NDLI: Does the DSM-IV clinical significance criterion for major depression reduce false positives? Evidence from the National Comorbidity Survey Replication.

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Does the DSM-IV clinical significance criterion for major depression reduce false positives? Evidence from the National Comorbidity Survey Replication.

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	Wakefield, Jerome C. Schmitz, Mark F. Baer, Judith C.
Spatial Coverage	United States
Description	Country affiliation: United States Author Affiliation: Wakefield JC ( School of Social Work, Department of Psychiatry, and InSPIRES (Institute for Social and Psychiatric Initiatives-Research, Education and Services), New York University, New York, USA. jerome.wakefield@nyu.edu)
Abstract	OBJECTIVE: To reduce false positive diagnoses, DSM-IV added a clinical significance criterion to many diagnostic criteria sets requiring that symptoms cause significant distress or impairment. The DSM-V Task Force is considering whether clinical significance should remain a diagnostic threshold or become a separate dimension, as it is in ICD. Yet, the criterion's effectiveness in validly reducing the prevalence of specific disorders remains unclear. Critics have argued that for some categories, notably major depression, the criterion is redundant with symptoms, which are inherently distressing or impairing. The authors empirically evaluated the criterion's effect on the prevalence of major depression in the community. This report also considers more broadly the relationship of symptoms to impairment in diagnosis. METHOD: Subjects were respondents, aged 18 to 54 years, who participated in the National Comorbidity Survey Replication (N=6,707). The effect of the clinical significance criterion's distress and impairment components on major depression was assessed in this sample. Distress questions were administered to all respondents reporting persistent sadness (> or = 2 weeks) or the equivalent. Questions pertaining to role impairment were asked of all respondents satisfying major depression symptom-duration criteria. RESULTS: Of 2,071 individuals reporting persistent sadness or the equivalent, 97.2% (N=2,016) satisfied criteria for distress. Of 1,542 individuals satisfying depression symptom-duration criteria, 96.2% (N=1,487) satisfied criteria for impairment. CONCLUSIONS: These findings support the redundancy thesis. Distress is virtually redundant with symptoms of persistent sadness, even in the absence of major depression, and impairment is almost always entailed by major depression-level symptoms. Thus, the clinical significance criterion does not substantially reduce the prevalence of major depression in the community. The DSM-V Task Force should consider eliminating the criterion and explore alternative ways to identify false positives in the diagnosis of depression. The criterion's status for other disorders should be evaluated on a disorder-by-disorder basis because the diagnostic relationship between symptoms and impairment varies across categories.
File Format	HTM / HTML
ISSN	0002953X
e-ISSN	15357228
Journal	American Journal of Psychiatry
Issue Number	3
Volume Number	167
Language	English
Publisher	American Psychiatric Association
Publisher Date	2010-03-01
Publisher Place	United States
Access Restriction	Open
Subject Keyword	Discipline Psychiatry Depressive Disorder, Major Diagnosis Epidemiology Diagnostic And Statistical Manual Of Mental Disorders Mass Screening Statistics & Numerical Data Activities Of Daily Living Psychology Adolescent Comorbidity Cross-sectional Studies False Positive Reactions Health Surveys Interview, Psychological Psychometrics Quality Of Life Reproducibility Of Results
Content Type	Text
Resource Type	Article
Subject	Psychiatry and Mental Health

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