Non-disabled cases in a national survey.
BACKGROUND
Lifetime and 12-month prevalence estimates of mental disorders consistently reported in large-scale community surveys have met with deserved scepticism. A crucial variable is the extent to which people who are considered cases are also disabled by their symptoms. In a national population survey, we hypothesized that an administratively significant proportion of persons with anxiety or depressive disorders according to ICD-10 and DSM-IV would report no disability.


METHODS
Interviews were sought on a nationally representative sample of people aged 18 and over across Australia. The Composite International Diagnostic Interview on laptop (CIDI-A) was used by professional survey interviewers to identify persons meeting ICD-10 or DSM-IV criteria for anxiety or depressive disorders in the previous 4 weeks, together with self-reported data on associated disability and medical consultations for the same period.


RESULTS
In an achieved sample of 10,641 persons (response rate = 78%), no disability in daily life was reported by 28% of persons with an anxiety disorder and 15% with a depressive disorder by ICD-10 criteria; and by 20.4% and 13.9% respectively by DSM-IV. Non-disabled respondents had lower scores on two measures of psychological distress and markedly lower rates for having consulted a doctor for their symptoms.


CONCLUSIONS
The ICD-10 and DSM-IV criteria for anxiety and depressive disorders, when applied to the information on symptoms elicited by the CIDI-A, inadequately discriminate between people who are and are not disabled by their symptoms. There may be a group of highly symptomatic people in the general population who tolerate their symptoms and are not disabled by them.
Henderson
S
S
Centre for Mental Health Research, The Australian National University, Canberra, ACT.
Korten
A
A
Medway
J
J
D000328:Adult; D001008:Anxiety Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology; D001315:Australia / Q000453:epidemiology; D003866:Depressive Disorder / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology; D005260:Female; D006306:Health Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D019989:Persons with Intellectual Disabilities / Q000523:psychology*; D011569:Psychiatric Status Rating Scales; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012647:Self-Assessment; D012803:Sick Role