were the most frequent categories. Despite differences in methodology concerning sampling, instruments, and case identification the similarities between the results of the two studies were considerable.