Summary
A central purpose of psychiatric community surveys is the amplification of the clinical picture by studying nonreferred cases. However, this demands an operationalized method of identifying cases. The choice of case definition determines both the prevalence of the disorder in the community and how community cases compare with referred cases. Usually case definitions are set with a fairly low threshold and include quite mild conditions. The recent use of the PSE and the DIS has led to reported prevalences of credible consistency. However, the relatively inclusive criteria for defining, for instance, affective disorders makes it difficult to equate prevalence with the need for treatment. Affective disorders in the clinic are associated with much greater impairment of social performance than nonreferred cases. It is argued here that the evaluation in the community of the need for treatment and services should be done directly, by adapting new techniques of need assessment. Only thus can the necessary alocation of resources be estimated.
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References
American Psychiatric Association (1980) Diagnostic and Statistical Manual of Mental Disorders (DSMIII), 3rd edn. American Psychiatric Association, Washington DC
Anthony JC, Folstein M, Romanoski AJ, Korff MR von, Nestadt GR, Chahal R, Merchant A, Brown CH, Shapiro S, Kramer M, Gruenberg EM (1985) Comparison of the lay Diagnostic Interview Schedule and a standardized psychiatric diagnosis. Arch Gen Psychiatry 42: 667–676
Bebbington P, Hurry J, Tennant C, Sturt E, Wing JK (1981) The epidemiology of mental disorders in Camberwell. Psychol Med 11: 561–580
Bebbington PE, Sturt E, Tennant C, Hurry J (1984) Misfortune and resilience: a community study of women. Psychol Med 14: 347–364
Bland RC, Newman SC, Orn H (1988) Epidemiology of psychiatric disorders in Edmonton. Acta Psychiatr Scand 77: [Suppl 338]
Blazer D, George LK, Landerman R, Pennybacker M, Melville ML, Woodbury M, Manton KG, Jordan K, Locke B (1985) Psychiatric disorders: a rural/urban comparison. Arch Gen Psychiatry 42: 651–656
Blumenthal MD, Dielman TE (1975) Depressive symptomatology and role function in a general population. Arch Gen Psychiatry 32: 985–991
Brewin CR, Wing JK, Mangen SP, Brugha TS, MacCarthy B (1987) Principles and practice of measuring need in the long term mentally ill: the MRC Needs for Care Assessment. Psychol Med 17: 971–981
Brown GW, Harris T (1978) Social origins of depression: a reply. Psychol Med 8: 577–588
Burnham MA, Hough RL, Escobar JI, Karno M, Timbers DM, Telles CA, Locke BZ (1987) Six month prevalence of specific psychiatric disorders among Mexican Americans and non-Hispanic whites in Los Angeles. Arch Gen Psychiatry 44: 687–694
Canino GJ, Bird HR, Shrout PE, Rubio-Stipec M, Bravo M, Martinez R, Sesman M, Guevara LM (1987) The prevalence of specific psychiatric disorders in Puerto Rico. Arch Gen Psychiatry 44: 727–735
Casey PR, Tyrer P, Platt S (1985) The relationship between social functioning and psychiatric symptomatology in primary care. Soc Psychiatry 20: 5–9
Cassel JC (1974) Psychiatric epidemiology. In: Arieti S, Caplan E (eds) American handbook of psychiatry (2nd edn). Basic Books, New York, pp 401–410
Costello CG (1982) Social factors associated with depression: a retrospective community study. Psychol Med 12: 329–339
Dean C, Surtees PG, Sashidharan SP (1983) Comparison of research diagnostic systems in an Edinburgh community sample. Br J Psychiatry 142: 247–256
Dohrenwend BP, Dohrenwend BS (1974) Social and cultural influences on psychopathology. Ann Rev Psychol 25: 417–452
Dohrenwend BP, Dohrenwend BS (1982) Perspectives on the past and future of psychiatric epidemiology. Am J Publ Health 72: 1271–1279
Eaton WW, Kessler LG (1985) Epidemiologic field methods in psychiatry: the NIMH Epidemiologic Catchment Area Program. Orlando, Academic Press
Eaton WW, Regier DA, Locke BZ, Taube CA (1981) The NIMH epidemiologic catchment area program. In: Wing JK, Bebbington PE, Robins L (eds) What is a case? The problem of definition in psychiatric community surveys. Grant MacIntyre, London, pp 99–106
Endicott J, Spitzer R (1978) A diagnostic interview: the schedule for affective disorders and schizophrenia. Arch Gen Psychiatry 35: 837–844
Farmer A, Katz R, McGuffin P, Bebbington PE (1987) A comparison between the Present State Examination (PSE) and the Composite International Diagnostic Interview (CIDI). Arch Gen Psychiatry 44: 1064–1068
Feighner JP, Robins E, Guze SB, Woodruff RA, Winokur G, Munoz R (1972) Diagnostic criteria for use in psychiatric research. Arch Gen Psychiatry 26: 57–63
Finlay-Jones R, Brown GW, Duncan-Jones P, Harris T, Murphy E, Prudo R (1980) Depression and anxiety in the community: replicating the diagnosis of a case. Psychol Med 10: 445–454
Foulds GA (1976) The hierarchical nature of illness. Academic Press, London
Henderson AS, Byrne DG, Duncan-Jones P (1981) Neurosis and the social environment. Academic Press, Sydney
Herzlich C (1973) Health and illness. Academic Press, London
Hodiamont P, Peer N, Syben N (1987) Epidemiological aspects of psychiatric disorder in a Dutch Health Area. Psychol Med 17: 495–506
Hurry J, Sturt E (1981) Social performance in a population sample: relation to psychiatric symptoms. In: Wing JK, Bebbington PE, Robins L (eds) What is a case? The problem of definition in psychiatric community surveys. Grant MacIntyre, London, pp 202–216
Hurry J, Sturt E, Bebbington PE, Tennant C (1983) Sociodemographic association with social disablement in a community sample. Soc Psychiatry 18: 113–121
Hurry J, Bebbington PE Tennant C (1987) Psychiatric symptoms and social disablement as determinants of illness behaviour. Aust NZ J Psychiatry 21: 68–74
Hwu H-G, Yeh E-K, Chang L-Y (1989) Prevalence of psychiatric disorders in Taiwan defined by the Chinese Diagnostic Interview Schedule. Acta Psychiatr Scand 79: 136–147
Kaeser AC, Cooper B (1971) The psychiatric patient, the general practitioner, and the out-patient clinic on operational study and a review. Psychol Med 1: 312–325
Karno M, Hough RL, Burnham MA, Escobar JI, Timbers DM, Santana F, Boyd JH (1987) Lifetime prevalence of specific psychiatric disorders among Mexican Americans and non-Hispanic whites in Los Angeles. Arch Gen Psychiatry 44: 695–701
Kleinman A (1986) Social origins of stress and disease: depression, neurasthenia and pain in modern China. New Haven, Yale University Press
Kreitman N, Sainsbury P, Morrissey J, Towers J, Scrivener J (1961) The reliability of psychiatric assessment: an analysis. J Ment Sci 107: 887–908
Lehtinen V, Lindholm T, Veijola J, Väisänen E (in press) The prevalence of PSE-CATEGO disorders in a Finnish, adult population cohort. Soc Psychiatry Psychiatr Epidemiology
Lehtinen V, Ioukamaa M, Lahtela K, Raitasalo R, Iyrkinen E, Kuusela V, Maatela, I, Aromaa A (in press) Occurrence of mental disorders and need for treatment by sex, age and domiciles. Acta Psychiatr Scand
Leighton DC, Harding JS, Macklin DB, MacMillan AM, Leighton AE (1963) The character of danger (Stirling County Study, Vol 3). Basic Books, New York
Mavreas VG, Bebbington PE (1987) Psychiatric morbidity in London's Greek Cypriot community, I. Association with sociodemographic variables. Soc Psychiatry 22: 150–159
Mavreas VG, Beis A, Mouyias A, Rigoni F, Lyketsos GC (1986) Prevalence of psychiatric disorder in Athens: a community study. Soc Psychiatry 21: 172–181
Mechanic D (1963) Some implications of illness behavior. N Engl J Med 269: 244
Mechanic D, Volkhart EA (1961) Stress, illness behavior and the sick role. Am Soc Rev 26: 51–58
Morris JN (1957) The uses of epidemiology. London, Livingstone
Mowbray RM, Blair W, Jobl L, Clarke A (1961) The general practitioner's attitude to psychiatry. Scott Med J 6: 314–321
Myers JK, Weissman MM, Tischler GL, Holzer CE, Leaf PJ, Orvaschel H, Anthony JC, Boyd JH, Burker JD, Kramer M, Stolzman R (1984) Six month prevalence of psychiatric disorders in three communities: 1980–1982. Arch Gen Psychiatry 41: 959–967
O'Connor DW, Pollitt PA, Hyde JB, Fellows JL, Miller ND, Brook CPB, Reiss BB, Roth M (1989) The prevalence of dementia as measured by the Cambridge Mental Disorders of the Elderly Examination. Acta Psychiatr Scand 79: 190–198
Oakley-Browne MA, Joyce PR, Wells JE, Bushnell JA, Hornblow AR (1989) Christchurch psychiatric epidemiology study, part 1: six month and other period prevalences of specific psychiatric disorders. Aust NZ J Psychiatry 23: 327–340
Orley J, Wing JK (1979) Psychiatric disorders in two African villages. Arch Gen Psychiatry 36: 513–520
Regier DA, Boyd JH, Burke JD, Rae DS, Myers JK, Kramer M, Robins LN, George LK, Karno M, Locke BZ (1988) One month prevalence of mental disorders in the United States. Arch Gen Psychiatry 45: 977–986
Robins LN, Helzer JE, Croughan JL, Ratcliff, K (1981) The NIMH Diagnostic Interview Schedule: its history, characteristics and validity. In: Wing JK, Bebbington P, Robins LN (eds) What is case? The problem of definition in psychiatric community surveys. Grant McIntyre, London, pp 79–98
Robins LN, Helzer JE, Weissman MM, Orvaschel H, Gruenberg E, Burke JD, Regier DA (1984) Lifetime prevalence of specific disorders in three sites. Arch Gen Psychiatry 41: 949–958
Robins LN, Helzer JE, Orvaschel H, Anthony JC, Blazer DG, Burnham A, Burke JD (1985 a) The Diagnostic Interview Schedule. In: Eaton WW, Kessler LG (eds) Epidemiologic field methods in psychiatry: the NIMH Epidemiologic Catchment Area Program. Academic Press, Orlando, pp 143–170
Robins LN, Wing JK, Helzer JE (1985 b) WHO-ADAMHA. Composite International Diagnostic Interview
Robins LN, Wing JK, Wittchen H-U, Helzer JE, Babor TF, Burke JD, Farmer A, Jablensky A, Pickens R, Regier DA, Sartorius N, Towle LH (1988) The Composite International Diagnostic Interview. Arch Gen Psychiatry 45: 1069–1077
Romans-Clarkson SE, Walton VA, Herbison GP, Mullen PE (1988) Marriage, motherhood and psychiatric morbidity in New Zealand. Psychol Med 18: 983–990
Roth WF, Luton FH (1942) The mental health program in Tennessee. Am J Psychiatry 99: 662–675
Semler G, Cranach M von, Wittchen H-U (1987) Comparison between the Composite International Diagnostic Interview and the Present State Examination, Report to the WHO-ADAMAHA Task Force On Instrument Development
Shapiro S, Skinner EA, Kramer M, Steinwachs DM, Regier DA (1985) Measuring need for mental health services in a general population. Med Care 23: 1033–1043
Shepherd M (1977) Beyond the layman's idea of madness: the extent of mental disease. In: Tanner JM (ed) Developments in psychiatric research. The Mental Health Foundation, London, pp 178–198
Silverman C (1968) Epidemiology of depression. Johns Hopkins Press, Baltimore
Sjögren T (1948) Genetic-statistical and psychiatric investigations of a west Swedish population. Acta Psychiatr Neurol [Suppl 52]
Spitzer RL, Endicott J, Robins E (1978) Research diagnostic criteria: rationale and reliability. Arch Gen Psychiatry 35: 773–782
Srole L, Langner T, Michael ST, Opler MK, Rennie, TAC (1962) Mental health in the metropolis. McGraw-Hill, New York
Strömgren E (1938) Beiträge zur psychiatrischen Erblehre. Munksgaard, Copenhagen
Sturt E, Bebbington PE, Hurry J, Tennant C (1981) The Present State Examination used by interviewers from a Survey Agency: Report from the Camberwell Community Survey. Psychol Med 11: 185–192
Surtees PG, Dean C, Ingham JG, Kreitman NB, Miller PMcC, Sashidharan SP (1983) Psychiatric disorder in women from an Edinburgh community: associations with demographic factors. Br J Psychiatry 142: 238–246
Teasdale JD (1988) Cognitive vulnerability to depression. Cognition Emotion 2: 247–274
Vazquez-Barquero J-L, Diez-Manrique JF, Pena C, Aldana J, Samaniego-Rodriguez C, Menendez-Arango J, Mirapeix C (1987) A community mental health survey in Cantabria: a general description of morbidity. Psychol Med 17: 227–242
Weissman MM, Leaf PJ, Tischler GL, Blazer DG, Karno M, Bruce ML, Florio MP (1988) Affective disorders in five United States communities. Psychol Med 18: 141–154
Wells JE, Bushnell JA, Hornblow AR, Joyce PR, Oakley-Browne MA (in press) Christchurch Psychiatric Epidemiology Study: methodology and lifetime prevalence for specific psychiatric disorders. Aust NZ J Psychiatry 23: 315–326
Williams P, Tarnopolsky A, Hand DJ (1980) Case definition and case identification in psychiatric epidemiology: review and assessment: Psychol Med 10: 101
Wing JK (in press) The measurement of ‘social disablement’: the MRC social behaviour and social performance schedules. Soc Psychiatriy Psychiatr Epidemiol 24: 173–178
Wing JK, Sturt E (1978) The PSE-ID-CATEGO system: a supplementary manual. Institute of Psychiatry, London (mimeo)
Wing JK, Cooper JE, Sartorius N (1974) The measurement and classification of pschiatric symptoms. Cambridge University Press, Cambridge
Wing JK, Bebbington PE, Hurry J, Tennant C (1981) The prevalence in the general population of disorders familiar to psychiatrists in hospital practice. In: Wing JK, Bebbington PE, Robins LN (eds) What is a case? Grant MacIntyre, London, pp 45–61
Wing JK, Babor T, Brugha T, Burke J, Cooper JE, Giel R, Jablensky A, Regier R, Sartorius N (in press) SCAN: Schedules for Clinical Assessment in Neuropsychiatry. Arch Gen Psychiatry
World Health Organization (1978) Mental Disorders: Glossary and Guide to their Classification in accordance with the Ninth Revision of the International Classification of Diseases. WHO, Geneva
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Bebbington, P.E. Population surveys of psychiatric disorder and the need for treatment. Soc Psychiatry Psychiatr Epidemiol 25, 33–40 (1990). https://doi.org/10.1007/BF00789068
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DOI: https://doi.org/10.1007/BF00789068