Health Disparities and Recent Initiatives

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Questions and Answers

What are some recent initiatives focused on gender, race, and class in the field of mental health disparities?

Healthy People 2020 and Achieving the Promise: Transforming Mental Health Care in America

What does DSM-V include to address cultural context in mental illness?

Cultural Formulation (correct)

Race Evaluation

Gender Formulation

Class Analysis

Gender bias only affects diagnostic categories and not the diagnostic process.

False

Race bias is particularly observed in the misdiagnosis of Black and Hispanic patients with ______ when symptoms suggest psychotic affective disorders.

schizophrenia Signup and view all the answers

Match the biased diagnostic constructs with their examples:

Biased diagnostic constructs = Represent an ethnocentric view of nonpathological individuals Biased instruments of assessment = May contain items that reflect dysfunction differently for different groups Biased application of diagnostic criteria = May result in overdiagnosis for specific groups based on social class or race Signup and view all the answers

In a low socioeconomic status sample, who was less likely to use specialty care for mental health problems compared to Whites?

Latinos Signup and view all the answers

Who is more likely to seek mental health care according to a general finding?

Women Signup and view all the answers

Higher socioeconomic status is related to longer stay in psychotherapy. (True/False)

True Signup and view all the answers

In some studies, socioeconomic status was not related to remaining in ___________.

treatment Signup and view all the answers

Which group is less likely to receive antidepressant, antianxiety or any drug therapy from primary care doctors according to the results discussed?

African Americans Signup and view all the answers

Match the following racial/ethnic groups with their drug treatment responses:

African Americans = Reduced responsiveness to beta blockers and more rapid response to tricyclic antidepressants Whites = More likely to be nonresponders to fluoxetine and need less lithium to control manic symptoms Signup and view all the answers

According to Chang (2003), what are the two basic research perspectives presented for understanding differences in mental health and mental health care?

Discover and describe common factors predicting sociodemographic differences; Assume unique historical, social, and cultural factors impacting groups Signup and view all the answers

How does culture play a role in the response of families to relatives with schizophrenia?

It influences the course of illness Signup and view all the answers

Mexican American patients were more likely to relapse if they returned to families characterized by low warmth.

False Signup and view all the answers

What factors are associated with acting-out problems in adolescents across different cultural groups?

risk and protective factors Signup and view all the answers

Immigrants have ______ prevalence rates of schizophrenia than those born in the United States.

lower Signup and view all the answers

Match the following cultural groups with their drinking behaviors:

European Americans = Rigid model of alcohol abuse based on biology or psychology American Indians = Contextually based line between normative and pathological drinking Signup and view all the answers

What is the definition of culture in the context of cultural psychopathology?

Beliefs and practices that pertain to a given ethnocultural group Signup and view all the answers

Which of the following are limitations of the traditional definition of culture as presented in the text?

Conceives of culture as residing largely within individuals Signup and view all the answers

In the context of cultural research, the purpose is to advance understanding of general processes only.

False Signup and view all the answers

The World Mental Health Report highlighted that mental illness produces a greater burden based on a 'disability-adjusted life years' index than that from _, _, or heart disease.

tuberculosis, cancer Signup and view all the answers

Match the symptoms with ataques de nervios:

Trembling, attacks of crying, screaming uncontrollably, verbal or physical aggression = Symptoms commonly associated with ataques de nervios Amnesia of what occurred after the ataque, quickly return to usual functioning = Typical post-episode experience Seizure-like or fainting episodes, dissociative experiences, suicidal gestures = Symptoms sometimes associated with ataques de nervios Signup and view all the answers

According to research, what emotional climate in families is associated with a higher likelihood of relapse for schizophrenia patients?

High criticism and hostility Signup and view all the answers

Which group of adolescents showed that peer influences were less relevant to misconduct?

Taipei Chinese Signup and view all the answers

Immigration status is associated with lower prevalence rates of schizophrenia among Mexican-origin adults.

False Signup and view all the answers

A rigid model of alcohol abuse defined by biology or psychology without significant attention to the sociocultural context is limited in distinguishing between normative and _______ drinking.

pathological Signup and view all the answers

What is the definition of culture?

Beliefs and practices that pertain to a given ethnocultural group Signup and view all the answers

What are the two separate, but related goals of cultural research mentioned in the text?

Studying culture to identify general processes, Studying culture to identify culture-specific processes Signup and view all the answers

Culture is depicted as a static and bounded phenomenon in the text. (True/False)

False Signup and view all the answers

The DSM-5 includes the ____________ Interview for cultural considerations.

Cultural Formulation Signup and view all the answers

What are the current classification systems mentioned in the text?

ICD-10 Signup and view all the answers

In which year was the Diagnostic and Statistical Manual of Mental Disorders (DSM-III) published?

1980 Signup and view all the answers

The DSM-IV committee aimed to base decisions on new diagnoses solely on scientific literature.

True Signup and view all the answers

DSM-5 was published in the year _____ .

2013 Signup and view all the answers

What major shift did DSM-5 make in its model?

Neurobiological model Signup and view all the answers

Which two classification systems are largely congruent?

The 10th edition of the World Health Organization’s International Classification of Diseases Signup and view all the answers

What was the purpose of the Statistical Manual for the Use of Institutions for the Insane developed in 1918?

to provide diagnostic classification for psychiatric disorders in institutions Signup and view all the answers

DSM-III was characterized by specific and explicit criterion sets for all disorders.

True Signup and view all the answers

The United States is required to use the coding system of the ______.

ICD Signup and view all the answers

Match the following editions to their corresponding organizations:

DSM-5 = American Psychiatric Association ICD-9 = World Health Organization DSM-IV = American Psychiatric Association ICD-10 = World Health Organization Signup and view all the answers

What does reliability refer to in psychological assessment?

Consistency of measurement Signup and view all the answers

What should test items be if a test is believed to measure the same trait?

Positively intercorrelated Signup and view all the answers

High validity occurs when the use of a test allows for inaccurate inferences about clients.

False Signup and view all the answers

What does incremental validity refer to?

The extent to which an instrument contributes information above and beyond what is already available Signup and view all the answers

____ refers to predictions made with test scores about future outcomes.

Predictive validity Signup and view all the answers

Match the validity source with its description:

Content validity = Evidence based on test content Convergent validity = Moderate or high correlations with other tests measuring the same attribute Discriminant validity = Low correlations with tests measuring other attributes Predictive validity = Using test scores to forecast future outcomes Concurrent validity = Correlations with indices or events measured at the same time Signup and view all the answers

What does reliability refer to in psychological assessment?

Consistency of measurement Signup and view all the answers

What is evaluated in several ways in relation to reliability?

All of the above Signup and view all the answers

Good reliability guarantees good validity in psychological assessments.

False Signup and view all the answers

What is incremental validity in the context of psychological assessment?

The extent to which an instrument contributes information above and beyond already available information Signup and view all the answers

____ validity is evidence based on test content.

Content Signup and view all the answers

Match the following types of validity with their descriptions:

Convergent validity = moderate or high correlations with other tests that measure the same attribute or diagnosis Discriminant validity = low correlations with tests that measure other attributes Predictive validity = When test scores are used to forecast future outcomes Concurrent validity = When scores are correlated with indices or events measured at approximately the same time Signup and view all the answers

What is the primary focus of process research in psychotherapy?

Investigating therapist behaviors and client interactions Signup and view all the answers

What is the main purpose of using control groups in psychotherapy research?

To investigate the effects of no treatment Signup and view all the answers

What is the primary advantage of using a waiting list control condition?

It allows researchers to draw conclusions about the effectiveness of a treatment Signup and view all the answers

What is the primary limitation of using a waiting list control condition?

It may not be ethically justifiable to delay treatment Signup and view all the answers

What is the primary difference between process research and outcome research?

Process research focuses on the therapy process, while outcome research focuses on treatment outcomes Signup and view all the answers

What is the primary purpose of randomized controlled trials (RCTs) in psychotherapy research?

To control for pre-existing differences among patients Signup and view all the answers

What is the primary advantage of using randomized controlled trials (RCTs) in psychotherapy research?

They allow researchers to draw causal inferences about treatment effects Signup and view all the answers

What is the primary limitation of using randomized controlled trials (RCTs) in psychotherapy research?

They may not be generalizable to all populations Signup and view all the answers

What is the primary goal of effectiveness research in psychotherapy?

To test whether a treatment works in real-world settings Signup and view all the answers

What is the main difference between efficacy and effectiveness research?

Efficacy research is conducted in controlled settings, while effectiveness research is conducted in real-world settings Signup and view all the answers

What do empirically validated treatments refer to?

Treatments that have been extensively tested in research studies Signup and view all the answers

What is the purpose of benchmarking in effectiveness research?

To compare the results of an effectiveness study to those of a similar efficacy study Signup and view all the answers

What is the criticism of empirically supported treatments (ESTs) in clinical practice?

ESTs are not effective in real-world clinical practice settings Signup and view all the answers

What is the definition of probably efficacious treatments?

Treatments that have been shown to be superior to waiting list control groups in one study, or to another treatment in at least one study Signup and view all the answers

What is the purpose of placebo controlled conditions in psychotherapy research?

To control for the nonspecific effects of psychotherapy Signup and view all the answers

What is the main difference between placebo controlled conditions and alternative therapy conditions?

Placebo controlled conditions are used to control for the nonspecific effects of psychotherapy, while alternative therapy conditions are used to compare the outcomes of different psychotherapy approaches Signup and view all the answers

What is the main limitation of efficacy research?

Efficacy research is not generalizable to real-world clinical practice settings Signup and view all the answers

What is the main advantage of effectiveness research?

It allows for the testing of treatments in real-world clinical practice settings Signup and view all the answers

What is the lifetime prevalence of generalized anxiety disorder?

3.3% Signup and view all the answers

What is a characteristic of anxiety in older adults?

Less frequent negative emotions Signup and view all the answers

What is a risk factor for late life drinking?

Lack of social support Signup and view all the answers

What is a biological etiology of anxiety?

Greater number of chronic health conditions Signup and view all the answers

Why may alcohol use disorders be under-detected in older adults?

Because symptoms are similar to those of other geriatric problems Signup and view all the answers

Why may older adults experience less anxiety later in life?

Due to improvements in emotion regulation skills Signup and view all the answers

What is a characteristic of schizophrenia?

A life-span neurodevelopmental disorder Signup and view all the answers

What is a challenge in diagnosing anxiety in older adults?

Providers may mistakenly attribute anxiety symptoms to normal aging Signup and view all the answers

Why may older adults drink excessively?

As a coping strategy for pain and depression Signup and view all the answers

What is a common disorder of late life?

Depression Signup and view all the answers

What is the prevalence of bipolar disorder in older adults?

0.5-1% Signup and view all the answers

What happens to excessive drinking behavior with age?

It decreases with age Signup and view all the answers

What is a characteristic of late onset depression?

Characterized by vascular risk factors Signup and view all the answers

What can be a challenge in diagnosing alcohol use disorders in older adults?

Symptoms similar to other geriatric problems Signup and view all the answers

What is a challenge in detecting depression in older adults?

Under-detection due to attribution to normal aging Signup and view all the answers

What is an effective therapy for depression in older adults?

Cognitive behavioral therapy Signup and view all the answers

What is the suicide rate for adults 65 years and older in 2011?

15.3 out of 100,000 Signup and view all the answers

What is the prevalence of problematic alcohol use among older adults in community populations?

1-22% Signup and view all the answers

Why are DSM diagnostic criteria limited in detecting alcohol use disorders in older adults?

All of the above Signup and view all the answers

What is the rate of suicide in adults 85 years and older in 2011?

16.9 out of 100,000 Signup and view all the answers

Why are suicidal acts and attempts in late life more likely to be fatal?

The exact reason is not specified in the text Signup and view all the answers

What is the overall national suicide rate in 2011 for all ages?

12.7 out of 100,000 Signup and view all the answers

According to Spielman's behavioral model, what increases vulnerability to insomnia?

Predisposing factors Signup and view all the answers

What is the percentage of dementia cases accounted for by Alzheimer's disease?

60-70% Signup and view all the answers

What is a characteristic of individuals with late-onset schizophrenia?

They are more likely to experience sensory impairments. Signup and view all the answers

What is effective in controlling positive symptoms in individuals with late-onset schizophrenia?

Antipsychotic medications. Signup and view all the answers

What is the name of the new diagnosis in DSM-5 that includes dementia?

Major neurocognitive disorder Signup and view all the answers

What is a common characteristic of older adults with anti-social personality disorder (ASPD)?

They are more likely to endorse lying or deception. Signup and view all the answers

According to Ohayon et al. (2004), what happens to total sleep time as people age?

It decreases by approximately 10 minutes per decade Signup and view all the answers

What is the estimated percentage of adults in their 80s with dementia?

15-25% Signup and view all the answers

What is the predisposition hypothesis related to?

The susceptibility to age-related stressors. Signup and view all the answers

What is the maturation hypothesis related to?

The improvement of immature personality types with age. Signup and view all the answers

What is the impact of dementia on life expectancy, especially for those 85 years and older?

It decreases life expectancy Signup and view all the answers

What is the name of the study that found up to 34% of adults aged 65 and older reported symptoms of insomnia?

Ancoli-Israel et al. (2008) Signup and view all the answers

What is a challenge in assessing personality disorders in older adults?

Differentiating behaviors consistent with personality disorders from behavior influenced by medical or neurological disorders. Signup and view all the answers

What is the prevalence of anti-social personality disorder (ASPD) in older adults?

0.2-0.3% Signup and view all the answers

What is the term for the brain's ability to sustain the effects of injury or disease, which influences the extent and timing of Alzheimer's disease?

Cognitive reserve capacity Signup and view all the answers

What is the prevalence of obsessive-compulsive personality disorders (OCPD) in older adults?

1.6-2.5% Signup and view all the answers

What is the typical age range in which sleep latency, or the time it takes to fall asleep, increases significantly?

65 years and older Signup and view all the answers

What is the percentage of worldwide dementia cases in 2012, according to the World Health Organization?

25.6 million Signup and view all the answers

What is the prevalence of schizoid personality disorders in older adults?

0.9-1.9% Signup and view all the answers

What is associated with better social functioning, coping skills, and insight in individuals with schizophrenia?

Cognitive behavioral social skills training. Signup and view all the answers

Study Notes

Recent Initiatives Focused on Gender, Race, and Class

Inequities exist in health and healthcare based on ethnicity, which is a well-known issue.
National attention to these inequities has increased recently.
Publications on mental health disparities have increased linearly from 2000 to 2007, with 180 publications in 2007.

Examples of Initiatives

Healthy People 2020 aims to achieve health equity and eliminate disparities.
Achieving the Promise: Transforming Mental Health Care in America outlines a plan to close the gap in access to quality mental health care for ethnic minorities.

Gender, Race, and Class and DSM-V

DSM-V includes a "Cultural Formulation" to provide guidelines for understanding the cultural context of mental illness.
Each diagnostic category includes "gender-related diagnostic issues" and/or "culture-related diagnostic issues" where relevant.

Role of Gender, Race, and Class in Diagnosis

Diagnostic systems are not perfect, making it difficult to answer questions about gender, race, and class in diagnosis.
Gender bias exists in diagnostic categories, such as antisocial personality disorder being more likely to be diagnosed in males.
Race bias exists in the diagnosis of schizophrenia and psychotic affective disorders, with Black and Hispanic patients being more likely to be misdiagnosed.

Gender, Race, and Class Bias

Gender bias exists in the diagnosis of antisocial personality disorder, with males being more likely to be diagnosed.
Race bias exists in the diagnosis of schizophrenia and psychotic affective disorders, with Black and Hispanic patients being more likely to be misdiagnosed.
Social class was not found to affect diagnoses.

Biased Diagnostic Constructs and Standards

The DSM classification system represents an ethnocentric and culturally biased construction of what a non-pathological individual is.
Women and individuals from collectivistic cultures are more likely to be diagnosed with a mental disorder due to cultural socialization and expectations.
The DSM criteria for histrionic personality disorder are biased against women, with a focus on "inappropriately sexually seductive" behavior.

Biased Instruments of Assessment

Diagnostic instruments can be biased due to differential item functioning, where test items have different measurement properties for different groups.
Sex bias and gender bias can occur in self-report instruments, with masculine or feminine individuals being more likely to endorse certain items.

Biased Application of the Diagnostic Criteria

Clinicians may be biased in making diagnoses, with a tendency to over-pathologize low-social-class individuals and diagnose race and gender biases.
Lower-class African American patients are more likely to receive a diagnosis of chronic alcohol abuse than White lower-class or African American higher-class patients.

Biased Sampling

Sampling biases can occur in clinical settings, where women and Whites may be more likely to seek treatment and have access to mental health care.

Role of Gender, Race, and Class in Treatment

The majority of individuals with psychological disorders do not receive care, with women and Whites being more likely to seek mental health care.
Men and African Americans are more likely to delay seeking treatment or seek care from primary care physicians.

Influence of the Client on Therapy Outcomes

Higher socioeconomic status is related to staying longer in psychotherapy, while higher levels of education are related to longer treatment for substance abuse programs.
Race and gender have a limited impact on therapy outcomes, with some studies finding African Americans gain less in therapy.

Client-Therapist Matching

Matching clients with therapists of the same race or gender may improve outcomes, but results are mixed.

Gender, Race, and Class and Pharmacotherapy

Exclusion of women and minorities from clinical trials has led to a lack of information about differential responses to psychopharmacological treatment.
Race and sex may affect responses to drug treatment, with differences in absorption, distribution, metabolism, and elimination.

Understanding Gender, Race, and Class

Chang (2003) presents two research perspectives for understanding differences in mental health and mental health care:
- Discover and describe common factors that predict sociodemographic differences.
- Assume that each group is embedded in a complex and unique set of historical, social, and cultural factors and that even when common factors are identified, each group may respond differently to them.

Conceptual Contributions

Definition of culture: Beliefs and practices that pertain to a given ethnocultural group
Limitations of this definition: Conceives of culture as residing largely within individuals and depicts culture as static and bounded
Culture involves process and change, constantly in flux both in its regions of origin and as people move around the globe
Two separate, but related goals of cultural research:
Studying culture to identify general processes
Studying culture to identify culture-specific processes

Major Advances

Incorporation of cultural factors in DSM-IV and continued development of cultural issues in DSM-5
Publication of the World Mental Health Report
Release of the U.S. Surgeon General’s Supplemental Report on Mental Health: Culture, Race and Ethnicity
Completion of the Collaborative Psychiatric Epidemiology Surveys (CPES)

Incorporation of Cultural Factors in DSM-IV/5

National Institute of Mental Health (NIMH) funded the establishment of a Culture and Diagnosis Work Group
The work group’s efforts resulted in three main contributions to DSM-IV:
Inclusion of cultural factors in the expression, assessment, and prevalence of disorders in each of the disorder chapters
An outline of a cultural formulation of clinical diagnosis to complement the multi-axial assessment
A glossary of relevant cultural-bound syndromes from around the world
Cultural considerations for DSM-5 build on the foundation provided by DSM-IV
Cultural conceptions of distress in the DSM-5 are divided into three categories:
Cultural syndromes
Cultural idioms of distress
Cultural explanation or perceived cause of illness
DSM-5 includes the Cultural Formulation Interview, which is highly structured and usable by clinicians

Publication of the World Mental Health Report

The report compiled research from across the world to identify the range of mental health and behavioral problems
The most significant findings:
Mental illness and related problems exact a significant toll on the health and wellbeing of people worldwide
Mental illness produces a greater burden based on a "disability-adjusted life years" index than that from tuberculosis, cancer, or heart disease
Depressive disorders alone were found to produce the fifth greatest burden for women and seventh greatest burden for men

Surgeon General’s Supplemental Report on Mental Health

The report focused on the mental health of four main minority groups: American Indians/Alaska Natives, African Americans, Asian Americans/Pacific Islanders, and Latino Americans
The main message was that “culture counts” and affects all aspects of mental health and illness

Collaborative Psychiatric Epidemiology Surveys (CPES)

Comprises three nationally representative surveys:
National Comorbidity Survey-Replication
National Survey of American Life
National Latino and Asian American Study
The contributions of the CPES have been significant, providing nationally representative samples of three major U.S. racial/ethnic minority groups

Ataque de nervios is an idiom of distress, particularly prominent among Latinos from the Caribbean
Symptoms commonly associated with ataques de nervios include trembling, attacks of crying, screaming uncontrollably, and verbal or physical aggression
Most episodes occur as a direct result of a stressful life event related to family or significant others
Prevalence: 16% of the large community sample in Puerto Rico experienced ataques de nervios
Ataques de nervios were found to be associated with a wide range of mental disorders, particularly anxiety and mood disorders

The effect of schizophrenia on individuals and communities depends on whether they conceive of the self as autonomous and separate from others or as connected and bound to others
Culture plays a role in the manner in which families respond to relatives with schizophrenia, which in turn influences the course of illness
Expressed emotion: criticism, hostility, and emotional involvement
Mexican American patients who returned to families marked by high warmth were less likely to relapse than those who returned to families characterized by low warmth

Conceptual Contributions

Definition of culture: Beliefs and practices that pertain to a given ethnocultural group
Limitations of this definition: Conceives of culture as residing largely within individuals and depicts culture as static and bounded
Culture involves process and change, constantly in flux both in its regions of origin and as people move around the globe
Two separate, but related goals of cultural research:
Studying culture to identify general processes
Studying culture to identify culture-specific processes

Major Advances

Incorporation of cultural factors in DSM-IV and continued development of cultural issues in DSM-5
Publication of the World Mental Health Report
Release of the U.S. Surgeon General’s Supplemental Report on Mental Health: Culture, Race and Ethnicity
Completion of the Collaborative Psychiatric Epidemiology Surveys (CPES)

Incorporation of Cultural Factors in DSM-IV/5

National Institute of Mental Health (NIMH) funded the establishment of a Culture and Diagnosis Work Group
The work group’s efforts resulted in three main contributions to DSM-IV:
Inclusion of cultural factors in the expression, assessment, and prevalence of disorders in each of the disorder chapters
An outline of a cultural formulation of clinical diagnosis to complement the multi-axial assessment
A glossary of relevant cultural-bound syndromes from around the world
Cultural considerations for DSM-5 build on the foundation provided by DSM-IV
Cultural conceptions of distress in the DSM-5 are divided into three categories:
Cultural syndromes
Cultural idioms of distress
Cultural explanation or perceived cause of illness
DSM-5 includes the Cultural Formulation Interview, which is highly structured and usable by clinicians

Publication of the World Mental Health Report

The report compiled research from across the world to identify the range of mental health and behavioral problems
The most significant findings:
Mental illness and related problems exact a significant toll on the health and wellbeing of people worldwide
Mental illness produces a greater burden based on a "disability-adjusted life years" index than that from tuberculosis, cancer, or heart disease
Depressive disorders alone were found to produce the fifth greatest burden for women and seventh greatest burden for men

Surgeon General’s Supplemental Report on Mental Health

The report focused on the mental health of four main minority groups: American Indians/Alaska Natives, African Americans, Asian Americans/Pacific Islanders, and Latino Americans
The main message was that “culture counts” and affects all aspects of mental health and illness

Collaborative Psychiatric Epidemiology Surveys (CPES)

Comprises three nationally representative surveys:
National Comorbidity Survey-Replication
National Survey of American Life
National Latino and Asian American Study
The contributions of the CPES have been significant, providing nationally representative samples of three major U.S. racial/ethnic minority groups

Ataque de nervios is an idiom of distress, particularly prominent among Latinos from the Caribbean
Symptoms commonly associated with ataques de nervios include trembling, attacks of crying, screaming uncontrollably, and verbal or physical aggression
Most episodes occur as a direct result of a stressful life event related to family or significant others
Prevalence: 16% of the large community sample in Puerto Rico experienced ataques de nervios
Ataques de nervios were found to be associated with a wide range of mental disorders, particularly anxiety and mood disorders

The effect of schizophrenia on individuals and communities depends on whether they conceive of the self as autonomous and separate from others or as connected and bound to others
Culture plays a role in the manner in which families respond to relatives with schizophrenia, which in turn influences the course of illness
Expressed emotion: criticism, hostility, and emotional involvement
Mexican American patients who returned to families marked by high warmth were less likely to relapse than those who returned to families characterized by low warmth

Classification Systems

Current classification systems include the 5th edition of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and the 10th edition of the World Health Organization's (WHO) International Classification of Diseases (ICD-10).
The DSM-5 and ICD-10 are largely congruent nomenclatures, with the primary distinction being that the ICD-10 has two versions, one for clinicians and one for researchers.

World Health Organization

The United States, as a member of the WHO, is required to use the coding system of the ICD.
The code numbers used in all clinics and hospitals within the United States (and included within DSM-5) are the ICD code numbers.
Each member country of the WHO can modify the diagnostic criteria for a respective disorder as long as the modification does not result in an entirely different disorder.
Each country can also decline to include a particular disorder within its version of the ICD or add a disorder to its own version of the ICD that is not included in the ICD.

Early History

The Statistical Manual for the Use of Institutions for the Insane (1918) was developed by the American Medico-Psychological Association (later renamed to the American Psychiatric Association).
The manual failed to gain widespread acceptance and included only 22 diagnoses.
Psychiatric disorders within the American Medical Association's Standard Classified Nomenclature of Disease were developed by the New York Academy of Medicine in 1928, but it eventually proved to be inadequate.

ICD-6 and DSM-I

World War II convinced the profession that a common language of psychopathology was needed, leading to the production of the 6th edition of the International Statistical Classification of Diseases, Injuries, and Causes of Death (ICD-6) by the WHO in 1948.
The United States Public Health Service commissioned a committee to create a nomenclature based upon the ICD-6, resulting in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM-I) in 1952.

ICD-8 and DSM-II

ICD-6 was revised to ICD-7 in 1955, but there were no revisions to the mental disorders.
In 1965, the American Psychiatric Association appointed a committee to revise DSM-I to be compatible with ICD-8 and suitable for use within the United States, resulting in DSM-II in 1968.
A fundamental problem continued to be the absence of empirical support for the reliability and validity of its diagnoses.

ICD-9 and DSM-III

The authors of ICD-9 included a glossary that provided more precise descriptions of each disorder.
The ICD-9 did not include the more specific and explicit criterion sets used in research.
DSM-III was published in 1980, including specific and explicit criterion sets for all but one of the disorders, a substantially expanded text discussion of each disorder, and removal of terms that appeared to favor a particular theoretical model for the disorder's etiology or pathology.

DSM-III-R

Many problems in DSM-III were due to insufficient research to guide the authors of the criterion sets.
The American Psychiatric Association authorized the development of a revision to DSM-III to make corrections and refinements.
Many proposals for new diagnoses were made, including sadistic personality disorder, self-defeating personality disorder, premenstrual dysphoric disorder, and paraphiliac rapism.

DSM-IV

The DSM-IV committee aspired to use a more conservative threshold for the inclusion of new diagnoses and to have decisions guided more explicitly by the scientific literature.
Proposals for additions, deletions, or revisions were guided by 175 literature reviews that used a required format that maximized the potential for critical review.

DSM-IV-TR

DSM-IV-TR included a relatively detailed text discussion of each disorder, including information on age of onset, gender, course, and familial pattern.
The text was expanded to include cultural and ethnic group variation, variation across age, and laboratory and physical exam findings.
Information concerning etiology, pathology, and treatment was largely excluded from the text.

DSM-5

Published in 2013, DSM-5 generated a substantial body of controversy.
Many new disorders were added, including disruptive mood dysregulation disorder, excoriation disorder, hoarding disorder, illness anxiety disorder, premenstrual dysphoric disorder, and binge eating disorder.

Issues with DSM-5

Empirical support for proposed revisions was inadequate.
The definition of mental disorder has been criticized for expanding into normal problems of living.
Diagnostic criteria can have different implications and meanings across different cultures.
The impact of values and cultural issues is a concern.
The shifting to a neurobiological model excludes cognitive, psychodynamic, or interpersonal-systems clinicians.
The shift to a dimensional model is a significant change from the categorical classification of DSM-IV.

Classification Systems

Current classification systems include the 5th edition of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and the 10th edition of the World Health Organization's (WHO) International Classification of Diseases (ICD-10).
The DSM-5 and ICD-10 are largely congruent nomenclatures, with the primary distinction being that the ICD-10 has two versions, one for clinicians and one for researchers.

World Health Organization

The United States, as a member of the WHO, is required to use the coding system of the ICD.
The code numbers used in all clinics and hospitals within the United States (and included within DSM-5) are the ICD code numbers.
Each member country of the WHO can modify the diagnostic criteria for a respective disorder as long as the modification does not result in an entirely different disorder.
Each country can also decline to include a particular disorder within its version of the ICD or add a disorder to its own version of the ICD that is not included in the ICD.

Early History

The Statistical Manual for the Use of Institutions for the Insane (1918) was developed by the American Medico-Psychological Association (later renamed to the American Psychiatric Association).
The manual failed to gain widespread acceptance and included only 22 diagnoses.
Psychiatric disorders within the American Medical Association's Standard Classified Nomenclature of Disease were developed by the New York Academy of Medicine in 1928, but it eventually proved to be inadequate.

ICD-6 and DSM-I

World War II convinced the profession that a common language of psychopathology was needed, leading to the production of the 6th edition of the International Statistical Classification of Diseases, Injuries, and Causes of Death (ICD-6) by the WHO in 1948.
The United States Public Health Service commissioned a committee to create a nomenclature based upon the ICD-6, resulting in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM-I) in 1952.

ICD-8 and DSM-II

ICD-6 was revised to ICD-7 in 1955, but there were no revisions to the mental disorders.
In 1965, the American Psychiatric Association appointed a committee to revise DSM-I to be compatible with ICD-8 and suitable for use within the United States, resulting in DSM-II in 1968.
A fundamental problem continued to be the absence of empirical support for the reliability and validity of its diagnoses.

ICD-9 and DSM-III

The authors of ICD-9 included a glossary that provided more precise descriptions of each disorder.
The ICD-9 did not include the more specific and explicit criterion sets used in research.
DSM-III was published in 1980, including specific and explicit criterion sets for all but one of the disorders, a substantially expanded text discussion of each disorder, and removal of terms that appeared to favor a particular theoretical model for the disorder's etiology or pathology.

DSM-III-R

Many problems in DSM-III were due to insufficient research to guide the authors of the criterion sets.
The American Psychiatric Association authorized the development of a revision to DSM-III to make corrections and refinements.
Many proposals for new diagnoses were made, including sadistic personality disorder, self-defeating personality disorder, premenstrual dysphoric disorder, and paraphiliac rapism.

DSM-IV

The DSM-IV committee aspired to use a more conservative threshold for the inclusion of new diagnoses and to have decisions guided more explicitly by the scientific literature.
Proposals for additions, deletions, or revisions were guided by 175 literature reviews that used a required format that maximized the potential for critical review.

DSM-IV-TR

DSM-IV-TR included a relatively detailed text discussion of each disorder, including information on age of onset, gender, course, and familial pattern.
The text was expanded to include cultural and ethnic group variation, variation across age, and laboratory and physical exam findings.
Information concerning etiology, pathology, and treatment was largely excluded from the text.

DSM-5

Published in 2013, DSM-5 generated a substantial body of controversy.
Many new disorders were added, including disruptive mood dysregulation disorder, excoriation disorder, hoarding disorder, illness anxiety disorder, premenstrual dysphoric disorder, and binge eating disorder.

Issues with DSM-5

Empirical support for proposed revisions was inadequate.
The definition of mental disorder has been criticized for expanding into normal problems of living.
Diagnostic criteria can have different implications and meanings across different cultures.
The impact of values and cultural issues is a concern.
The shifting to a neurobiological model excludes cognitive, psychodynamic, or interpersonal-systems clinicians.
The shift to a dimensional model is a significant change from the categorical classification of DSM-IV.

Psychometric Principles: Reliability

Reliability refers to the consistency of measurement
There are several ways to evaluate reliability:
- Internal consistency: Test items should be positively intercorrelated
- Test-retest reliability: Similar scores should be obtained on separate administrations of the test
- Interrater reliability: Different psychologists should tend to agree on diagnoses or judgments

Psychometric Principles: Validity

Validity refers to the accuracy of interpretations and judgments
Types of validity:
- Content validity: Evidence based on test content
- Convergent validity: Moderate or high correlations with other tests that measure the same attribute or diagnosis
- Discriminant validity: Low correlations with tests that measure other attributes
- Predictive validity: Test scores are used to forecast future outcomes
- Concurrent validity: Scores are correlated with indices or events measured at approximately the same time
- Incremental validity: The extent to which an instrument contributes information above and beyond already available information

Psychometric Principles: Difference Between Reliability and Validity

Reliability refers to the consistency of test scores and judgments
Validity refers to the accuracy of interpretations and judgments
Good reliability does not equal good validity

Psychometric Principles: Treatment Utility

Describes the extent to which an assessment instrument contributes to decisions about treatment that lead to better outcomes
An assessment instrument could have good validity and good incremental validity, yet not lead to improved treatment outcome

Signal Detection Theory (SDT)

A statistical approach used when the task is to detect a signal, such as the presence of major depression in a client
Can describe the validity of an assessment instrument across all base rates and across all cutoff scores

Norms

Scores that provide a frame of reference for interpreting a client's results
In the assessment of psychopathology, normative data can be collected by administering a test to a representative sample of individuals in the community

Interviews

Unstructured interviews are used predominantly in clinical practice
Structured and semi-structured interviews are used predominantly in research, but are being used increasingly in clinical care
Reliability of diagnoses using the DSM:
- Good interrater reliability for some diagnostic categories
- Unacceptable reliability for others

Interviews: Validity

Structured interviews are on average more valid than unstructured interviews

Interviews: Limitations

It is relatively easy for respondents to consciously underreport or overreport psychopathology on structured interviews
Reports in interviews are often inaccurate or incomplete, even when clients are not intentionally trying to deceive the interviewer
Considerable clinical judgment is required to describe and diagnose the client because information from different sources must be integrated

Brief Self-Rated and Clinician-Rated Measures

Developed for monitoring psychotherapy progress and providing information necessary for delivering standardized evidence-based interventions
Reliability and validity of many of these measures appears to be adequate, but evaluation of their validity has been limited

Behavioral Assessment Methods

Diary measures can provide accurate information about symptoms and behaviors
Cell phones have made it easier to collect and analyze self-monitoring data

Psychophysiological Assessment

Polysomnographic evaluation can provide valuable information about sleep patterns
Measures of psychophysiological arousal can provide important information in the assessment of posttraumatic stress disorder

Global Measures of Personality and Psychopathology

Projective techniques:
- Designed to measure broad aspects of personality and psychopathology
- Include the Rorschach, Thematic Apperception Test (TAT), and human figure drawings
- Problems: reliable scoring is often difficult to achieve, and normative data have often been unavailable or inaccurate
Self-report personality inventories:
- Require clients to indicate whether a statement describes them
- Relatively structured, with clear stimuli and constrained response formats
- Include the Minnesota Multiphasic Personality Inventory-2, the Personality Assessment Inventory, and the Millon Clinical Multiaxial Inventory-III
- Validity of primary scales of some tests has generally been supported, but validity evidence for scales of other widely used tests is weaker and less consistent

Clinical Judgment and Decision Making

Clinicians often do not benefit from experience due to:
- Lack of clearcut feedback concerning their judgments and predictions
- Vague and ambiguous feedback
- Limited access to necessary data
- Misleading feedback from clients
Cognitive biases:
- Confirmatory bias
- Premature closure
Group biases in judgment:
- Sex bias
- Race bias
- Social class bias

Psychometric Principles: Reliability

Reliability refers to the consistency of measurement
There are several ways to evaluate reliability:
- Internal consistency: Test items should be positively intercorrelated
- Test-retest reliability: Similar scores should be obtained on separate administrations of the test
- Interrater reliability: Different psychologists should tend to agree on diagnoses or judgments

Psychometric Principles: Validity

Validity refers to the accuracy of interpretations and judgments
Types of validity:
- Content validity: Evidence based on test content
- Convergent validity: Moderate or high correlations with other tests that measure the same attribute or diagnosis
- Discriminant validity: Low correlations with tests that measure other attributes
- Predictive validity: Test scores are used to forecast future outcomes
- Concurrent validity: Scores are correlated with indices or events measured at approximately the same time
- Incremental validity: The extent to which an instrument contributes information above and beyond already available information

Psychometric Principles: Difference Between Reliability and Validity

Reliability refers to the consistency of test scores and judgments
Validity refers to the accuracy of interpretations and judgments
Good reliability does not equal good validity

Psychometric Principles: Treatment Utility

Describes the extent to which an assessment instrument contributes to decisions about treatment that lead to better outcomes
An assessment instrument could have good validity and good incremental validity, yet not lead to improved treatment outcome

Signal Detection Theory (SDT)

A statistical approach used when the task is to detect a signal, such as the presence of major depression in a client
Can describe the validity of an assessment instrument across all base rates and across all cutoff scores

Norms

Scores that provide a frame of reference for interpreting a client's results
In the assessment of psychopathology, normative data can be collected by administering a test to a representative sample of individuals in the community

Interviews

Unstructured interviews are used predominantly in clinical practice
Structured and semi-structured interviews are used predominantly in research, but are being used increasingly in clinical care
Reliability of diagnoses using the DSM:
- Good interrater reliability for some diagnostic categories
- Unacceptable reliability for others

Interviews: Validity

Structured interviews are on average more valid than unstructured interviews

Interviews: Limitations

It is relatively easy for respondents to consciously underreport or overreport psychopathology on structured interviews
Reports in interviews are often inaccurate or incomplete, even when clients are not intentionally trying to deceive the interviewer
Considerable clinical judgment is required to describe and diagnose the client because information from different sources must be integrated

Brief Self-Rated and Clinician-Rated Measures

Developed for monitoring psychotherapy progress and providing information necessary for delivering standardized evidence-based interventions
Reliability and validity of many of these measures appears to be adequate, but evaluation of their validity has been limited

Behavioral Assessment Methods

Diary measures can provide accurate information about symptoms and behaviors
Cell phones have made it easier to collect and analyze self-monitoring data

Psychophysiological Assessment

Polysomnographic evaluation can provide valuable information about sleep patterns
Measures of psychophysiological arousal can provide important information in the assessment of posttraumatic stress disorder

Global Measures of Personality and Psychopathology

Projective techniques:
- Designed to measure broad aspects of personality and psychopathology
- Include the Rorschach, Thematic Apperception Test (TAT), and human figure drawings
- Problems: reliable scoring is often difficult to achieve, and normative data have often been unavailable or inaccurate
Self-report personality inventories:
- Require clients to indicate whether a statement describes them
- Relatively structured, with clear stimuli and constrained response formats
- Include the Minnesota Multiphasic Personality Inventory-2, the Personality Assessment Inventory, and the Millon Clinical Multiaxial Inventory-III
- Validity of primary scales of some tests has generally been supported, but validity evidence for scales of other widely used tests is weaker and less consistent

Clinical Judgment and Decision Making

Clinicians often do not benefit from experience due to:
- Lack of clearcut feedback concerning their judgments and predictions
- Vague and ambiguous feedback
- Limited access to necessary data
- Misleading feedback from clients
Cognitive biases:
- Confirmatory bias
- Premature closure
Group biases in judgment:
- Sex bias
- Race bias
- Social class bias

Psychotherapy Research

Psychotherapy research is a broad field that encompasses multiple streams of research, including process research, outcome research, and randomized controlled trials (RCTs).

Process Research

Focuses on identifying and delineating important events in therapy.
Examines what happens in a therapeutic session, including variables such as therapist behaviors, client behaviors, and interactions between the therapist and client.
Linked to outcome research to identify factors that may be important in treatment outcome.

Outcome Research

Focuses on the effects of psychotherapy, including immediate and long-term changes in the problems for which a person seeks treatment.
Examines improvement on broader variables such as quality of life or interpersonal functioning.

Randomized Controlled Trials (RCTs)

Patients are randomly assigned to the treatment of interest or to one or more control groups or alternative treatments.
Random assignment helps to eliminate systematic pre-existing differences among patients.

Control Groups

Used to determine whether any improvement with treatment might be due to factors such as the passage of time, assessment procedures, or making a decision to do something about the problem.
Types of control groups include:
- Waiting list control conditions: clients receive the treatment under investigation after a prescribed delay.
- Placebo controlled conditions: e.g., a pill placebo combined with regular brief meetings with a supportive psychiatrist.
- Alternative therapy conditions: e.g., supportive counseling.

Empirically Validated/Supported Treatments

Refer to treatments that have met the standards set by one or more groups who have reviewed the psychotherapy literature to identify treatments that work for particular disorders or presenting problems.
ESTs can be categorized as probably efficacious or efficacious, based on the number of studies that have shown their superiority to waiting list control groups or placebo conditions.

Effectiveness Research

Focuses on testing whether a treatment works in the real world, with the sorts of patients who may not have participated in university-based research trials.
Often involves less tightly controlled designs and may be simple pretest-posttest studies with no control group.
Benchmarking may be used to compare results to those in published efficacy research.

Criticism of ESTs

The claim is often made that ESTs will not work in clinical practice settings because the clients in practice settings are possibly more severe or have more comorbid conditions than clients treated in research studies.
Westen and Morrison (2001) estimated that the average inclusion rate for studies of depression, panic disorder, and generalized anxiety disorder ranged from 32−36%.

Anxiety Disorders

Generalized anxiety disorder has a lifetime prevalence of 3.3%.
Anxiety disorders are relatively common in older adults, but relatively few people experience a first onset episode in late life.
Older adults tend to report less frequent negative emotions compared to younger adults.
Phobias and panic attacks often co-occur with physical illnesses, which are more common among older adults.

Anxiety: Etiology

Biological factors contributing to anxiety in older adults include chronic health conditions and hypertension.
Psychological factors include external locus of control and neuroticism.
Social factors include quality of social support.

Anxiety: Explanation for Age Differences

Developmental changes in social, familial, and occupational roles may impact the manifestation of anxiety symptoms in older adults.
Older adults may experience less anxiety later in life due to improvements in emotion regulation skills.

Mood Disorders

Depression is a leading cause of disability and is associated with elevated risk of mortality in older adults.
Bipolar disorder is relatively rare in older adults, affecting 0.5-1% of the population.
At least half of older adults with depression experienced their first episode at age 60 or later.

Mood Disorders: Etiology

Late onset depression is characterized by vascular risk factors, lesions in the deep white matter of the brain, and executive functioning deficits.
Early onset depression is associated with neuroticism.

Mood Disorders: Explanation for Age Differences

Changes in frequency or impact of risk and protective factors over time may contribute to age differences in mood disorders.
Biological risk factors increase with age, while psychological and social protective factors also increase.

Treatment and Assessment

Depression is often under-detected in late life, and therapies include cognitive behavioral therapy, cognitive bibliotherapy, and problem-solving therapy.
Internet-delivered cognitive behavioral therapy is equally effective in older adults as in younger and middle-aged individuals.

Suicide

Older adults, particularly older men, have elevated rates of death by suicide.
The rate of suicide in adults 65 years and older is 15.3, and 16.9 in adults 85 years and older.
Suicidal acts and attempts in late life are exponentially more likely to be fatal than in younger adults.

Alcohol Use Disorders

Alcohol use disorders are associated with severe mental and physical health consequences and increased risk of mortality.
The prevalence of problematic alcohol use among older adults ranges from 1% to 22% in community populations.
Excessive drinking declines with age, with the average amount consumed decreasing over time.

Personality Disorders

Antisocial personality disorder and borderline personality disorder are less prevalent in older adults.
Schizoid personality disorder and obsessive-compulsive personality disorder appear to be more prevalent.
Older adults with antisocial personality disorder are more likely to endorse lying or deception than younger adults.

Sleep Disorders

Sleep difficulties are common in older adults, with up to 34% reporting symptoms of insomnia.
Sleep latency increases with age, becoming most pronounced after age 65.
Total sleep time decreases by approximately 10 minutes for each decade of the life span.

Dementia

The prevalence of dementia increases with age, with rates ranging from 1.5% in adults in their 60s to 15-25% in adults in their 80s.
Dementia is more common among women than men.
Life expectancy decreases with severity of dementia, especially for those 85 years and older.
Alzheimer's disease accounts for approximately 60-70% of all dementia cases.

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This quiz focuses on recent initiatives addressing health disparities based on gender, race, and class. It covers national attention to these inequities and examples of initiatives aiming to achieve health equity.

Health Disparities and Recent Initiatives

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Questions and Answers

What are some recent initiatives focused on gender, race, and class in the field of mental health disparities?

What does DSM-V include to address cultural context in mental illness?

Gender bias only affects diagnostic categories and not the diagnostic process.

Race bias is particularly observed in the misdiagnosis of Black and Hispanic patients with ______ when symptoms suggest psychotic affective disorders.

Match the biased diagnostic constructs with their examples:

In a low socioeconomic status sample, who was less likely to use specialty care for mental health problems compared to Whites?

Who is more likely to seek mental health care according to a general finding?

Higher socioeconomic status is related to longer stay in psychotherapy. (True/False)

In some studies, socioeconomic status was not related to remaining in ___________.

Which group is less likely to receive antidepressant, antianxiety or any drug therapy from primary care doctors according to the results discussed?

Match the following racial/ethnic groups with their drug treatment responses:

According to Chang (2003), what are the two basic research perspectives presented for understanding differences in mental health and mental health care?

How does culture play a role in the response of families to relatives with schizophrenia?

Mexican American patients were more likely to relapse if they returned to families characterized by low warmth.

What factors are associated with acting-out problems in adolescents across different cultural groups?

Immigrants have ______ prevalence rates of schizophrenia than those born in the United States.

Match the following cultural groups with their drinking behaviors:

What is the definition of culture in the context of cultural psychopathology?

Which of the following are limitations of the traditional definition of culture as presented in the text?

In the context of cultural research, the purpose is to advance understanding of general processes only.

The World Mental Health Report highlighted that mental illness produces a greater burden based on a 'disability-adjusted life years' index than that from _______, _______, or heart disease.

Match the symptoms with ataques de nervios:

According to research, what emotional climate in families is associated with a higher likelihood of relapse for schizophrenia patients?

Which group of adolescents showed that peer influences were less relevant to misconduct?

Immigration status is associated with lower prevalence rates of schizophrenia among Mexican-origin adults.

A rigid model of alcohol abuse defined by biology or psychology without significant attention to the sociocultural context is limited in distinguishing between normative and _______ drinking.

What is the definition of culture?

What are the two separate, but related goals of cultural research mentioned in the text?

Culture is depicted as a static and bounded phenomenon in the text. (True/False)

The DSM-5 includes the ____________ Interview for cultural considerations.

What are the current classification systems mentioned in the text?

In which year was the Diagnostic and Statistical Manual of Mental Disorders (DSM-III) published?

The DSM-IV committee aimed to base decisions on new diagnoses solely on scientific literature.

DSM-5 was published in the year _____ .

What major shift did DSM-5 make in its model?

Which two classification systems are largely congruent?

What was the purpose of the Statistical Manual for the Use of Institutions for the Insane developed in 1918?

DSM-III was characterized by specific and explicit criterion sets for all disorders.

The United States is required to use the coding system of the ______.

Match the following editions to their corresponding organizations:

What does reliability refer to in psychological assessment?

What should test items be if a test is believed to measure the same trait?

High validity occurs when the use of a test allows for inaccurate inferences about clients.

What does incremental validity refer to?

____ refers to predictions made with test scores about future outcomes.

Match the validity source with its description:

What does reliability refer to in psychological assessment?

What is evaluated in several ways in relation to reliability?

Good reliability guarantees good validity in psychological assessments.

What is incremental validity in the context of psychological assessment?

____ validity is evidence based on test content.

Match the following types of validity with their descriptions:

What is the primary focus of process research in psychotherapy?

What is the main purpose of using control groups in psychotherapy research?

What is the primary advantage of using a waiting list control condition?

What is the primary limitation of using a waiting list control condition?

What is the primary difference between process research and outcome research?

What is the primary purpose of randomized controlled trials (RCTs) in psychotherapy research?

What is the primary advantage of using randomized controlled trials (RCTs) in psychotherapy research?

What is the primary limitation of using randomized controlled trials (RCTs) in psychotherapy research?

What is the primary goal of effectiveness research in psychotherapy?

What is the main difference between efficacy and effectiveness research?

What do empirically validated treatments refer to?

What is the purpose of benchmarking in effectiveness research?

What is the criticism of empirically supported treatments (ESTs) in clinical practice?

What is the definition of probably efficacious treatments?

What is the purpose of placebo controlled conditions in psychotherapy research?

What is the main difference between placebo controlled conditions and alternative therapy conditions?

What is the main limitation of efficacy research?

What is the main advantage of effectiveness research?

What is the lifetime prevalence of generalized anxiety disorder?

What is a characteristic of anxiety in older adults?

What is a risk factor for late life drinking?

What is a biological etiology of anxiety?

Why may alcohol use disorders be under-detected in older adults?

Why may older adults experience less anxiety later in life?

The World Mental Health Report highlighted that mental illness produces a greater burden based on a 'disability-adjusted life years' index than that from _, _, or heart disease.