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(2011)Journal ArticleObjective: To present scoring rules for predicting DSM-IV mental illness in the past 12 month using the Kessler Psychological Distress Scale in the Australian population. Method: The method described in Kessler et al., [1] was closely followed using data from the 2007 Australian Survey of Mental Health and Wellbeing. A series of 93 nested logistic regression models were generated and compared to estimate the predicted probabilities of mental illness for each survey respondent using scores on the Kessler Psychological Distress Scale. The best model was selected using information theoretic criteria. Concordance between the predicted probabilities of mental illness generated by the best models with DSM-IV defined mental illness, assessed using the Composite International Diagnostic Interview, was determined using receiver operating characteristic analysis. Results: The best fitting models were found to contain the quadratic form of the Kessler Psychological Distress Scale (both 6 item and 10 item versions). Age was found to be significant in the model predicting mood, anxiety, and substance use with serious impairment using the 6 item version whilst age and gender was found to be significant in the model for the 10 item version. The concordance between the predicted probabilities of mood, anxiety, and substance use with serious impairment generated from the best models and DSM-IV mood, anxiety, and substance use with serious impairment was within an acceptable level for both versions. Results were similar when predicting DSM-IV mood, anxiety, and substance use without seriousness indicators and DSM-IV anxiety and depression. The performance of predicted probabilities was then examined in various subpopulations of the Australian population. Conclusions: Using a logistic regression model, the Kessler Psychological Distress Scale can be used to generate predicted probabilities of mental illness with an acceptable level of agreement in Australian-based population studies where it is not feasible to conduct a comprehensive assessment.
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(2010)Journal ArticleBackground: Large community based epidemiological surveys have consistently identified high co-morbidity between major depressive episode (MDE) and generalized anxiety disorder (GAD). Some have suggested that this co-morbidity may be artificial and the product of the current diagnostic system. Due to the added direct and indirect costs associated with co-morbidity it is important to investigate if methods of diagnostic classification are artificially increasing the level of observed co-morbidity. Methods: The item response theory log-likelihood ratio procedure was used to test for differential item functioning of MDE symptoms between respondents with and without a diagnosis of GAD in the 2001-2002 National Epidemiological Survey on Alcohol and Related Conditions. Results: The presence of GAD significantly increased the chances of reporting any symptom of MDE with odds ratios ranging from 2.54 to 3.60. However, there was no indication of significant differential item functioning of MDE symptoms in respondents with and without GAD. Conclusions: The lack of any significant differential item functioning indicates that cases with GAD do not present with a distinct MDE symptom profile, one that is consistent with the endorsement of symptoms that are conceptually similar in nature between the two disorders, compared to cases without GAD. This does not support the hypothesis that co-morbidity between MDE and GAD is artificially inflated due to similar symptom criteria required by the current diagnostic system. Instead, MDE and GAD may be thought of as two distinct diagnostic entities that frequently co-occur due to a shared underlying trait.
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(2008)Journal ArticleObjectives: It has been previously argued that the methodology employed by the Composite International Diagnostic Interview version 2.1 to assess the substance induced and general medical condition exclusion criteria are inadequate. As a result prevalence estimates generated from epidemiological studies using this interview may be underestimated. The purpose of the current study was to examine the substance induced and general medical condition exclusion criteria in the Australian National Survey for Mental Health and Well-being and determine the impact they have on prevalence estimates of the common mental disorders. Method: Data from the 1997 Australian National Survey of Mental Health and Wellbeing were analyzed. Frequencies were generated as an indication of how many respondents believed their psychiatric symptoms were always due to a substance or general medical condition. New DSM-IV prevalence estimates were calculated ignoring the application of the substance induced and general medical condition exclusion criteria and compared to standard DSM-IV prevalence estimates. Results: The effect of the substance induced and general medical condition exclusion criteria on final prevalence rates were minimal with around a 0.1% increase when the exclusions were ignored. This equates to a relative difference ranging from no difference for Generalized Anxiety Disorder to an increase of 12% of the base prevalence estimate for Agoraphobia. Conclusions: In surveys that use the Composite International Diagnostic Interview version 2.1 the substance induced and general medical condition exclusion criteria have a minor impact on determining final case definition in the majority of mental disorders.
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(2013)Journal Article
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(2013)Journal ArticleObjective: The aim of the present study is to examine the mental health correlates of anger in the general population using data collected as part of the 2007 Australian National Survey of Mental Health and Wellbeing (2007 NSMHWB). Method: The 2007 NSMHWB was a nationally representative household survey of 8,841 Australians aged between 16-85 years. The survey assessed for 30-day DSM-IV mental health disorders and 30-day anger symptoms. Results: A range of mood, anxiety and substance use disorders were found to be independently associated with symptoms of anger after controlling for demographics and comorbidity. These included major depressive disorder, bipolar disorder, social phobia, generalised anxiety disorder, obsessive compulsive disorder, post traumatic stress disorder, and alcohol and drug use disorders. Conclusions: This study is the first epidemiological investigation of the mental health correlates of anger in the Australian general population. Anger can have extremely maladaptive effects on behaviour and can lead to serious consequences for the individual and for the community. The findings of the present study denote the importance of assessing anger symptoms among individuals presenting with these common mental health disorders.
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(2012)Journal ArticleAlthough prolonged exposure (PE) has received the most empirical support of any treatment for posttraumatic stress disorder (PTSD), clinicians are often hesitant to use PE due to beliefs that it is contraindicated for many patients with PTSD. This is especially true for PTSD patients with comorbid problems. Because PTSD has high rates of comorbidity, it is important to consider whether PE is indeed contraindicated for patients with various comorbid problems. Therefore, in this study, we examine the evidence for or against the use of PE with patients with problems that often co-occur with PTSD, including dissociation, borderline personality disorder, psychosis, suicidal behavior and non-suicidal self-injury, substance use disorders, and major depression. It is concluded that PE can be safely and effectively used with patients with these comorbidities, and is often associated with a decrease in PTSD as well as the comorbid problem. In cases with severe comorbidity, however, it is recommended to treat PTSD with PE while providing integrated or concurrent treatment to monitor and address the comorbid problems.