Childhood adversities have strong associations with all classes of disorders at all life-course stages in all groups of WMH countries. Long-term associations imply the existence of as-yet undetermined mediators.

Context There is limited information on the prevalence and correlates of bipolar spectrum disorder in international population-based studies using common methodology. Objective To describe the prevalence, impact, patterns of comorbidity, and patterns of service utilization for bipolar spectrum disorder in the WHO World Mental Health survey (WMH) initiative. Design Cross-sectional face-to-face household surveys Participants 61,392 community adults in 11 countries in the Americas, Europe, and Asia Main Outcome Measure DSM-IV disorders, severity, and treatment assessed with the World Mental Health version of the WHO Composite International Diagnostic Interview (WMH CIDI 3.0), a fully-structured lay-administered psychiatric diagnostic interview. Results The aggregate lifetime prevalence of BP-I disorder was 0.6%, BP-II was 0.4%, subthreshold BP was 1.4%, and Bipolar Spectrum (BPS) was 2.4%. Twelve-month prevalence of BP-I disorder was 0.4%, BP-II was 0.3%, subthreshold BP was 0.8%, and BPS was 1.5%. Severity of both manic and depressive symptoms, and suicidal behavior increased monotonically from subthreshold BP to BP-I. By contrast, role impairment was similar across bipolar subtypes. Symptom severity was greater for depressive than manic episodes, with approximately 75% of respondents with depression and 50% of respondents with mania reporting severe role impairment. Three-quarters of those with BPS met criteria for at least one other disorder, with anxiety disorders, particularly panic attacks, being the most common comorbid condition. Less than half of those with lifetime BPS received mental health treatment, particularly in low-income countries where only 25% reported contact with the mental health system. Conclusions Despite cross-site variation in the prevalence rates of bipolar spectrum disorder, the severity, impact, and patterns of comorbidity were remarkably similar internationally. The uniform increases in clinical correlates, suicidal behavior and comorbidity across each diagnostic category provide evidence for the validity of the concept of a bipolar spectrum. BPS treatment needs are often unmet, particularly in low-income countries.

BackgroundMajor depression is one of the leading causes of disability worldwide, yet epidemiologic data are not available for many countries, particularly low- to middle-income countries. In this paper, we present data on the prevalence, impairment and demographic correlates of depression from 18 high and low- to middle-income countries in the World Mental Health Survey Initiative.MethodsMajor depressive episodes (MDE) as defined by the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DMS-IV) were evaluated in face-to-face interviews using the World Health Organization Composite International Diagnostic Interview (CIDI). Data from 18 countries were analyzed in this report (n = 89,037). All countries surveyed representative, population-based samples of adults.ResultsThe average lifetime and 12-month prevalence estimates of DSM-IV MDE were 14.6% and 5.5% in the ten high-income and 11.1% and 5.9% in the eight low- to middle-income countries. The average age of onset ascertained retrospectively was 25.7 in the high-income and 24.0 in low- to middle-income countries. Functional impairment was associated with recency of MDE. The female: male ratio was about 2:1. In high-income countries, younger age was associated with higher 12-month prevalence; by contrast, in several low- to middle-income countries, older age was associated with greater likelihood of MDE. The strongest demographic correlate in high-income countries was being separated from a partner, and in low- to middle-income countries, was being divorced or widowed.ConclusionsMDE is a significant public-health concern across all regions of the world and is strongly linked to social conditions. Future research is needed to investigate the combination of demographic risk factors that are most strongly associated with MDE in the specific countries included in the WMH.

Background Little population-based data exist outside the United States on the epidemiology of binge eating disorder (BED). Cross-national data on BED are presented and compared to bulimia nervosa (BN) based on the WHO World Mental Health Surveys. Methods Community surveys with 24,124 respondents (ages 18+) across 14 mostly upper-middle and high income countries assessed lifetime and 12-month DSM-IV mental disorders with the WHO Composite International Diagnostic Interview. Physical disorders were assessed with a chronic conditions checklist. Results Country-specific lifetime prevalence estimates are consistently (median; inter-quartile range) higher for BED (1.4%;0.8–1.9%) than BN (0.8%;0.4–1.0%). Median age-of-onset is in the late teens to early 20s for both disorders but slightly younger for BN. Persistence is slightly higher for BN (6.5 years; 2.2–15.4) than BED (4.3 years; 1.0–11.7). Lifetime risk of both disorders is elevated for women and recent cohorts. Retrospective reports suggest that comorbid anxiety, mood, and disruptive behavior disorders predict subsequent onset of BN somewhat more strongly than BED and that BN predicts subsequent comorbid psychiatric disorders somewhat more strongly than does BED. Significant comorbidities with physical conditions are due almost entirely to BN and BED predicting subsequent onset of these conditions, again with BN somewhat stronger than BED. Role impairments are similar for BN and BED. Fewer than half of lifetime BN or BED cases receive treatment. Conclusions BED represents a public health problem at least equal to BN. Low treatment rates highlight the clinical importance of questioning patients about eating problems even when not included among presenting complaints.

Data are reported on the background and performance of the K6 screening scale for serious mental illness (SMI) in the World Health Organization (WHO) World Mental Health (WMH) surveys. The K6 is a 6-item scale developed to provide a brief valid screen for DSM-IV SMI based on the criteria in the US ADAMHA Reorganization Act. Although methodological studies have documented good K6 validity in a number of countries, optimal scoring rules have never been proposed. Such rules are presented here based on analysis of K6 data in nationally or regionally representative WMH surveys in 14 countries (combined n = 41,770 respondents). Twelve-month prevalence of DSM-IV SMI was assessed with the fully-structured WHO Composite International Diagnostic Interview. Nested logistic regression analysis was used to generate estimates of the predicted probability of SMI for each respondent from K6 scores taking into consideration the possibility of variable concordance as a function of respondent age, gender, education, and country. Concordance, assessed by calculating the area under the receiver operating characteristic curve (AUC), was generally substantial (Median .83; Range .76-.89; Inter-quartile range .81-.85). Based on this result, optimal scaling rules are presented for use by investigators working with the K6 scale in the countries studied.