Abstract
As researchers, clinicians and health systems strive to understand and improve mental health and well-being in youth, the parameters by which mental illness itself is defined have increasingly become the topic of inquiry. In the March 2015 issue of SPPE, Roberts et al. (Soc Psychiatry Psychiatr Epidemiol 50(3):397–406, 2015) integrate DSM diagnostic criteria with impairment in adolescents, showing that the latter is more frequent in full-syndrome disorders but still relevant for sub-threshold conditions, which have higher overall prevalence. These findings shift the focus away from specific diagnostic criteria and thresholds, and towards the backdrop of distress and impairment in young people. They also have implications for staging models and clinical services for youth mental health, particularly for prevention and early intervention efforts.
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References
Cuthbert BN (2014) The RDoC framework: facilitating transition from ICD/DSM to dimensional approaches that integrate neuroscience and psychopathology. World Psychiatry 13:28–35. doi:10.1002/wps.20087
Frances AJ, Nardo JM (2013) ICD-11 should not repeat the mistakes made by DSM-5. Br J Psychiatry 203:1–2. doi:10.1192/bjp.bp.113.127647
Levy F (2014) Child and adolescent changes to DSM-5. Asian J Psychiatr 11:87–92. doi:10.1016/j.ajp.2014.03.013
Smink FRE, van Hoeken D, Oldehinkel AJ, Hoek HW (2014) Prevalence and severity of DSM-5 eating disorders in a community cohort of adolescents. Int J Eat Disord 47:610–619. doi:10.1002/eat.22316
Vande Voort JL, He J-P, Jameson ND, Merikangas KR (2014) Impact of the DSM-5 attention-deficit/hyperactivity disorder age-of-onset criterion in the US adolescent population. J Am Acad Child Adolesc Psychiatry 53:736–744. doi:10.1016/j.jaac.2014.03.005
Merikangas KR, He J-P, Burstein M et al (2010) Lifetime prevalence of mental disorders in US adolescents: results from the National Comorbidity Survey Replication-Adolescent Supplement (NCS-A). J Am Acad Child Adolesc Psychiatry 49:980–989. doi:10.1016/j.jaac.2010.05.017
Iyer S, Boksa P, Lal S, et al. (2015) Transforming youth mental health: a Canadian perspective. Irish J Psychol Med (In press)
van Os J, Linscott RJ, Myin-Germeys I et al (2009) A systematic review and meta-analysis of the psychosis continuum: evidence for a psychosis proneness-persistence-impairment model of psychotic disorder. Psychol Med 39:179–195. doi:10.1017/S0033291708003814
Fusar-Poli P, Borgwardt S, Bechdolf A et al (2013) The psychosis high-risk state: a comprehensive state-of-the-art review. JAMA Psychiatry 70:107–120. doi:10.1001/jamapsychiatry.2013.269
Yung AR, Yuen HP, Berger G et al (2007) Declining transition rate in ultra high risk (prodromal) services: dilution or reduction of risk? Schizophr Bull 33:673–681. doi:10.1093/schbul/sbm015
Roberts RE, Fisher PW, Blake Turner J, Tang M (2015) Estimating the burden of psychiatric disorders in adolescence: the impact of subthreshold disorders. Soc Psychiatry Psychiatr Epidemiol 50(3):397–406
Shankman SA, Lewinsohn PM, Klein DN et al (2009) Subthreshold conditions as precursors for full syndrome disorders: a 15-year longitudinal study of multiple diagnostic classes. J Child Psychol Psychiatry 50:1485–1494. doi:10.1111/j.1469-7610.2009.02117.x
Costello EJ, Angold A, Keeler GP (1999) Adolescent outcomes of childhood disorders: the consequences of severity and impairment. J Am Acad Child Adolesc Psychiatry 38:121–128. doi:10.1097/00004583-199902000-00010
Angold A, Costello EJ, Farmer EM et al (1999) Impaired but undiagnosed. J Am Acad Child Adolesc Psychiatry 38:129–137. doi:10.1097/00004583-199902000-00011
Fusar-Poli P, Yung AR, McGorry P, van Os J (2013) Lessons learned from the psychosis high-risk state: towards a general staging model of prodromal intervention. Psychol Med. doi:10.1017/S0033291713000184
Linscott RJ, van Os J (2010) Systematic reviews of categorical versus continuum models in psychosis: evidence for discontinuous subpopulations underlying a psychometric continuum. Implications for DSM-V, DSM-VI, and DSM-VII. Annu Rev Clin Psychol 6:391–419. doi:10.1146/annurev.clinpsy.032408.153506
Carpenter WT, van Os J (2011) Should Attenuated Psychosis Syndrome Be a DSM-5 Diagnosis? Am J Psychiatry 168:460–463. doi:10.1176/appi.ajp.2011.10121816
Weisz JR, Chorpita BF, Palinkas LA et al (2012) Testing standard and modular designs for psychotherapy treating depression, anxiety, and conduct problems in youth: a randomized effectiveness trial. Arch Gen Psychiatry 69:274–282. doi:10.1001/archgenpsychiatry.2011.147
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Shah, J.L. Sub-threshold mental illness in adolescents: within and beyond DSM’s boundaries. Soc Psychiatry Psychiatr Epidemiol 50, 675–677 (2015). https://doi.org/10.1007/s00127-015-1015-4
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DOI: https://doi.org/10.1007/s00127-015-1015-4