The purpose of the current report is to present nationally representative estimates of lifetime prevalence and age-of-onset distributions of the DSM-IV disorders assessed in the recently completed National Comorbidity Survey Replication (NCS-R).¹ While the Epidemiological Catchment Area Study² and the baseline National Comorbidity Survey (NCS)³ both reported high lifetime prevalence and generally early age-of-onset distributions of most DSM-III (NCS) and DSM-III-R (NCS-R) disorders, it is not clear whether similar results will hold for DSM-IV disorders because of the greater emphasis on clinically significant distress and impairment in DSM-IV than in earlier editions.

Community epidemiological surveys estimate that as many as 30% of the adult population in the United States meet criteria for a 12-month DSM mental disorder.^1,2 Clinical reappraisal studies confirm these estimates.³ Although fewer than half these people receive treatment,^4,5 unmet need for treatment may not be a major problem, because a high proportion of untreated cases might be mild or self-limiting. However, no definitive epidemiological data exist on this possibility, because severity has not been a focus of previous psychiatric epidemiological surveys. Although secondary analysis of surveys in the United States⁶ and other countries^7,8 suggests that many 12-month cases are mild, this conclusion is based on crude post hoc severity indicators.

Although community surveys of mental disorders have been conducted in the United States since the end of World War II,^1-3 it was not until the early 1980s that fully structured lay interviews were developed to diagnose specific mental disorders. The first such instrument was the Diagnostic Interview Schedule (DIS),⁴ which was developed for use in the Epidemiologic Catchment Area (ECA) study⁵ to estimate the general population prevalence of mental disorders by Diagnostic and Statistical Manual of Mental Disorders, Third Edition (DSM-III) criteria.⁶ Major depressive disorder (MDD) prevalence estimates in the ECA sites were 3.0% to 5.9% for lifetime and 1.7% to 3.4% for 12-month.⁷

Background. A self-report screening scale of adult attention-deficit/hyperactivity disorder (ADHD), the World Health Organization (WHO) Adult ADHD Self-Report Scale (ASRS) was developed in conjunction with revision of the WHO Composite International Diagnostic Interview (CIDI). The current report presents data on concordance of the ASRS and of a short-form ASRS screener with blind clinical diagnoses in a community sample.Method. The ASRS includes 18 questions about frequency of recent DSM-IV Criterion A symptoms of adult ADHD. The ASRS screener consists of six out of these 18 questions that were selected based on stepwise logistic regression to optimize concordance with the clinical classification. ASRS responses were compared to blind clinical ratings of DSM-IV adult ADHD in a sample of 154 respondents who previously participated in the US National Comorbidity Survey Replication (NCS-R), oversampling those who reported childhood ADHD and adult persistence.Results. Each ASRS symptom measure was significantly related to the comparable clinical symptom rating, but varied substantially in concordance (Cohen's κ in the range 0·16–0·81). Optimal scoring to predict clinical syndrome classifications was to sum unweighted dichotomous responses across all 18 ASRS questions. However, because of the wide variation in symptom-level concordance, the unweighted six-question ASRS screener outperformed the unweighted 18-question ASRS in sensitivity (68·7% v. 56·3%), specificity (99·5% v. 98·3%), total classification accuracy (97·9% v. 96·2%), and κ (0·76 v. 0·58).Conclusions. Clinical calibration in larger samples might show that a weighted version of the 18-question ASRS outperforms the six-question ASRS screener. Until that time, however, the unweighted screener should be preferred to the full ASRS, both in community surveys and in clinical outreach and case-finding initiatives.

Although the 1990s saw enormous change in the mental health care system in the United States, little is known about changes in the prevalence or rate of treatment of mental disorders. We examined trends in the prevalence and rate of treatment of mental disorders among people 18 to 54 years of age during roughly the past decade. Data from the National Comorbidity Survey (NCS) were obtained in 5388 face-to-face household interviews conducted between 1990 and 1992, and data from the NCS Replication were obtained in 4319 interviews conducted between 2001 and 2003. Anxiety disorders, mood disorders, and substance-abuse disorders that were present during the 12 months before the interview were diagnosed with the use of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV). Treatment for emotional disorders was categorized according to the sector of mental health services: psychiatry services, other mental health services, general medical services, human services, and complementary–alternative medical services. The prevalence of mental disorders did not change during the decade (29.4 percent between 1990 and 1992 and 30.5 percent between 2001 and 2003, P=0.52), but the rate of treatment increased. Among patients with a disorder, 20.3 percent received treatment between 1990 and 1992 and 32.9 percent received treatment between 2001 and 2003 (P<0.001). Overall, 12.2 percent of the population 18 to 54 years of age received treatment for emotional disorders between 1990 and 1992 and 20.1 percent between 2001 and 2003 (P<0.001). Only about half those who received treatment had disorders that met diagnostic criteria for a mental disorder. Significant increases in the rate of treatment (49.0 percent between 1990 and 1992 and 49.9 percent between 2001 and 2003) were limited to the sectors of general medical services (2.59 times as high in 2001 to 2003 as in 1990 to 1992), psychiatry services (2.17 times as high), and other mental health services (1.59 times as high) and were independent of the severity of the disorder and of the sociodemographic characteristics of the respondents. Despite an increase in the rate of treatment, most patients with a mental disorder did not receive treatment. Continued efforts are needed to obtain data on the effectiveness of treatment in order to increase the use of effective treatments.