Diagnostic stability in adolescents followed up 2 years after hospitalization

The authors examined the stability of DSM-III-R disorders and groups of disorders in adolescent inpatients followed up 2 years after hospitalization.

Seventy hospitalized adolescents were reliably assessed by using structured diagnostic interviews for DSM-III-R disorders. Two years later the subjects were independently assessed with the same interviews. Diagnostic stability was measured by determining both the percentage of persisting cases and the kappa statistic.

Internalizing disorders had the highest percentage of persisting cases (59%) but an insignificant kappa due to many new cases at follow-up. Externalizing disorders had a lower percentage of stable cases (39%) but a significant kappa because of fewer new cases. Substance use disorders were fairly stable (53%) and had a significant kappa, indicating that this may be the most stable group of disorders in adolescents. Personality disorder clusters were relatively unstable, especially clusters A and C.

Diagnostic stability in these hospitalized adolescents was less than that reported for adults. This may indicate that DSM-III-R diagnoses in adolescents have poor construct validity, but it may also reflect the different paths for development of psychopathology during adolescence. For axis I, externalizing disorders appear most specific to adolescence, with some persistence but decreasing incidence over time. Existing cases of internalizing disorders tend to be even more persistent, but the high incidence of new cases during adolescence contributes to lower overall stability. Substance use disorders appear to be most stable, and personality disorders appear to be least stable, in adolescents.