Improving accuracy of major depression age‐of‐onset reports in the US National Comorbidity Survey

Abstract

The current report discusses only one aspect of the information-retrieval process: the recollection of age of onset of psychiatric disorders in epidemiological surveys. Age-of-onset information is often collected in clinical interviews as part of the history-taking process and is used along with other retrospective information about course and family history to build up an initial understanding of the nature of the disorder being treated. Exact dating is generally not critical here, although it is useful to know the general life stage in which symptoms first occurred. In cases where there is an interest in establishing the importance of a triggering event, however, accurate dating of age of onset in relation to a presumed precipitant becomes more important. In cases where there is an interest in distinguishing primary and secondary comorbidity, furthermore, accurate comparative age-of-onset information is needed to distinguish between temporally primary and secondary disorders.Precise age-of-onset information is more important in epidemiological surveys that focus on lifetime disorders. Retrospective age-of-onset reports are used in such surveys to estimate survival curves and synthetic cohort effects (such as Fombonne, 1994 of-onset reports than those obtained a decade earlier in the Epidemiologic Catchment Area (ECA) Study. The test-retest consistency of age-of-onset reports was also higher in the NCS than the ECA. Despite these improvements, considerable inconsistency in age-of-onset reports remains in the NCS test-retest data. The paper closes with a discussion of potentially promising future directions to improve retrospective age-of-onset reports in new psychiatric epidemiological surveys.Key words: age of onset, major depression, accuracy, autobiographical memory, diagnostic interview, epidemiology surveys International Journal of Methods in Psychiatric Research, Volume 8, Number 1All psychiatric diagnostic interviews use retrospective information of one sort or another. They differ, though, in the length of the recall period and in the relative importance of information about the present and the past. Clinical intake interviews, for example, are primarily concerned with current complaints, but they interpret these complaints in the context of retrospective reports about history. Community epidemiological risk factor surveys, in comparison, are usually concerned with lifetime prevalence, whereas needs assessment surveys are usually concerned with prevalence over a time interval used for administrative planning, such as the last six months or year.In all of these cases, the clinician or researcher needs to develop strategies for eliciting information that is as accurate as possible about the past. Success in this task requires an understanding of how information is stored in memory and of how successful memory retrieval operates. It requires questioning strategies that use these understandings to help respondents maximize their information retrieval capabilities. And it requires an appreciation of the limi...

Specifying race-ethnic differences in risk for psychiatric disorder in a USA national sample

“…Age of onset was set at the upper end of the bound (e.g., age 12 for respondents who reported that onset was before they became teenagers). Experimental research shows this question sequence yields responses with a much more plausible age of onset distribution than the standard CIDI age of onset question (Knauper et al, 1999).…”

Mental disorders among English-speaking Mexican immigrants to the US compared to a national sample of Mexicans

“…Age of onset was set at the upper end of the bound (e.g., age 12 for respondents who reported that onset was before they became teenagers). Experimental research shows that this question sequence yields responses with a much more plausible age of onset distribution than the standard CIDI age of onset question (Knauper et al, 1999).…”

Broadening the definition of generalized anxiety disorder: Effects on prevalence and associations with other disorders in the National Comorbidity Survey Replication

“…Second, the temporal order of disorders was determined from retrospective age-of-onset reports. While we used a probing strategy that has been shown to improve recall of age of onset (Knauper et al, 1999), there were doubtlessly residual errors, perhaps especially when distinguishing GAD from disorders with overlapping symptoms. To help mitigate this concern, we performed sensitivity analyses within subsamples reporting an onset of GAD at least five years before the comorbid disorder.…”