title: Developing a science of clinical utility in diagnostic classification systems field study strategies for ICD-11 mental and behavioral disorders.
abstract: The World Health Organization (WHO) Department of Mental Health and Substance Abuse has developed a systematic program of field studies to evaluate and improve the clinical utility of the proposed diagnostic guidelines for mental and behavioral disorders in the Eleventh Revision of the International Classification of Diseases and Related Health Problems (ICD-11). The clinical utility of a diagnostic classification is critical to its function as the interface between health encounters and health information, and to making the ICD-11 be a more effective tool for helping the WHO's 194 member countries, including the United States, reduce the global disease burden of mental disorders. This article describes the WHO's efforts to develop a science of clinical utility in regard to one of the two major classification systems for mental disorders. We present the rationale and methodologies for an integrated and complementary set of field study strategies, including large international surveys, formative field studies of the structure of clinicians' conceptualization of mental disorders, case-controlled field studies using experimental methodologies to evaluate the impact of proposed changes to the diagnostic guidelines on clinicians' diagnostic decision making, and ecological implementation field studies of clinical utility in the global settings in which the guidelines will ultimately be implemented. The results of these studies have already been used in making decisions about the structure and content of ICD-11. If clinical utility is indeed among the highest aims of diagnostic systems for mental disorders, as their developers routinely claim, future revision efforts should continue to build on these efforts. (PsycINFO Database Record
authors.affiliation: Department of Psychology, Mississippi State University.
authors.forename: Jared W
authors.initials: JW
authors.lastname: Keeley
authors.affiliation: Department of Mental Health and Substance Abuse, World Health Organization.
authors.forename: Geoffrey M
authors.initials: GM
authors.lastname: Reed
authors.affiliation: Clinical Child Psychology Program, University of Kansas.
authors.forename: Michael C
authors.initials: MC
authors.lastname: Roberts
authors.affiliation: Clinical Child Psychology Program, University of Kansas.
authors.forename: Spencer C
authors.initials: SC
authors.lastname: Evans
authors.affiliation: National Institute of Psychiatry "Ramón de la Fuente"
authors.forename: María Elena
authors.initials: ME
authors.lastname: Medina-Mora
authors.affiliation: National Institute of Psychiatry "Ramón de la Fuente"
authors.forename: Rebeca
authors.initials: R
authors.lastname: Robles
authors.affiliation: Global Mental Health Program, Columbia University Medical Center.
authors.forename: Tahilia
authors.initials: T
authors.lastname: Rebello
authors.affiliation: Department of Psychiatry, All India Institute of Medical Sciences.
authors.forename: Pratap
authors.initials: P
authors.lastname: Sharan
authors.affiliation: Department of Psychiatry, University of Ibadan.
authors.forename: Oye
authors.initials: O
authors.lastname: Gureje
authors.affiliation: Department of Psychiatry, Columbia University Medical Center.
authors.forename: Michael B
authors.initials: MB
authors.lastname: First
authors.affiliation: Department of Psychiatry, Columbia University Medical Center.
authors.forename: Howard F
authors.initials: HF
authors.lastname: Andrews
authors.affiliation: Department of Psychiatry, Universidad Autónoma de Madrid.
authors.forename: José Luís
authors.initials: JL
authors.lastname: Ayuso-Mateos
authors.affiliation: Department of Psychiatry, Heinrich-Heine University.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Gaebel
authors.affiliation: Department of Psychiatry, Heinrich-Heine University.
authors.forename: Juergen
authors.initials: J
authors.lastname: Zielasek
authors.affiliation: Department of Mental Health and Substance Abuse, World Health Organization.
authors.forename: Shekhar
authors.initials: S
authors.lastname: Saxena
mesh_terms: D039721:Diagnostic and Statistical Manual of Mental Disorders; D006801:Humans; D038801:International Classification of Diseases; D001523:Mental Disorders / Q000145:classification* / Q000175:diagnosis* / Q000523:psychology; D011570:Psychiatry; D014944:World Health Organization