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• W1984886791 abstract "Michael Phillips and colleagues (June 13, p 2041)1Phillips MR Zhang J Shi Q et al.Prevalence, treatment, and associated disability of mental disorders in four provinces in China during 2001–05: an epidemiological survey.Lancet. 2009; 373: 2041-2053Summary Full Text Full Text PDF PubMed Scopus (748) Google Scholar report that about one in five adults (1-month prevalence 17·5%) in China has a current mental disorder as defined by the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV).2American Psychiatric AssociationDiagnostic and Statistical Manual of Mental Disorders. 4th edn. American Psychiatric Association, Washington, DC1994Google Scholar This makes China one of the most mentally ill countries in the world.3Demyttenaere K Bruffaerts R Posada-Villa J et al.Prevalence, severity, and unmet need for treatment of mental disorders in the World Health Organization World Mental Health Surveys.JAMA. 2004; 291: 2581-2590Crossref PubMed Scopus (2325) Google Scholar Phillips and colleagues indicate that structured clinical interviews for DSM-IV (SCID) with added flexible probes were more sensitive and generated higher and more valid prevalence than did structured composite international diagnostic interviews (CIDI). Thus, if respondents did not endorse questions for core diagnostic symptoms, they were asked various substitute symptom questions. For depression, some of these symptoms such as “pessimism” are more like optional or unrecognised than core diagnostic symptoms of DSM-IV depression.2American Psychiatric AssociationDiagnostic and Statistical Manual of Mental Disorders. 4th edn. American Psychiatric Association, Washington, DC1994Google Scholar Secondary probes for various anxiety disorders were not mentioned. Since diagnoses based on these innovatively broadened SCID questions have never been validated, the conceptual and empirical justification for making the modifications to generate higher prevalence is debatable. This is especially so because the SCID was administered by mental hospital psychiatrists who were more familiar with psychotic disorders than the spectrum of depressive and anxiety disorders in the community. The CIDI can also be made to generate much higher prevalence estimates by changing the diagnostic thresholds of core symptoms.4Chang SM Hahm BJ Lee JY et al.Cross-national difference in the prevalence of depression caused by the diagnostic threshold.J Affect Disord. 2008; 106: 159-167Summary Full Text Full Text PDF PubMed Scopus (109) Google Scholar Internationally, multiethnic surveys documenting high prevalence of mental disorders have been successfully done by careful translation and choice of interviewers, despite dialect barriers, not by modifying core diagnostic criteria.5Baxter J Kokaua J Wells JE et al.Ethnic comparisons of the 12 month prevalence of mental disorders and treatment contact in Te Rau Hinengaro: the New Zealand Mental Health Survey.Aust N Z J Psychiatry. 2006; 40: 905-913Crossref PubMed Google Scholar A high prevalence of “not otherwise specified” disorders indicates that, although the modified questions identified more respondents than the original core questions might, many did not fulfil syndromal criteria. Without external validation their inclusion in estimates of prevalence and burden risks medicalisation. I am Asia-Pacific coordinator of the World Mental Health Survey Initiative (http://www.hcp.med.harvard.edu/wmh/) and use both the CIDI and SCID in research. Mental illness in China – Authors' replySing Lee's main concern is that, by allowing clinicians to use flexible probes, we have relaxed the diagnostic criteria and, thus, inflated the estimated prevalence of mental disorders. We should clarify that the additional probes are used only when the clinician is aware that the respondent does not understand the intent of the original structured clinical interviews for DSM-IV (SCID) probe—a relatively common problem when interviewing people of different educational levels who speak a variety of Chinese dialects. Full-Text PDF" @default.
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• W1984886791 title "Mental illness in China" @default.
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