Reliability and clinical validity of UM-CIDI DSM-III-R generalized anxiety disorder

Design and field procedures for the clinical reappraisal of the Composite International Diagnostic Interview version 3.3 in Qatar's national mental health study

BACKGROUND

The Composite International Diagnostic Interview (CIDI) has been clinically reappraised in several studies conducted mainly in the US and Europe. This report describes the methodology used to conduct one of the Middle East's largest clinical reappraisal studies. The study was carried out in conjunction with the World Mental Health Qatar-the first national psychiatric epidemiological study of common mental disorders in the country. This study aimed to evaluate the diagnostic consistency of core modules of the newly translated and adapted Arabic version of the CIDI 5.0 against the independent clinical diagnoses based on the Structured Clinical Interview for DSM-5 (SCID-5).

METHODS

Telephone follow-up interviews were administered by trained clinicians using the latest research edition of the SCID for DSM-5. Telephone administered interviews were key in the data collection, as the study took place during the COVID-19 pandemic.

RESULTS

Overall, within 12 months, 485 interviews were completed. The response rate was 52%. Quality control monitoring documented excellent adherence of clinical interviews to the rating protocol.

CONCLUSIONS

The overall methods used in this study proved to be efficient and effective. For future research, instrument cultural adaptation within the cultural context is highly recommended.

The prevalence and correlates of bulimia nervosa, binge-eating disorder, and anorexia nervosa: The Saudi National Mental Health Survey

OBJECTIVE

Limited studies have been conducted in the Kingdom of Saudi Arabia on eating disorders (EDs). This study presents national epidemiological survey data on the prevalence and correlates of anorexia nervosa (AN), bulimia nervosa (BN), and binge-eating disorder (BED) and their association with other mental health disorders, impairment in role functioning, and individual help-seeking behaviors in the Saudi National Mental Health Survey (SNMHS).

METHOD

A face-to-face survey was conducted in a nationally representative household sample of Saudi citizens aged 15-65 (n = 4004). The Composite International Diagnostic Interview (CIDI 3.0) was used to produce estimates of lifetime and 12-month prevalence and treatment of common DSM-IV mental disorders.

RESULTS

Twelve-month prevalence of any of the three EDs was 3.2%; the overall lifetime prevalence was 6.1%. Education and marital status were significantly associated with both 12-month and lifetime EDs prevalence. Significant mental health comorbidities associated with 12-month EDs were anxiety, mood, and impulse-control disorders, while lifetime EDs were significantly related to all disorders. A similar percentage of respondents that reported having ED-related treatment at some point in their lifetime utilized healthcare and nonhealthcare sector. There was a significant relationship between body mass index category, and lifetime BED and BN.

DISCUSSION

The 12-month prevalence of EDs in the Saudi population was higher than the EDs rates reported worldwide. These findings can help healthcare experts, and policymakers in the implementation of initiatives for raising awareness of EDs among the Saudi population, and the development of a country-wide plan for the prevention of EDs.

PUBLIC SIGNIFICANCE STATEMENT

The study presents data on the prevalence, correlates, and help-seeking behaviors of AN, BN, and BED, in the Saudi National Mental Health Survey (SNMHS). Obtaining information on this underrepresented region is essential due to the large differences in cross-national data in addition to cultural beliefs about mental illness and treatment seeking to exert an important influence on eating disorders. Such knowledge could provide a better understand of mechanisms underlying the development of eating disorders and thereby improve prediction, prevention, and treatment.

A network approach to relationships between cannabis use characteristics and psychopathology in the general population

Cannabis use characteristics, such as earlier initiation and frequent use, have been associated with an increased risk for developing psychotic experiences and psychotic disorders. However, little is known how these characteristics relate to specific aspects of sub-clinical psychopathology in the general population. Here, we explore the relationships between cannabis use characteristics and psychopathology in a large general population sample (N = 2,544, mean age 29.2 years, 47% women) by employing a network approach. This allows for the identification of unique associations between two cannabis use characteristics (lifetime cumulative frequency of cannabis use, age of cannabis use initiation), and specific psychotic experiences and affective symptoms, while controlling for early risk factors (childhood trauma, urban upbringing). We found particularly pronounced unique positive associations between frequency of cannabis use and specific delusional experiences (persecutory delusions and thought broadcasting). Age of cannabis use initiation was negatively related to visual hallucinatory experiences and irritability, implying that these experiences become more likely the earlier use is initiated. Earlier initiation, but not lifetime frequency of cannabis use, was related to early risk factors. These findings suggest that cannabis use characteristics may contribute differentially to risk for specific psychotic experiences and affective symptoms in the general population.

Structural and functional brain networks of individual differences in trait anger and anger control: An unsupervised machine learning study

The ability to experience, use and eventually control anger is crucial to maintain well-being and build healthy relationships. Despite its relevance, the neural mechanisms behind individual differences in experiencing and controlling anger are poorly understood. To elucidate these points, we employed an unsupervised machine learning approach based on independent component analysis to test the hypothesis that specific functional and structural networks are associated with individual differences in trait anger and anger control. Structural and functional resting state images of 71 subjects as well as their scores from the State-Trait Anger Expression Inventory entered the analyses. At a structural level, the concentration of grey matter in a network including ventromedial temporal areas, posterior cingulate, fusiform gyrus and cerebellum was associated with trait anger. The higher the concentration, the higher the proneness to experience anger in daily life due to the greater tendency to orient attention towards aversive events and interpret them with higher hostility. At a functional level, the activity of the default mode network (DMN) was associated with anger control. The higher the DMN temporal frequency, the stronger the exerted control over anger, thus extending previous evidence on the role of the DMN in regulating cognitive and emotional functions in the domain of anger. Taken together, these results show, for the first time, two specialized brain networks for encoding individual differences in trait anger and anger control.

More treatment but no less depression: The treatment-prevalence paradox

Treatments for depression have improved, and their availability has markedly increased since the 1980s. Mysteriously the general population prevalence of depression has not decreased. This "treatment-prevalence paradox" (TPP) raises fundamental questions about the diagnosis and treatment of depression. We propose and evaluate seven explanations for the TPP. First, two explanations assume that improved and more widely available treatments have reduced prevalence, but that the reduction has been offset by an increase in: 1) misdiagnosing distress as depression, yielding more "false positive" diagnoses; or 2) an actual increase in depression incidence. Second, the remaining five explanations assume prevalence has not decreased, but suggest that: 3) treatments are less efficacious and 4) less enduring than the literature suggests; 5) trial efficacy doesn't generalize to real-world settings; 6) population-level treatment impact differs for chronic-recurrent versus non-recurrent cases; and 7) treatments have some iatrogenic consequences. Any of these seven explanations could undermine treatment impact on prevalence, thereby helping to explain the TPP. Our analysis reveals that there is little evidence that incidence or prevalence have increased as a result of error or fact (Explanations 1 and 2), and strong evidence that (a) the published literature overestimates short- and long-term treatment efficacy, (b) treatments are considerably less effective as deployed in "real world" settings, and (c) treatment impact differs substantially for chronic-recurrent cases relative to non-recurrent cases. Collectively, these a-c explanations likely account for most of the TPP. Lastly, little research exists on iatrogenic effects of current treatments (Explanation 7), but further exploration is critical.

The effect of physical activity on the association between perceived racial discrimination and depression in African Americans

BACKGROUND

The purpose of this cross-sectional study was to examine the effect of physical activity (PA) on the relationship between perceived racial discrimination and major depressive disorder (MDD) in African Americans.

METHODS

645 African Americans (mean age 45 years) were interviewed on their perceived racial discrimination, PA, and past 12-month MDD. Participants were categorized into tertiles (lower, middle, upper) of racial discrimination as well as "active" or "inactive" groups based on the US PA guidelines. Odds ratios and 95% confidence intervals (CIs) were calculated for MDD prevalence across discrimination tertiles stratified by PA group after adjusting for potential confounders.

RESULTS

The upper (higher) discrimination group had 2.99 (95% CIs 1.03-8.67) increased odds of MDD compared with the lower group after adjusting for potential confounders. The stratified analysis indicated that the increased odds of MDD in the upper discrimination group were observed only among the inactive group (5.19 [1.08-24.87]) after adjusting for age and sex. The association between discrimination and MDD was not significant among active participants.

LIMITATIONS

Limitations include generalizability since participants were predominantly women and recruited solely from Iowa or Georgia; the low number of MDD cases in some groups; and that causation cannot be inferred from this cross-sectional study.

CONCLUSION

Not meeting the PA guidelines may be associated with higher depression among African Americans experiencing higher levels of perceived racial discrimination.

Clinical reappraisal of the Composite International Diagnostic Interview Version 3.0 in the Saudi National Mental Health Survey

OBJECTIVES

The DSM-IV diagnoses generated by the fully structured lay-administered Composite International Diagnostic Interview Version 3.0 (CIDI 3.0) in the Saudi National Mental Health Survey (SNMHS) were compared to diagnoses based on blinded clinical reappraisal interviews.

METHODS

Telephone follow-up interviews were administered using the clinician-administered non-patient edition of the Structured Clinical Interview for DSM-IV (SCID) in separate sub-samples of SNMHS respondents who screened positive for four disorders that are of special importance in Arab countries: obsessive-compulsive disorder, separation anxiety disorder, social phobia, and major depressive episode.

RESULTS

Initial diagnoses based on the CIDI were found to have higher prevalence than those based on the SCID for all four disorders. For reasons having to do with respondent denial of symptoms in the SCID reported in the CIDI, we interpreted these differences as due more to under-diagnoses in the SCID than over-diagnoses in the CIDI. Nonetheless, CIDI diagnostic thresholds for three of the four disorders were increased to make sure prevalence estimates based on the CIDI were conservative. The procedures used to implement these recalibrations are described in this paper.

CONCLUSIONS

The CIDI interviews used in the SNMHS generated valid but conservative diagnoses of common mental disorders in the Saudi population.

Test-retest reliability of the computer-assisted DIA-X-5 interview for mental disorders

BACKGROUND

There is a need of comprehensive standardized diagnostic assessment tools of psychopathology that match recent changes in diagnostic classification systems, such as the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Therefore, the computer-assisted DIA-X-5 was developed and its test-retest reliability was explored. The DIA-X-5 is based on the DIA-X/M-CIDI (Diagnostisches Expertensystem für psychische Störungen/Munich-Composite International Diagnostic Interview) which referred to the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV).

METHODS

A convenience sample (N = 60, age: 15-67) was interviewed twice with the computer-assisted DIA-X-5 interview, on average nine days apart, by trained and blinded interviewers. The DIA-X-5 is a standardized instrument for research purposes covering symptoms, syndromes and diagnoses from eleven classes of mental disorders according to the DSM-5 with matching F codes of the 10th edition of the International Classification of Diseases (ICD-10).

RESULTS

Kappa values ranged from 0.90 for post-traumatic stress disorder to 0.30 for social anxiety disorder. For age of onset and age of recency, test-retest reliability as measured by intra-class correlation was satisfying with values above 0.90 for most disorders.

CONCLUSIONS

Test-retest reliability of the DIA-X-5 syndromes and diagnoses were comparable to those of previous DSM-IV/DIA-X diagnoses for most disorders. Due to low case numbers for some diagnoses, further research in larger samples is required.

A functional connectome phenotyping dataset including cognitive state and personality measures

The dataset enables exploration of higher-order cognitive faculties, self-generated mental experience, and personality features in relation to the intrinsic functional architecture of the brain. We provide multimodal magnetic resonance imaging (MRI) data and a broad set of state and trait phenotypic assessments: mind-wandering, personality traits, and cognitive abilities. Specifically, 194 healthy participants (between 20 and 75 years of age) filled out 31 questionnaires, performed 7 tasks, and reported 4 probes of in-scanner mind-wandering. The scanning session included four 15.5-min resting-state functional MRI runs using a multiband EPI sequence and a hig h-resolution structural scan using a 3D MP2RAGE sequence. This dataset constitutes one part of the MPI-Leipzig Mind-Brain-Body database.

Neighborhood racial discrimination and the development of major depression

This study examined the impact of neighborhood racial discrimination on the development of major depressive disorder (MDD) in a sample of African American women. Participants were 499 women from Georgia and Iowa with no history of MDD who were followed for 9 to 11 years. Several neighborhood characteristics (community social disorder, community cohesion, and community racism) and individual characteristics (negative life events, financial strain, personal outlook, religious involvement, relationship quality, negative affectivity, and individual experiences of racism) were employed as predictors of whether or not the women met criteria for MDD during this period of time. In a multilevel logistic regression analysis, neighborhood-level discrimination as well as individual-level variables including the number of negative life events, financial strain, and negative affectivity were found to be significant predictors of developing MDD. Analyses of cross-level interactions indicated that the effects of neighborhood-level discrimination were moderated by the quality of individuals' relationships, such that better relationships with others served to lessen the effect of neighborhood discrimination on depression. Implications of these findings for understanding the negative effects of racial discrimination are discussed. (PsycINFO Database Record

Modulation of Cognitive and Emotional Control in Age-Related Mild-to-Moderate Hearing Loss

Progressive hearing loss is a common phenomenon in healthy aging and may affect the perception of emotions expressed in speech. Elderly with mild to moderate hearing loss often rate emotional expressions as less emotional and display reduced activity in emotion-sensitive brain areas (e.g., amygdala). However, it is not clear how hearing loss affects cognitive and emotional control mechanisms engaged in multimodal speech processing. In previous work we showed that negative, task-relevant and -irrelevant emotion modulates the two types of control in younger and older adults without hearing loss. To further explore how reduced hearing capacity affects emotional and cognitive control, we tested whether moderate hearing loss (>30 dB) at frequencies relevant for speech impacts cognitive and emotional control. We tested two groups of older adults with hearing loss (HL; N = 21; mean age = 70.5) and without hearing loss (NH; N = 21; mean age = 68.4). In two EEG experiments participants observed multimodal video clips and either categorized pronounced vowels (cognitive conflict) or their emotions (emotional conflict). Importantly, the facial expressions were either matched or mismatched with the corresponding vocalizations. In both conflict tasks, we found that negative stimuli modulated behavioral conflict processing in the NH but not the HL group, while the HL group performed at chance level in the emotional conflict task. Further, we found that the amplitude difference between congruent and incongruent stimuli was larger in negative relative to neutral N100 responses across tasks and groups. Lastly, in the emotional conflict task, neutral stimuli elicited a smaller N200 response than emotional stimuli primarily in the HL group. Consequently, age-related hearing loss not only affects the processing of emotional acoustic cues but also alters the behavioral benefits of emotional stimuli on cognitive and emotional control, despite preserved early neural responses. The resulting difficulties in the multimodal integration of incongruent emotional stimuli may lead to problems in processing complex social information (irony, sarcasm) and impact emotion processing in the limbic network. This could be related to social isolation and depression observed in the elderly with age-related hearing loss.

Clinical and functional outcomes of cannabis use among individuals with anxiety disorders: A 3-year population-based longitudinal study

BACKGROUND

Cannabis use has been reported to negatively affect the course and outcome of various psychiatric disorders, yet little is known on its effect on rates of remission from anxiety disorders and associated clinical and functional outcomes.

METHODS

In this study, data were drawn from Waves 1 and 2 of the National Epidemiologic survey on Alcohol and Related Conditions, focusing on individuals who qualified for a diagnosis of any anxiety disorder (social anxiety, panic disorder, generalized anxiety disorder, and specific phobias) at Wave 1 (N = 3,723). Cannabis users and individuals with cannabis use disorders (CUDs) throughout a 4-year period were compared to nonusers in rates of remission, suicidality, general functioning, and quality of life at Wave 2, while controlling for baseline confounders.

RESULTS

Although rates of remission decreased with level of cannabis use, this was not maintained in adjusted models. Aside from specific outcomes (individuals with CUDs were significantly more prone to report breaking up from a romantic relationship; adjusted odds ratio [AOR] = 3.85, 95% confidence interval [CI] = 1.66-8.97) and repeatedly quitting school (AOR = 6.02, 95% CI = 2.65-13.66)), following adjustment no additional differences were found in outcome measures.

CONCLUSIONS

These findings add to previous reports suggesting that poorer outcome of anxiety disorders among cannabis users may be attributed mainly to differences in baseline factors and not cannabis use.

Symptom severity and disability in psychiatric disorders: The U.S. Collaborative Psychiatric Epidemiology Survey

BACKGROUND

While most psychiatric diagnoses are based on simple counts of symptoms, some symptoms may be sign of a more severe mental syndrome than others. This calls for validated estimates of the relative severity specific symptoms imply within a disorder. We focused on four diagnostic disorders: Manic Episode (ME), Major Depressive Episode (MDE), Post-traumatic Stress Disorder (PTSD) and Generalized Anxiety Disorder (GAD). Symptom-specific severity parameters were estimated, and validated by examining their association with levels of self-reported disability in daily activities over and above the number of symptoms.

METHODS

Data from the cohort study of the U.S. Collaborative Psychiatric Epidemiology Surveys (CPES) was used, which comprises the National Comorbidity Survey Replication, National Survey of American Life, and the National Latino and Asian American Study. The four analytic datasets included respondents who endorsed disorder-specific pre-screening symptoms according to the World Mental Health Survey Initiative's version of the Composite International Diagnostic Interview. Disability was measured using the WHO Disability Assessment Schedule. Item Response Theory and Tobit models were implemented.

RESULTS

For ME, PTSD, and GAD (not MDE) symptom severity based on psychometric Item Response Theory predicted disability outcomes after adjusting for symptom count. For PTSD, symptom count was not associated with disability.

LIMITATIONS

The analytic sample for each psychiatric disorder was based on a pre-selection stemming from index criteria (e.g. sadness or pleasure loss for MDE), which implies that our results are only generalizable to those individuals at risk rather than for the entire population. Additionally, we acknowledge that the use of unidimensional models is only one of the several options to model psychopathological constructs.

CONCLUSIONS

The same number of symptoms may be related to different levels of disability, depending on the specific symptoms from which the person suffers. Diagnostic procedures and treatment decisions may benefit from such additional information without extra costs.

The Influence of Negative Emotion on Cognitive and Emotional Control Remains Intact in Aging

Healthy aging is characterized by a gradual decline in cognitive control and inhibition of interferences, while emotional control is either preserved or facilitated. Emotional control regulates the processing of emotional conflicts such as in irony in speech, and cognitive control resolves conflict between non-affective tendencies. While negative emotion can trigger control processes and speed up resolution of both cognitive and emotional conflicts, we know little about how aging affects the interaction of emotion and control. In two EEG experiments, we compared the influence of negative emotion on cognitive and emotional conflict processing in groups of younger adults (mean age = 25.2 years) and older adults (69.4 years). Participants viewed short video clips and either categorized spoken vowels (cognitive conflict) or their emotional valence (emotional conflict), while the visual facial information was congruent or incongruent. Results show that negative emotion modulates both cognitive and emotional conflict processing in younger and older adults as indicated in reduced response times and/or enhanced event-related potentials (ERPs). In emotional conflict processing, we observed a valence-specific N100 ERP component in both age groups. In cognitive conflict processing, we observed an interaction of emotion by congruence in the N100 responses in both age groups, and a main effect of congruence in the P200 and N200. Thus, the influence of emotion on conflict processing remains intact in aging, despite a marked decline in cognitive control. Older adults may prioritize emotional wellbeing and preserve the role of emotion in cognitive and emotional control.

Validity of the Associated Symptom Criteria for Generalized Anxiety Disorder: Observations From the Singapore Mental Health Study

Previous findings on the diagnostic validity and reliability of generalized anxiety disorder (GAD)-associated symptom criteria suggest need for further evaluation. The current study examined convergent validity and specificity of GAD-associated symptoms in a representative Singapore community sample. The Singapore of Mental Health Study a cross-sectional epidemiological survey conducted among 6166 Singapore residents aged 18 and older. The Composite International Diagnostic Interview version 3.0 was used to diagnose mental disorders. Associated symptoms in the GAD criteria and autonomic hyperactivity symptoms showed convergent validity with a GAD diagnosis. However, associated symptoms of GAD were also linked to major depressive disorder (MDD), bipolar disorder, and obsessive-compulsive disorder, suggesting lack of adequate specificity. The inability of the diagnostic criteria to differentiate GAD from symptoms of other conditions highlights the need to better define its associated symptoms criteria. The relationship of overlapping symptoms between GAD and MDD is also discussed.

Do Psychological Characteristics Explain Socioeconomic Stratification of Self-rated Health?

This study evaluated whether negative emotions explain socioeconomic status (SES) stratification of self-rated health (SRH) and whether this putative relation is independent of established SRH determinants. Mood disorders, trait negative affect and health status indices were assessed in a representative cross-sectional survey of 3032 adults in the National Survey of Midlife Development in the United States (MIDUS). Adjustment for health behaviors and health status appreciably reduced SES influence on SRH, but adjustment for negative emotions did not. However, both psychological resources (e.g. social support, extraversion) and negative emotions independently predicted SRH. Detection of SRH determinants was sensitive to binary versus ordinal SRH definitions.

Projection in Person Perception among Spouses as a Function of the Similarity in their Shared Experiences

Past research has demonstrated that the psychological state of observers influences how they view others. This influence often has been termed “projection.” The current study explores projection in close relationships of cohabiting partners. In Study 1a, structural equation modeling revealed a significant component of projection when spouses reported on the depressive symptoms of their partners. In Study 1b, the same analysis was expanded to include spouses’ reports on a variety of affective states, attitudes, and behaviors of their partners. It was demonstrated that the degree of projection increases with the increase in the magnitude of the correlation between the self-views of the spouses. A cognitive process that accounts for this finding is proposed, along with a view of projection as a heuristic device rather than a bias.

Validity of Chinese Version of the Composite International Diagnostic Interview-3.0 in Psychiatric Settings

BACKGROUND

The Composite International Diagnostic Interview-3.0 (CIDI-3.0) is a fully structured lay-administered diagnostic interview for the assessment of mental disorders according to ICD-10 and Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria. The aim of the study was to investigate the concurrent validity of the Chinese CIDI in diagnosing mental disorders in psychiatric settings.

METHODS

We recruited 208 participants, of whom 148 were patients from two psychiatric hospitals and 60 healthy people from communities. These participants were administered with CIDI by six trained lay interviewers and the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I, gold standard) by two psychiatrists. Agreement between CIDI and SCID-I was assessed with sensitivity, specificity, positive predictive value and negative predictive value. Individual-level CIDI-SCID diagnostic concordance was evaluated using the area under the receiver operator characteristic curve and Cohen's K.

RESULTS

Substantial to excellent CIDI to SCID concordance was found for any substance use disorder (area under the receiver operator characteristic curve [AUC] = 0.926), any anxiety disorder (AUC = 0.807) and any mood disorder (AUC = 0.806). The concordance between the CIDI and the SCID for psychotic and eating disorders is moderate. However, for individual mental disorders, the CIDI-SCID concordance for bipolar disorders (AUC = 0.55) and anorexia nervosa (AUC = 0.50) was insufficient.

CONCLUSIONS

Overall, the Chinese version of CIDI-3.0 has acceptable validity in diagnosing the substance use disorder, anxiety disorder and mood disorder among Chinese adult population. However, we should be cautious when using it for bipolar disorders and anorexia nervosa.

The mental health of sexual minority adults in and out of the closet: A population-based study

OBJECTIVES

Previous studies have found that sexual orientation concealment affords escape from stigma and discrimination but also creates a psychological toll. While disclosure alleviates the mental burden of concealment, it invites the stress of navigating a new public identity. Population-based samples that include both "in" and "out" sexual minorities provide an ideal opportunity to resolve limitations and inconsistencies of previous nonprobability investigations into the mental health correlates of concealment and disclosure.

METHOD

Sexual minority participants in the California Quality of Life Survey (n = 2,083) indicated whether and when they first disclosed their sexual orientation to others. Prevalence of 1-year major depressive disorder and generalized anxiety disorder was derived from the Composite International Diagnostic Interview-Short Form.

RESULTS

Closeted men (n = 84) were less likely to be depressed than out men, n = 1,047; odds ratio (OR) = 0.41; 95% CI [0.17, 0.996]. Men who were recently out (n = 201) experienced higher odds of major depressive disorder, OR = 6.21; 95% CI [1.53, 24.47], and generalized anxiety disorder, OR = 5.51; 95% CI [1.51, 20.13], as compared to closeted men. Men who were distantly out (n = 846) also experienced higher odds of major depressive disorder than men who were closeted, OR = 2.91; 95% CI [1.10, 7.69]. Recently out women (n = 243) experienced lower odds of depression than closeted women, n = 63; OR = 0.21; 95% CI [0.05, 0.96].

CONCLUSION

Whether being in or out of the closet is associated with depression and anxiety largely depends on gender. Clinical and policy implications are discussed in terms of the unique stressors facing men and women both in and out of the closet.

Procedural validity of the AUDADIS-5 depression, anxiety and post-traumatic stress disorder modules: Substance abusers and others in the general population

BACKGROUND

Little is known about the procedural validity of lay-administered, fully-structured assessments of depressive, anxiety and post-traumatic stress (PTSD) disorders in the general population as determined by comparison with clinical re-appraisal, and whether this differs between current regular substance abusers and others. We evaluated the procedural validity of the Alcohol Use Disorder and Associated Disabilities Interview Schedule, DSM-5 Version (AUDADIS-5) assessment of these disorders through clinician re-interviews.

METHODS

Test-retest design among respondents from the National Epidemiologic Survey on Alcohol and Related Conditions-III (NESARC-III): (264 current regular substance abusers, 447 others). Clinicians blinded to AUDADIS-5 results administered the semi-structured Psychiatric Research Interview for Substance and Mental Disorders, DSM-5 version (PRISM-5). AUDADIS-5/PRISM-5 concordance was indicated by kappa (κ) for diagnoses and intraclass correlation coefficients (ICC) for dimensional measures (DSM-5 symptom or criterion counts). Results were compared between current regular substance abusers and others.

RESULTS

AUDADIS-5 and PRISM-5 concordance for DSM-5 depressive disorders, anxiety disorders and PTSD was generally fair to moderate (κ=0.24-0.59), with concordance on dimensional scales much better (ICC=0.53-0.81). Concordance differed little between regular substance abusers and others.

CONCLUSIONS

AUDADIS-5/PRISM-5 concordance indicated procedural validity for the AUDADIS-5 among substance abusers and others, suggesting that AUDADIS-5 diagnoses of DSM-5 depressive, anxiety and PTSD diagnoses are informative measures in both groups in epidemiological studies. The stronger concordance on dimensional measures supports the current movement toward dimensional psychopathology measures, suggesting that such measures provide important information for research in the NESARC-III and other datasets, and possibly for clinical purposes as well.

The Alcohol Use Disorder and Associated Disabilities Interview Schedule-5 (AUDADIS-5): reliability of substance use and psychiatric disorder modules in a general population sample

BACKGROUND

The purpose of this study was to assess the test-retest reliability of substance use disorder and psychiatric modules in the Alcohol Use Disorder and Associated Disabilities Interview Schedule, Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) Version (AUDADIS-5).

METHODS

Kappa and intraclass correlation coefficients were calculated for DSM-5 substance use and psychiatric disorder diagnoses and dimensional criteria scales using a test-retest design among 1006 respondents drawn from the National Epidemiologic Survey on Alcohol and Related Conditions-III (NESARC-III).

RESULTS

Reliabilities of substance use disorder diagnoses and associated criteria scales were generally good to excellent, while reliabilities for mood, anxiety and trauma and stress-related disorders and associated scales were generally in the fair to good range.

CONCLUSIONS

The observed reliability of the DSM-5 diagnoses and dimensional scales for the substance use and psychiatric disorders found in this study indicates that the AUDADIS-5 can be a useful tool in various research settings, particularly in studies of the general population, the target population for which it was designed.

Changes in the prevalence of mood and anxiety disorders among male and female current smokers in the United States: 1990-2001

PURPOSE

The present study investigated whether the prevalence of mood and anxiety disorders has increased over time among current smokers and whether these trends differ by gender and in comparison with nonsmokers.

METHODS

Data were drawn from the National Comorbidity Survey (1990) and the National Comorbidity Survey-Replication (2001), representative samples of the US adult population. Binomial regression analyses were used to determine differences between mood and anxiety disorders among current smokers in 1990 and 2001 and whether these differed by gender and in comparison with those who were former or never current smokers.

RESULTS

Any anxiety disorder, panic attacks, panic disorder, social anxiety disorder and dysthymia were all significantly more common among current smokers in 2001 compared with 1990 and except for social anxiety disorder these increases were significantly greater than any trend found in non-smokers. Increases in panic attacks, social anxiety disorder, and dysthymia were more pronounced in female than in male smokers. Major depressive disorder and generalized anxiety disorder were not found to increase over time among smokers.

CONCLUSIONS

The prevalence of several anxiety disorders and dysthymia among current smokers appears to have increased from 1990 to 2001. Future studies are needed to determine whether these trends have continued. If so, interventions aimed at moving the prevalence lower may have limited success if treatment of mental health problems such as anxiety disorders and certain mood disorders are not considered in the development and dissemination of tobacco control programs.

Global health benefits of being raised in a rural setting: results from the National Comorbidity Survey

AIM

The aim of this study was to examine the association between being raised in a rural setting and physical and mental health among adults in the USA.

METHODS

Data were drawn from the National Comorbidity Survey (n = 8098), a household probability sample representative of adults aged 15-54 years in the USA. Multiple logistic regression analyses were used to determine the association between being raised in a rural area and the likelihood of mental disorders, physical disorders, suicide behavior, and parental mental health. Odds ratios (OR) with 95% confidence intervals were calculated, adjusting for differences in demographic characteristics.

RESULTS

Being raised in a rural setting was associated with decreased odds of ulcer (OR = 0.56 [0.34, 0.91]). Mental disorders (any lifetime) (OR = 0.74 [0.64, 0.85]), any anxiety disorder (OR = 0.75 [0.6, 0.92]) and any substance use disorder (OR = 0.79 [0.65, 0.94]) were significantly less likely among adults who were raised in a rural setting. Maternal psychopathology and exposure to trauma were significantly lower among those raised in a rural setting, compared with those who were not. These relations were not explained by sociodemographic differences.

CONCLUSIONS

These data provide preliminary evidence that being raised in a rural environment lowers the risk of mental and physical health problems in adulthood. Being raised in a rural community also appears to be associated with significantly lower likelihood of exposure to trauma and maternal psychopathology. Future studies that can identify potential protective factors and mechanisms underlying these pathways are needed next.

Psychometric properties of the Cannabis Abuse Screening Test in Hungarian samples of adolescents and young adults

AIM

The aim of our study was to analyze psychometric properties of the Cannabis Abuse Screening Test (CAST).

METHODS

Our sample comprised Hungarian high school (n = 476; male 56.3%; mean age 19.0 years, SD = 0.65 years) and college students (n = 439; male 65.1%; mean age 23.9 years, SD = 1.56 years) who reported cannabis use in the past year. The sample covered the five biggest universities of Hungary. Besides the CAST, participants responded to the Munich-Composite International Diagnostic Interview. Factor structure was analyzed by a confirmatory factor analysis. Receiver operating characteristic curve analysis was made to assess cut-off scores. Data collection took place in 2010.

RESULTS

CAST proved to be a reliable (Cronbach's α 0.71 and 0.76) one-dimensional measure. Regarding both cannabis dependence and cannabis use disorders, a cut-off of 2 points proved to be ideal in both samples, resulting in optimal specificity, negative predictive values and accuracy, but less than optimal positive predictive values (dependence) and low sensitivity (cannabis use disorder).

DISCUSSION AND CONCLUSIONS

In line with former results, the CAST proved to be an adequate measure for the screening of cannabis-related problems among adolescents and young adults in an Eastern European country where this scale has not been studied before.

Assessing the specificity of posttraumatic stress disorder's dysphoric items within the dysphoria model

The factor structure of posttraumatic stress disorder (PTSD) currently used by the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), has received limited support. A four-factor dysphoria model is widely supported. However, the dysphoria factor of this model has been hailed as a nonspecific factor of PTSD. The present study investigated the specificity of the dysphoria factor within the dysphoria model by conducting a confirmatory factor analysis while statistically controlling for the variance attributable to depression. The sample consisted of 429 individuals who met the diagnostic criteria for PTSD in the National Comorbidity Survey. The results concluded that there was no significant attenuation in any of the PTSD items. This finding is pertinent given several proposals for the removal of dysphoric items from the diagnostic criteria set of PTSD in the upcoming DSM-5.

Composite International Diagnostic Interview screening scales for DSM-IV anxiety and mood disorders

BACKGROUND

Lack of coordination between screening studies for common mental disorders in primary care and community epidemiological samples impedes progress in clinical epidemiology. Short screening scales based on the World Health Organization (WHO) Composite International Diagnostic Interview (CIDI), the diagnostic interview used in community epidemiological surveys throughout the world, were developed to address this problem.

METHOD

Expert reviews and cognitive interviews generated CIDI screening scale (CIDI-SC) item pools for 30-day DSM-IV-TR major depressive episode (MDE), generalized anxiety disorder (GAD), panic disorder (PD) and bipolar disorder (BPD). These items were administered to 3058 unselected patients in 29 US primary care offices. Blinded SCID clinical reinterviews were administered to 206 of these patients, oversampling screened positives.

RESULTS

Stepwise regression selected optimal screening items to predict clinical diagnoses. Excellent concordance [area under the receiver operating characteristic curve (AUC)] was found between continuous CIDI-SC and DSM-IV/SCID diagnoses of 30-day MDE (0.93), GAD (0.88), PD (0.90) and BPD (0.97), with only 9-38 questions needed to administer all scales. CIDI-SC versus SCID prevalence differences are insignificant at the optimal CIDI-SC diagnostic thresholds (χ2 1 = 0.0-2.9, p = 0.09-0.94). Individual-level diagnostic concordance at these thresholds is substantial (AUC 0.81-0.86, sensitivity 68.0-80.2%, specificity 90.1-98.8%). Likelihood ratio positive (LR+) exceeds 10 and LR- is 0.1 or less at informative thresholds for all diagnoses.

CONCLUSIONS

CIDI-SC operating characteristics are equivalent (MDE, GAD) or superior (PD, BPD) to those of the best alternative screening scales. CIDI-SC results can be compared directly to general population CIDI survey results or used to target and streamline second-stage CIDIs.

Anxiety disorders and drug dependence: evidence on sequence and specificity among adults

AIM

The goal of this study was to investigate the relation between specific anxiety disorders and substance dependence, adjusting for potentially confounding demographic factors (e.g. sex) and comorbidity (e.g. alcohol dependence, major depression), among adults in the USA.

METHODS

Data were drawn from the National Comorbidity Survey (NCS), a nationally representative population sample of the US adult population aged 15-54. The temporal sequence of onset of anxiety and substance dependence disorders was examined.

RESULTS

Substance dependence temporally precedes several anxiety disorders, particularly panic disorder. Specifically, a history of past substance dependence predicts current panic disorder (odds ratio [OR] =2.62, 95% confidence interval [CI] =1.29, 5.32), social phobia (OR=1.7, 95%CI=1.12, 2.41), and agoraphobia (OR=1.78, 95%CI=1.08, 2.94). Conversely, in more than 50% of substance abuse disorder cases, in nearly 40% of post-traumatic stress disorder (PTSD) cases, and in nearly 30% of generalized anxiety disorder (GAD) cases, the anxiety disorder has first onset. Similarly, a lifetime history of social phobia, PTSD, or GAD significantly predicts lifetime substance dependence (OR=1.51 for social phobia, 2.06 for PTSD, 1.45 for GAD).

CONCLUSION

For any particular anxiety disorder, a diagnosis of substance abuse can occur prior to or subsequent to an anxiety disorder. Nevertheless, there is also evidence for the specificity of some associations between anxiety and substance dependence disorders; these are independent of the effects of sex and other comorbid disorders, may be causal in nature, and deserve particular attention in clinical settings. The possibility that within a particular anxiety disorder there are a variety of mechanisms of association with various substances should be addressed in future work.

Institutional predictors of developmental outcomes among racially diverse foster care alumni

Child welfare practitioners are confronted with the responsibility of relying on best practice to ensure children in foster care transition successfully into adulthood after leaving the foster care system. Yet, despite recent reforms and efforts to address their needs, research clearly shows that foster care alumni are still more likely to experience negative developmental outcomes compared to adults in the general population. The purpose of this study was to better understand how child-serving systems of care adequately prepare racially diverse foster care alumni to thrive. Controlling for gender, age, placement instability, and circumstances of exit from foster care, study findings highlighted salient racial and ethnic differences relative to which factors predicted the odds of mental health, education, and employment outcomes. Implications for developing and implementing culturally sensitive, evidence-based prevention and intervention programs to promote positive developmental outcomes among racially diverse foster care alumni are discussed.

Perceived quality of early paternal relationships and mental health in adulthood

We aimed to determine the association between perceived paternal relationships and mental health and social functioning among adults in the community. Data were drawn from the National Comorbidity Survey (N = 8098), a nationally representative sample of adults aged 15 to 54 years in the United States. Multiple logistic regression analyses were used to assess the relationships between quality of paternal relationship in childhood and current mental disorders, quality of current social relationships, and attachment style. Poor paternal relationship was associated with a significantly increased likelihood of mood and anxiety disorders. Poorer quality of paternal relationships was also associated with poorer current social functioning and avoidant and dependent attachment styles. Our findings suggest that quality of paternal relationships is associated with mental health and social functioning in adulthood and highlight a need for increased understanding of the role of paternal relationships in social/emotional development.

Computational non-linear dynamical psychiatry: a new methodological paradigm for diagnosis and course of illness

The goal of this article is to highlight the significant potential benefits of applying computational mathematical models to the field of psychiatry, specifically in relation to diagnostic conceptualization. The purpose of these models is to augment the current diagnostic categories that utilize a "snapshot" approach to describing mental states. We hope to convey to researchers and clinicians that non-linear dynamics can provide an additional useful longitudinal framework to understand mental illness. Psychiatric phenomena are complex processes that evolve in time, similar to many other processes in nature that have been successfully described and understood within deterministic chaos and non-linear dynamic computational models. Dynamical models describe mental processes and phenomena that change over time, more like a movie than a photograph, with multiple variables interacting over time. The use of these models may help us understand why and how current diagnostic categories are insufficient. They may also provide a new, more descriptive and ultimately more predictive approach leading to better understanding of the interrelationship between psychological, neurobiological, and genetic underpinnings of mental illness.

Help-seeking behaviors in a community sample of young adults with substance use disorders

Despite the high prevalence of substance use disorders (SUDs) in the U.S., many with a SUD go untreated and/or report lengthy delays to help-seeking initiation. From a public health standpoint, because SUDs often emerge in early adulthood, information on help-seeking behaviors among young adults is important. Using data from young adults ages 18-23 years with a history of a SUD (n = 672) in Miami-Dade County, Florida, this study estimates the prevalence of lifetime help-seeking initiation and examines factors related to help seeking and delays to help-seeking initiation. The majority (68%) of young adults with a history of a SUD reported never having sought help, and those who reported help seeking experienced relatively lengthy delays (1-7 years) to help-seeking initiation. These findings underscore the need for both timely substance abuse treatment and for accelerated research on successful outreach strategies for young adults with SUDs.

Perception of Health, Suicidal Ideation, and Suicide Attempt Among Adults in the Community

Background: There is a well-known association between perception of poor physical health and higher rates of physical and psychological morbidity. However, little is known about the possible link between perception of health and suicidality. Aims: The study examines the relationship between perception of poor health and suicidal ideation and suicide attempt among adults in the community. Methods: Data were drawn from the National Comorbidity Survey (n = 5,877), a representative sample of individuals 15–54 years of age in the United States. Multiple logistic regression analyses were used to determine the relationship between perception of poor health and the likelihood of suicidal ideation and suicide attempt. Sociodemographic characteristics, comorbid mental disorders, and physical illnesses were adjusted for in the final model. Results: Perception of poor health was associated with a significantly increased likelihood of suicidal ideation (OR = 2.14 (1.36, 3.35) and suicide attempt (OR = 2.03 (1.06, 3.91)), which persisted after adjusting for differences in sociodemographic characteristics, mental disorders, and self-reported physical illnesses. Conclusions: Our findings provide initial evidence that perception of poor health is associated with a significantly increased likelihood of suicidal ideation and suicide attempt among adults in the community.

The diagnostic threshold of generalized anxiety disorder in the community: a developmental perspective

Discussion surrounds the question as to whether criteria for generalized anxiety disorder (GAD) should change, particularly in youth. This study examines the effects of possible criteria changes on GAD prevalence and clinical correlates. DSM-IV GAD was assessed using the M-CIDI in a community sample of adolescents and young adults. Diagnostic thresholds were modified in two age spans (9-20 and 21-34 years) using a person-by-year data file (N = 38,534 cases). Relaxing the duration or excessiveness criteria led to the most pronounced changes in GAD prevalence, while relaxing frequency, uncontrollability, or associated-symptom criteria had smaller effects. A lower duration requirement increased rates more in older than younger age spans. Opposite effects occurred for changes in associated-symptoms or clinical-significance criteria. Broader GAD definitions identified cases in both age spans that appeared mostly milder than DSM-IV cases but that still differed from non-GAD cases in various clinical factors and validators. Developmental aspects require stronger consideration in future diagnostic systems.

Trauma and stress among older adults in the criminal justice system: a review of the literature with implications for social work

The purpose of this article was to review the empirical literature that investigated trauma and stress among older adults in the criminal justice system. Nineteen journal articles published between 1988 and 2010 were identified and extracted via research databases and included mixed age samples of adjudicated older and younger adults (n = 11) or older adult only samples (n = 8). Findings revealed past and current trauma and stress, consequences and/or correlates, and internal and external coping resources among aging offenders. The implications and future directions for gerontological social work, research, and policy with older adults in the criminal justice system are advanced.

Generalized anxiety disorder: clinical presentation, diagnostic features, and guidelines for clinical practice

Generalized anxiety disorder (GAD) is a prevalent and disabling disorder characterised by persistent worrying, anxiety symptoms, and tension. General practitioners and mental healthcare professionals frequently misdiagnose the presenting symptoms. This article addresses the clinical presentation of GAD and provides guidelines for discriminating GAD from other disorders, based on theoretical considerations and clinical experience. Debate relating to the validity of the definition of GAD is discussed, and suggestions are made for improving the criteria for GAD, which may guide future versions of classification systems such as the Diagnostic and Statistical Manual.

Comparison of the Composite International Diagnostic interview (CIDI-Auto) with clinical diagnosis in a suicidal population

The objective was to examine agreement between routine clinician diagnoses of DSM-IV Anxiety, Depressive, Substance-Use disorders with diagnoses generated by CIDI-Auto Version 2.1, administered by trained interviewers. Subjects were 329 deliberate self poisoning patients at a tertiary referral center in Australia. Tests of agreement were: percentage agreement, sensitivity, specificity, positive and negative predictive values, positive and negative likelihood ratios, and Cohen's kappa coefficients, for 1 month and 12 month CIDI diagnoses. Agreement was poor (kappa <0.40) for Anxiety, Depressive and Substance-Use disorders. Since diagnosis largely determines subsequent treatment, these findings did not support the use of the less expensive CIDI-Auto procedure to replace clinical diagnosis by experienced clinicians for this group of patients exhibiting suicidal behavior.

Health-related quality of life across the anxiety disorders: results from the national epidemiologic survey on alcohol and related conditions (NESARC)

OBJECTIVE

Although clinical studies have documented that specific anxiety disorders are associated with impaired psychosocial functioning, little is known regarding their comparative effects on health-related quality of life within a general population. The current analysis compares health-related quality of life in a US community-dwelling sample of adults with DSM-IV social anxiety disorder, generalized anxiety disorders (GAD), panic disorder, and specific phobia.

METHOD

A face-to-face survey of a US nationally representative sample of over 43,000 adults aged 18 years and older residing in households and group quarters was conducted. Prevalence of DSM-IV anxiety disorders and relative associations with health-related quality of life indicators were examined. The survey was conducted from 2001 to 2002.

RESULTS

Roughly 9.8% of respondents met diagnostic criteria for at least 1 of 4 twelve-month DSM-IV anxiety disorders which, relative to the non-anxiety-disordered general population, were each associated with lower personal income, increased rates of 12-month physical conditions, and greater numbers of Axis I and Axis II DSM-IV psychiatric conditions. After adjusting for sociodemographic and clinical correlates, including other anxiety disorders, GAD was associated with significant decrements in the SF-12 mental component summary score. In similar models, GAD and, to a lesser extent, panic disorder were significantly associated with impairment in social functioning, role emotional, and mental health SF subscales.

CONCLUSIONS

GAD, followed by panic disorder, appears to exact significant and independent tolls on health-related quality of life. Results underscore the importance of prompt and accurate clinical identification and improving access to effective interventions for these disorders.

Assessing the validity of social anxiety disorder subtypes using a nationally representative sample

The purpose of this study was to examine and validate social anxiety disorder subtypes using the nationally representative National Comorbidity Survey Replication (N=9282). Generalized and non-generalized subtypes were defined as fearing at least 8 (i.e., most) and fewer than 7 of 14 possible social situations, respectively, following the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR). Results indicated that in those with social anxiety disorder, the odds of having comorbid major depression, a comorbid anxiety disorder, and suicidal ideation were significantly greater in the generalized subtype. However, differences were no longer significant when adjusting for the number of feared social situations. Results further indicated that the number of feared social situations was significantly associated with comorbid major depression, a comorbid anxiety disorder, and suicidal ideation. These findings call into question the validity of DSM-IV-defined subtypes and provide additional support for the notion that clinicians and researchers should consider viewing this disorder on a single continuum with greater number of feared situations associated with greater clinical severity.

Generalized worry disorder: a review of DSM-IV generalized anxiety disorder and options for DSM-V

BACKGROUND

Generalized anxiety disorder (GAD) has undergone a series of substantial classificatory changes since its first inclusion in DSM-III. The majority of these revisions have been in response to its poor inter-rater reliability and concerns that it may lack diagnostic validity. This article provides options for the revision of the DSM-IV GAD criteria for DSM-V.

METHOD

First, searches were conducted to identify the evidence that previous DSM Work Groups relied upon when revising the DSM-III-R GAD and the overanxious disorder classifications. Second, the literature pertaining to the DSM-IV criteria for GAD was examined.

CONCLUSIONS

The review presents a number of options to be considered for DSM-V. One option is for GAD to be re-labeled in DSM-V as generalized worry disorder. This would reflect its hallmark feature. Proposed revisions would result in a disorder that is characterized by excessive anxiety and worry generalized to a number of events or activities for 3 months or more. Worry acts as a cognitive coping strategy that manifests in avoidant behaviors. The reliability and validity of the proposed changes could be investigated in DSM-V validity tests and field trials.

New women-specific diagnostic modules: the Composite International Diagnostic Interview for Women (CIDI-VENUS)

The World Health Organization-Composite International Diagnostic Interview (WHO-CIDI) is a highly structured interview for the assessment of mental disorders, based on the definitions and criteria of the fourth edition of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). Over the past decade it has become evident that the CIDI does not sufficiently address the assessment needs of women. Women are affected by most mental disorders, particularly mood and anxiety disorders, approximately twice as frequently as men. Women-specific disorders, such as Premenstrual Syndrome (PMS), Premenstrual Dysphoric Disorder (PMDD), psychiatric disorders during pregnancy and postpartum as well as during the perimenopause, menopause and beyond are not addressed by the standard CIDI diagnostic modules. In addition, the CIDI in its current form does not address the potential effect that female reproductive milestones may have on diagnosis, treatment and prevention of mental disorders in women. Our aim was to develop a new women specific platform (CIDI-VENUS; CIDI-V) to be embedded in the existing CIDI that will address the above mentioned current deficiencies. Guided by a team of experts in the field of Women's Mental Health from Canada and Germany the following modules were developed: 1) A complete menstrual history and comprehensive contraceptive history with a link to the Premenstrual Symptoms Screening Tool (PSST). 2) A complete perinatal history of pregnancies, miscarriages, terminations, still births, death of a child, with details of current pregnancy including gestation and expected date of confinement, labour history and breastfeeding, history of tobacco, alcohol, and other substance use including prescription drugs during pregnancy and postpartum, a section on specific phobias and on recurrent obsessive/compulsive thoughts/behaviours (OCD) related to the baby with a link to the Perinatal Obsessive-Compulsive Scale (POCS), as well as a link to the Edinburgh Postnatal Depression Scale (EPDS). 3). A detailed history of use of hormone therapy (e.g. pills, patches, implants, etc.) with a focus on (peri-) menopausal women, differentiating between physical and psychological symptoms with a link to the Menopause Visual Analogue Scales (M-VAS) and to the Greene Climacteric Scale. 4) An iterative module concluding each CIDI section to specify the course of mental disorders during the reproductive stages and menopausal transition. While retaining core diagnostic sections and diagnostic algorithms, the CIDI-V is enriched by women-specific diagnostic modules, providing a wealth of clinically relevant information about women's mental health, not available anywhere else in our current psychiatric diagnostic instruments.

Structure of genetic and environmental risk factors for dimensional representations of DSM-IV anxiety disorders

BACKGROUND

Twin data permit decomposition of comorbidity into genetically and environmentally derived correlations. No previous twin study includes all major forms of anxiety disorder.

AIMS

To estimate the degree to which genetic and environmental risk factors are shared rather than unique to dimensionally scored panic disorder, generalised anxiety disorder, phobias, obsessive-compulsive disorder and post-traumatic stress disorder.

METHOD

Data obtained from 2801 young-adult Norwegian twins by means of the Composite International Diagnostic Interview were analysed with the Mx program.

RESULTS

A multivariate common factor model fitted best. The latent liability to all anxiety disorders was substantially more heritable (54%) than the individual disorders (23% to 40%). Most of the genetic effect was common to the disorders. Genes contributed just over 50% to the covariance between liabilities.

CONCLUSIONS

The five anxiety disorders all share genetic and environmental risk factors. This has implications for the revision of the anxiety disorder section in DSM-V.

Lessons learned from the clinical reappraisal study of the Composite International Diagnostic Interview with Latinos

Given recent adaptations of the World Health Organization's World Mental Health Composite International Diagnostic Interview (WMH-CIDI), new methodological studies are needed to evaluate the concordance of CIDI diagnoses with clinical diagnostic interviews. This paper summarizes lessons learned from a clinical reappraisal study done with US Latinos. We compare CIDI diagnoses with independent clinical diagnosis using the World Mental Health Structured Clinical Interview for DSM-IV (WMH-SCID 2000). Three sub-samples stratified by diagnostic status (CIDI positive, CIDI negative, or CIDI sub-threshold for a disorder) based on nine disorders were randomly selected for a telephone re-interview using the SCID. We calculated sensitivity, specificity, and weight-adjusted Cohen's kappa. Weighted 12 month prevalence estimates of the SCID are slightly higher than those of the CIDI for generalized anxiety disorder, alcohol abuse/dependence, and drug abuse/dependence. For Latinos, CIDI-SCID concordance at the aggregate disorder level is comparable, albeit lower, to other published reports. The CIDI does very well identifying negative cases and classifying disorders at the aggregate level. Good concordance was also found for major depressive episode and panic disorder. Yet, our data suggests that the CIDI presents problems for assessing post-traumatic stress disorder (PTSD) and generalized anxiety disorder (GAD). Recommendations on how to improve future versions of the CIDI for Latinos are offered.

National comorbidity survey replication adolescent supplement (NCS-A): III. Concordance of DSM-IV/CIDI diagnoses with clinical reassessments

OBJECTIVE

To report results of the clinical reappraisal study of lifetime DSM-IV diagnoses based on the fully structured lay-administered World Health Organization Composite International Diagnostic Interview (CIDI) Version 3.0 in the U.S. National Comorbidity Survey Replication Adolescent Supplement (NCS-A).

METHOD

Blinded clinical reappraisal interviews with a probability subsample of 347 NCS-A respondents were administered using the Schedule for Affective Disorders and Schizophrenia for School-Age Children (K-SADS) as the gold standard. The DSM-IV/CIDI cases were oversampled, and the clinical reappraisal sample was weighted to adjust for this oversampling.

RESULTS

Good aggregate consistency was found between CIDI and K-SADS prevalence estimates, although CIDI estimates were meaningfully higher than K-SADS estimates for specific phobia (51.2%) and oppositional defiant disorder (38.7%). Estimated prevalence of any disorder, in comparison, was only slightly higher in the CIDI than K-SADS (8.3%). Strong individual-level CIDI versus K-SADS concordance was found for most diagnoses. Area under the receiver operating characteristic curve, a measure of classification accuracy not influenced by prevalence, was 0.88 for any anxiety disorder, 0.89 for any mood disorder, 0.84 for any disruptive behavior disorder, 0.94 for any substance disorder, and 0.87 for any disorder. Although area under the receiver operating characteristic curve was unacceptably low for alcohol dependence and bipolar I and II disorders, these problems were resolved by aggregation with alcohol abuse and bipolar I disorder, respectively. Logistic regression analysis documented that consideration of CIDI symptom-level data significantly improved prediction of some K-SADS diagnoses.

CONCLUSIONS

These results document that the diagnoses made in the NCS-A based on the CIDI have generally good concordance with blinded clinical diagnoses.

Heterogeneity in comorbidity between major depressive disorder and generalized anxiety disorder and its clinical consequences

Major depressive disorder (MDD) and generalized anxiety disorder (GAD) are highly comorbid and, as diagnoses, problematic because they are heterogeneous, may impair functioning even in subclinical manifestations, and may not predict important external criteria as well as empirically-derived classifications. The present study employed a latent class analysis using data from National Comorbidity Survey (1990-1992) and focused on respondents who endorsed at least 1 screening question for MDD and 1 for GAD (N = 1009). Results revealed 4 symptom domains (somatic anxiety, somatic depression, psychological anxiety, and psychological depression) reflecting the heterogeneity of MDD and GAD, and 7 respondent classes. Analysis revealed that people in classes with a high prevalence of either somatic anxiety or somatic depression symptoms presented with the highest levels of disability, distress, and service utilization. Evidence also was found for clinically meaningful subthreshold comorbid conditions. Anxiety-related and depression-related symptoms can be meaningfully differentiated, but differentiating between somatic and psychological symptoms has the greatest practical significance.

Symptoms of anxiety in depression: assessment of item performance of the Hamilton Anxiety Rating Scale in patients with depression

BACKGROUND

Although diagnostically dissociable, anxiety is strongly co-morbid with depression. To examine further the clinical symptoms of anxiety in major depressive disorder (MDD), a non-parametric item response analysis on "blinded" data from four pharmaceutical company clinical trials was performed on the Hamilton Anxiety Rating Scale (HAMA) across levels of depressive severity.

METHODS

The severity of depressive symptoms was assessed using the 17-item Hamilton Depression Rating Scale (HAMD). HAMA and HAMD measures were supplied for each patient on each of two post-screen visits (n=1,668 observations). Option characteristic curves were generated for all 14 HAMA items to determine the probability of scoring a particular option on the HAMA in relation to the total HAMD score. Additional analyses were conducted using Pearson's product-moment correlations.

RESULTS

Results showed that anxiety-related symptomatology generally increased as a function of overall depressive severity, though there were clear differences between individual anxiety symptoms in their relationship with depressive severity. In particular, anxious mood, tension, insomnia, difficulties in concentration and memory, and depressed mood were found to discriminate over the full range of HAMD scores, increasing continuously with increases in depressive severity. By contrast, many somatic-related symptoms, including muscular, sensory, cardiovascular, respiratory, gastro-intestinal, and genito-urinary were manifested primarily at higher levels of depression and did not discriminate well at lower HAMD scores.

CONCLUSIONS

These results demonstrate anxiety as a core feature of depression, and the relationship between anxiety-related symptoms and depression should be considered in the assessment of depression and evaluation of treatment strategies and outcome.

Social anxiety disorder as a risk factor for alcohol use disorders: a prospective examination of parental and peer influences

Elucidation of mechanisms underlying the high rates of alcohol use disorder (AUD) remains a pressing clinical and research concern. Despite data indicating that social anxiety disorder (SAD) may be a psychological vulnerability that increases AUD risk, no known prospective research has examined underlying mechanisms. Given the nature of SAD, social support and peer alcohol use may be implicated. The present study set out to clarify the SAD-AUD link in several ways using a prospective dataset comprised of 1803 (47% female) young adults at T1, 1431 of whom were assessed again approximately 3 years later. First, stringent criteria were used to directly test whether SAD was a risk for AUD. Second, we examined whether social support and peer alcohol use moderated the prospective SAD-AUD link. Structured diagnostic interviews were conducted to assess DSM-IV Axis I disorders, negative life events, social support, and peer alcohol use. Among men, Time 1 (T1) SAD was not significantly related to Time 2 (T2) AUD. Yet, among women, T1 SAD was related to T2 AUD. Further, T1 SAD was the only internalizing disorder to significantly predict T2 AUD after controlling for relevant variables (e.g., T1 depression, other anxiety, alcohol and marijuana use disorders). The SAD-AUD relation demonstrated directional specificity. Family cohesion and adverse family relations significantly moderated this relation. Findings highlight the important role of SAD and familial support in the onset of AUD among women.

Personality Disorders in Alcohol-Dependent Individuals: Relationship with Alcohol Dependence Severity

The rate of axis II disorders in alcohol-dependent individuals is suggested to be high. The aim of this investigation is to assess the rate of DSM-IV axis II diagnoses in alcohol-dependent inpatients and their correlation with clinical characteristics of alcohol dependence (AD). 1,079 inpatients with DSM-IV AD from three inpatient addiction treatment centers ('qualified detoxification', open psychiatric university hospital wards) were included. Characteristics of AD were obtained using standardized structured interviews. Diagnoses of DSM-IV personality disorders (PDs) were generated with SCID-II-PQ and SCID-II interviews. Alcoholism severity was measured using the number of DSM-IV criteria endorsed and age at first drinking. Approximately 60% of the sample had at least one PD. However, rates of Axis II disorders differed significantly across centers. The most frequent PDs were obsessive-compulsive, borderline, narcissistic and paranoid PD. Diagnosis of any PD was related to a more severe clinical profile of AD. Regression analyses revealed that obsessive-compulsive PD was related to the number of DSM-IV criteria endorsed while antisocial PD was related to early age at first drinking. The majority of alcohol-dependent individuals had one or more comorbid axis II disorders. Univariate and multivariate analyses indicate that different PDs are related to age at first dinking and alcoholism severity.

Gustatory and olfactory sensitivity in patients with anorexia and bulimia in the course of treatment

BACKGROUND

The majority of studies on taste and smell in eating disorders have revealed several alterations of olfactory or gustatory functions. Aim of this prospective study was to employ detailed olfactory and gustatory testing in female subjects of three homogenous groups - anorexia nervosa, bulimia nervosa and healthy controls - and to look at the effects of treatment on these measures.

METHODS

Sixteen hospitalized female patients with anorexia (restricting type, mean age [M]=24.5 years), 24 female patients with bulimia (purging type, M=24.3 years) as well as 23 healthy controls (M=24.5 years) received olfactory ("Sniffin' Sticks") and gustatory testing ("Taste Strips"). Group differences in olfactory and gustatory sensitivity, body mass index (BMI), the Beck depression inventory, the eating attitudes test (EAT), and the influence of therapy on gustatory and olfactory function were investigated.

RESULTS

(1) Group differences were present for odor discrimination and overall olfactory function with anorexic patients having the lowest scores. (2) Regarding taste function, controls scored higher than patients with anorexia. (3) At admission small but significant correlations were found between overall olfactory function and body weight (r(63)=0.35), BMI (r(63) = 0.37), and EAT score (r(63) = -0.27). Similarly, (4) the taste test score correlated significantly with body weight (r(63)= 0.48), and BMI (r(63) = 0.45). Finally, (5) at discharge overall olfactory and gustatory function were significantly higher compared to admission in anorexic patients.

CONCLUSIONS

As compared to healthy controls and bulimic patients our results show lowered olfactory and gustatory sensitivities in anorexic patients that improved with increasing BMI and decreasing eating pathology in the course of treatment.

The association between earlier marijuana use and subsequent academic achievement and health problems: a longitudinal study

In this prospective longitudinal study, the authors investigated the association between marijuana use over a period of 13 years and subsequent health problems at age 27. A community sample of 749 participants from upstate New York was interviewed at mean ages of 14, 16, 22, and 27 years. Marijuana use over time was significantly associated with increased health problems by the late twenties, including respiratory problems, general malaise, neurocognitive problems, and lower academic achievement and functioning. Effective prevention and intervention programs should consider the wide range of adverse physiological and psychosocial outcomes associated with marijuana use over time.