title: Independent review of social and population variation in mental health could improve diagnosis in DSM revisions.
abstract: At stake in the May 2013 publication of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), are billions of dollars in insurance payments and government resources, as well as the diagnoses and treatment of millions of patients. We argue that the most recent revision process has missed social determinants of mental health disorders and their diagnosis: environmental factors triggering biological responses that manifest themselves in behavior; differing cultural perceptions about what is normal and what is abnormal behavior; and institutional pressures related to such matters as insurance reimbursements, disability benefits, and pharmaceutical marketing. In addition, the experts charged with revising the DSM lack a systematic way to take population-level variations in diagnoses into account. To address these problems, we propose the creation of an independent research review body that would monitor variations in diagnostic patterns, inform future DSM revisions, identify needed changes in mental health policy and practice, and recommend new avenues of research. Drawing on the best available knowledge, the review body would make possible more precise and equitable psychiatric diagnoses and interventions.
authors.affiliation: New York University, New York City, NY, USA. helena.hansen@nyumc.org
authors.forename: Helena B
authors.initials: HB
authors.lastname: Hansen
authors.forename: Zoe
authors.initials: Z
authors.lastname: Donaldson
authors.forename: Bruce G
authors.initials: BG
authors.lastname: Link
authors.forename: Peter S
authors.initials: PS
authors.lastname: Bearman
authors.forename: Kim
authors.initials: K
authors.lastname: Hopper
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Bates
authors.forename: Keely
authors.initials: K
authors.lastname: Cheslack-Postava
authors.forename: Kristin
authors.initials: K
authors.lastname: Harper
authors.forename: Seth M
authors.initials: SM
authors.lastname: Holmes
authors.forename: Gina
authors.initials: G
authors.lastname: Lovasi
authors.forename: Kristen W
authors.initials: KW
authors.lastname: Springer
authors.forename: Julien O
authors.initials: JO
authors.lastname: Teitler
mesh_terms: D026683:Advisory Committees; D039721:Diagnostic and Statistical Manual of Mental Disorders; D004345:Drug Industry; D006291:Health Policy; D006801:Humans; D058025:Interdisciplinary Studies; D001523:Mental Disorders / Q000145:classification / Q000175:diagnosis* / Q000209:etiology; D011584:Psychology; D058996:Quality Improvement / Q000458:organization & administration; D064890:Social Determinants of Health / Q000706:statistics & numerical data; D012959:Socioeconomic Factors
keywords: Determinants Of Health; Health Reform; International/Global Health Studies; Mental Health/Substance Abuse