Academic journal article Bulletin of the World Health Organization

Cross-National Comparisons of the Prevalences and Correlates of Mental Disorders

Academic journal article Bulletin of the World Health Organization

Cross-National Comparisons of the Prevalences and Correlates of Mental Disorders

Article excerpt

Voir page 423 le resume en francais. En la pagina 424 figura un resumen en espanol.


Community epidemiological surveys of mental disorders have been carried out in many parts of the world since the end of the Second World War (e.g. 1-3) but, in the absence of a common format for diagnostic interviews, no cross-national syntheses or comparisons of the results of these surveys could be made. However, in the early 1980s a fully structured research diagnostic interview -- the Diagnostic Interview Schedule (DIS) which could be used by trained lay interviewers -- was developed (4) and quickly became the standard instrument for community epidemiological surveys of mental disorders. The DIS was first used in the Epidemiologic Catchment Area (ECA) Study (5), a landmark survey of the prevalences and correlates of mental disorders in the USA. The widespread dissemination of the ECA results led to a number of similar studies in other countries (6-12). These surveys were subsequently brought together in a series of important cross-national comparative analyses of specific disorders (13-15).

Beginning in the mid-1980s, WHO, in collaboration with the US Public Health Service, encouraged further cross-national collaboration by developing a fully structured research diagnostic interview, similar to the DIS, which could generate reliable and valid diagnoses in many different languages. This new instrument, known as the WHO Composite International Diagnostic Interview (CIDI), was created by an international WHO working group which elaborated and refined the DIS to include ICD (International Classification of Diseases) criteria (16), and carried out extensive cross-national field trials to guarantee that the instrument was reliable and valid cross-nationally (17). Version 1.0 of CIDI was released in 1990 (18) and was subsequently revised to include Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) criteria (19).

In the 10 years since it first became available, the CIDI has been used in a number of large-scale community epidemiological surveys throughout the world (20-26). In 1998, in recognition of this wide use, WHO created a research consortium -- WHO International Consortium in Psychiatric Epidemiology (ICPE) -- to coordinate comparative analyses of the results from these surveys. This article presents some findings from the first generation of ICPE surveys.



The results of CIDI surveys in seven countries -- in North America (Canada and the USA), Latin America (Brazil and Mexico), and Europe (Germany, Netherlands, and Turkey) -- are presented in this article. The total sample size was 29 644 persons. All the surveys were based on general population probability samples and not on patient samples or quota samples of the general population. The interviews were all carried out face to face and not by telephone or by post. As shown in Table 1, the age range of the pooled sample was [is greater than or equal to] 18 years and the response rates in separate surveys were 60.4-82.4%. A description of the sampling design for each survey is presented below. The data sets in Canada, Germany, the Netherlands, and the USA were weighted to adjust for differences between the sociodemographic characteristics of the samples and the populations from which they were selected. These adjustments were not possible in the other data sets owing to lack of population data.

Table 1. Sample characteristics of the ICPE surveys in the seven study countries

Country       Name and type               Sample characteristics

Brazil        The Epidemiological         Stratified area
              Catchment Area Study in     probability sample of the
              the city of Sao Paulo       catchment area of the
              (ECA-SP) WHO-CIDI with      University of Sao Paulo
              DSM-III-R                   Medical Centre.
                                          Oversampling of ages
                                          18-24 years and [is
                                          greater than or equal to]
                                          59 (ref. … 
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