Relationship between ICD-10 Psychosocial Categories and Psychiatric Diagnosis in Israeli Adolescents
Fennig, Silvana, Apter, Alan, Horesh, Netta, Arzi, Ruth, Zalsman, Gil, Weizman, Avi, Fennig, Shmuel, The Israel Journal of Psychiatry and Related Sciences
Aim: The study examined the relationship between psychosocial categories obtained by WHO-developed semistructured interviews (ICD-10 Axis V) and clinical Axis I psychiatric diagnoses in psychiatrically hospitalized adolescents.
Methods: The sample included 71 consecutive patients admitted to an adolescent unit and their mothers. Mothers completed a semi-structured interview derived from the criteria for each psychosocial category (Axis V), and the adolescents were diagnosed by experienced psychiatrists using the Schedule for Affective Disorders for School Age Children (K-SADS-P).
Results: Anorexia nervosa and conduct disorder were associated with a psychosocial category of "abnormal qualities of upbringing," and conduct disorder and schizophrenia were associated with a psychosocial category of "events brought about by the child's own behavior."
Conclusions: The systematic assessment of psychosocial categories add specific information to the validity of the Axis I diagnosis.
The established role of psychosocial stress as a risk factor for psychiatric disorders in adults led to its investigation in the development of child and adolescent mental disorders (1) and to its association in the course of mental disorders and in the response to treatment (2). Research on psychopathology in this age group highlighted the problems of reliability of the different sources of information and how to resolve those differences (3-5). These findings suggested that psychopathology should be approached from a developmental perspective with assessments of family, peer, school, and their environmental relationships, thereby obviating the need for a structured and systematic psychosocial diagnsosis.
In 1990, a work group of the World Health Organization (WHO) specified criteria for abnormal psychosocial situation in a similar fashion to the clinical Axis I psychiatric disorders in the research version of ICD-10 and the DSM-IV (6). The tenth revision of the ICD-10 adopted these recommendations in the form of the new nine-category qualitative classification for children based on previous studies (7). This axis suggests a way to code abnormal psychosocial conditions based on the developmental age of the child and his past history. The categories were chosen based on their ability to validate significant risk factors even if they were not considered a direct etiological factor (8, 9). Clear operational criteria were developed for each category, and two semistructured interviews, one for children and one for their parents, were constructed. The psychosocial categories form the fifth axis of the five-part multiaxial classification of childhood psychiatric disorders (7). We found as part of the present study that all of the psychosocial categories of Axis V were common and relevant to a population of inpatient adolescents and we conclude, based on our findings, that it is possible to make reliable and relevant diagnoses in severely ill adolescents (10).
In the present paper we aimed to further investigate the specific links between the psychiatric diagnosis and the psychosocial categories.
Sarason et al. (11) claim that there is a correlation between specific life events and specific psychiatric disorders. It is widely accepted that depression and mania are associated with life events and the ability to adjust to them. Specific life events like loss, divorce of parents and traumatic events in the parent are associated with higher rates of mood disorders later in life, especially if those events occur during childhood (12, 13). Abnormal family relationship and rearing practices have been related to eating disorders for many years (14). However, when anorexic patients are studied separately from those with other eating disorders the results of controlled studies are conflicting (15). In a recent study women with bulimia nervosa tended to report more troubled childhood expriences than did women from a non-morbid comparison group. …