LIMITATIONS OF DIAGNOSTIC-CRITERIA AND ASSESSMENT INSTRUMENTS FOR MENTAL-DISORDERS - IMPLICATIONS FOR RESEARCH AND POLICY

During the past 2 decades, psychiatric epidemiological studies have co ntributed a rapidly growing body of scientific knowledge on the scope and risk factors associated with mental disorders in communities. Tech nological advances in diagnostic criteria specificity and community ca se-identification interview methods, which made such progress feasible , now face new challenges. Standardized methods are needed to reduce a pparent discrepancies in prevalence rates between similar population s urveys and to differentiate clinically important disorders in need of treatment from less severe syndromes. Reports of some significant diff erences in mental disorder rates from 2 large community surveys conduc ted in the United States-the Epidemiologic Catchment Area study-and th e National Comorbidity Survey-provide the basis for examining the stab ility of methods in this field. We discuss the health policy implicati ons of discrepant and/or high prevalence rates for determining treatme nt need in the context of managed care definitions of ''medical necess ity''.