About half of Americans will meet the criteria for a DSM-IV disorder sometime in their life, with first onset usually in childhood or adolescence. Interventions aimed at prevention or early treatment need to focus on youth.

LTHOUGH COMMUNITY SURveys of mental disorders have been conducted in the United States since the end of World War II, 1-3 it was not until the early 1980s that fully structured lay interviews were developed to diagnose specific mental disorders. The first such instrument was the Diagnostic Interview Schedule (DIS), 4 which was developed for use in the Epidemiologic Catchment Area (ECA) study 5 to estimate the general population prevalence of mental disorders by Diagnostic and Statistical Manual of Mental Disorders, Third Edition (DSM-III) criteria. 6 Major depressive disorder (MDD) prevalence estimates in the ECA sites were 3.0% to 5.9% for lifetime and 1.7% to 3.4% for 12-month. 7 The first nationally representative survey using a method similar to the ECA, the National Comorbidity Survey (NCS), 8 was conducted a decade later in 1990-1992. The NCS diagnostic instrument was a modified version of the Composite International Diagnostic Interview (CIDI) 9 to assess mental disorders by Author Affiliations are listed at the end of this article.

Context Although significant associations of childhood adversities (CAs) with adult mental disorders have been documented consistently in epidemiological surveys, these studies generally have examined only one CA per study. As CAs are highly clustered, this approach results in over-estimating the importance of individual CAs. Multivariate CA studies have been based on insufficiently complex models. Objective To examine the joint associations of 12 retrospectively reported CAs with first onset of DSM-IV disorders in the National Comorbidity Survey Replication (NCS-R) using substantively complex multivariate models. Design Cross-sectional community survey with retrospective reports of CAs and lifetime DSM-IV disorders. Setting/Participants Nationally representative sample of 5,692 adults in the US household population. Intervention None Main Outcome Measures Lifetime prevalence of 20 DSM-IV anxiety, mood, disruptive behavior, and substance disorders assessed with the WHO Composite International Diagnostic Interview (CIDI). Results The CAs studied were highly prevalent and inter-correlated. CAs in a maladaptive family functioning (MFF) cluster (parental mental illness, substance disorder, and criminal behavior; family violence; physical abuse; sexual abuse; neglect) were the strongest correlates of disorder onset. The best-fitting model included terms for each type of CA, number of MFF CAs, and number of other CAs. Multiple MFF CAs had significant sub-additive associations with disorder onset. Little specificity was found for particular CAs with particular disorders. Associations declined in magnitude with life course stage and number of prior lifetime disorders, but increased with length of recall period. Simulations suggest that CAs are associated with 44.6% of all childhood-onset disorders and 25.9-32.0% of later-onset disorders. Conclusions The fact that associations increased with length of recall raises the possibility of recall bias inflating estimates. Even taking this into consideration, though, the results suggest that CAs have powerful and often sub-additive associations with onset of many types of largely primary mental disorders throughout the life course.

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.

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