Using Survey Results to Improve the Validity of the Standard PsychiatricNomenclature

Abstract

Measuring the validity of psychiatric diagnoses is still an unsolved problem. Yet, revisions of the Diagnostic and Statistical Manual of Mental Disorders and of chapter V of the International Classification of Diseases are now under way, with the hope of improving the validity of the current systems. This article suggests data that could be used to assist in this goal. This article has 3 objectives. (1) To show that although the validity of the interview protocols used in collecting epidemiologic survey data has not itself been proven, the data banks they have collected are well suited to raising questions about the validity of the existing diagnostic nomenclature. This is the case because they faithfully operationalize the current nomenclature in large interview studies of diverse general populations. (2) To show the kinds of changes that appropriate analysis of these data may suggest as ways to improve the validity of the nomenclature. (3) To show how suggested changes that emerge from such analyses should be tested to learn whether they actually improve validity before they are implemented. The data sets from large epidemiologic studies have hardly been tapped for testing the validity of the current nomenclature. It is feasible to use them for this purpose because they are in the public domain and because they assess the presence or absence of each of the criteria in the manuals before applying the manuals' algorithms for combining them to make a diagnosis. Thus, these data banks allow exploration of the effects of combining and splitting diagnoses, of omitting criteria or reweighting them, and of choosing altered algorithms with respect to age at onset, number of symptoms, and duration of episodes. Assessing the consequences of these alterations can be tested by applying some of the criteria of Robins and Guze and Kendell.

Concordance between the diagnostic guidelines for alcohol and cannabis use disorders in the draft ICD‐11 and other classification systems: analysis of data from the WHO's World Mental Health Surveys

“…The issues facing investigations of diagnostic validity, and strategies to investigate validity, have been outlined by eminent clinicians and researchers (e.g. ). They argued that to establish validity of a syndrome, one needed: a description of the syndrome (including the profile of symptoms as well as characteristics and risk factors for the syndrome); distinction from other disorders; prognostic value of the description; family studies showing evidence of heritability; and treatment response .…”

How did we arrive at burden of disease estimates for mental and illicit drug use disorders in the Global Burden of Disease Study 2010?

“…In contrast, the mechanisms underlying mental and drug use disorders are complex and incompletely understood. Features proposed to characterize a valid mental and drug use disorder require the diagnostic entity to predict a patient's prognosis (relative to someone who does not meet the criteria); be independent of other diagnoses; predict treatment response if the patient is treated for that disorder; and predict the course of the disorder over time [10][11][12][13].…”

Case ascertainment of alcohol dependence in general population surveys: ‘gated’ versus ‘ungated’ approaches

“…It may go without saying that large epidemiologic studies can augment the information value of prevalence estimates based solely upon counts of clinically recognized cases admitted to treatment facilities (Robins, 2004); in addition, these surveys may detect and assess a large number of cases of a 'borderline' severity character, less often seen in clinical samples, and may give a picture of the distribution of individual features and disorders across the general population. Moreover, through fi eld surveys, case identifi cation biases in clinical sample research can be constrained; the resulting estimates may be less sensitive to iatrogenic shaping of clinical features, as occurs when effective treatment interventions may lead the affected case to greater insights about previously unrecognized alcohol-related harms (Berkson, 1946;Robins and Guze, 1970;Narrow et al, 2002;Robins, 2004).…”

“…Survey researchers who wish to study alcohol dependence in panoramic epidemiologic studies face the challenge of translating existing psychiatric nomenclature into standardized survey assessments that may be administered by lay interviewers, in such a way as to accurately measure the constructs as presently defi ned (Blazer and Kaplan, 2000;Robins, 2004;Narrow et al, 2002;Frances, 1998;Pincus et al, 1998). Somewhat unsurprisingly given its 'necessarily vague' nature, much debate has occurred about how to gauge 'clinical signifi cance' appropriately, such that true cases are included, and both false positives and false negatives are minimized (Frances, 1998;Narrow et al, 2002;Blazer and Kaplan, 2000;Beals et al, 2004).…”