Mild disorders should not be eliminated from the DSM-V

Area of Science:

• Psychiatry and Epidemiology
• Mental Health Services Research

Background:

• High prevalence of mental disorders in surveys raises concerns about the Diagnostic and Statistical Manual of Mental Disorders (DSM) system being overly inclusive.
• This has led to discussions about excluding mild cases from future DSM editions.

Purpose of the Study:

• To determine if DSM-III-R disorders from the National Comorbidity Survey (NCS) exhibit a severity gradient.
• To assess if this gradient correlates with outcomes measured a decade later in the NCS follow-up (NCS-2).
• To investigate if there is an inflection point at the mild severity level.

Main Methods:

• Utilized data from the baseline National Comorbidity Survey (NCS), a representative household survey of DSM-III-R disorders (1990-1992).
• Analyzed data from the NCS follow-up survey (NCS-2), reinterviewing 4375 NCS respondents (2000-2002).
• NCS-2 outcomes included mental health/substance disorder hospitalizations, work disability, suicide attempts, and serious mental illness.

Main Results:

• Twelve-month NCS/DSM-III-R disorders were categorized: 3.2% severe, 3.2% serious, 8.7% moderate, and 16.0% mild.
• All case categories showed significantly increased risk for NCS-2 outcomes compared to non-cases (P<.05).
• Odds ratios for any outcome increased monotonically from 2.4 (mild) to 15.1 (severe), with non-significant differences between mild and moderate cases.

Conclusions:

• A graded relationship exists between mental illness severity and subsequent clinical outcomes.
• Retaining mild cases in the DSM is crucial for accurately reflecting the spectrum of mental disorder severity.
• Treatment decisions for mild cases should prioritize cost-effectiveness, recognizing potential prevention of future serious conditions.