DSM-5 proposals for mood disorders: a cost-benefit analysis

Area of Science:

• Psychiatry
• Mental Health Diagnostics
• Clinical Psychology

Background:

• The Diagnostic and Statistical Manual of Mental Disorders (DSM)-5 is undergoing revision.
• Draft proposals for changes to mood disorder classifications were released in February 2010.

Purpose of the Study:

• To examine draft proposals for DSM-5 mood disorder revisions.
• To explain the rationale behind these proposed changes.
• To consider the relative costs versus benefits of each proposal.

Main Methods:

• Review of draft proposals for DSM-5 mood disorder revisions.
• Analysis of the rationale for proposed changes.
• Cost-benefit assessment of potential diagnostic revisions.

Main Results:

• Proposals include a comorbid anxiety dimension, a new 'mixed anxiety depression' disorder, a 'mixed features' specifier, and removal of the bereavement exclusion.
• Some proposals, like the anxiety dimension and PHQ-9 for severity, may enhance clinical utility.
• Other proposals, such as 'mixed anxiety depression' and removing the bereavement exclusion, risk false positives; 'mixed features' has unclear utility; and CGI for manic severity is problematic.

Conclusions:

• Cost-benefit analysis of mood disorder proposals yields mixed outcomes.
• Some proposals present significant benefits, while others carry substantial risks.
• Only proposals where benefits demonstrably outweigh costs should be adopted in the final DSM-5.