Concordance between the diagnostic guidelines for alcohol and cannabis use disorders in the draft ICD-11 and other classification systems: analysis of data from the WHO's World Mental Health Surveys

on behalf of the WHO World Mental Health Survey Collaborators

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Background and aims: The World Health Organization's (WHO's) proposed International Classification of Diseases, 11th edition (ICD-11) includes several major revisions to substance use disorder (SUD) diagnoses. It is essential to ensure the consistency of within-subject diagnostic findings throughout countries, languages and cultures. To date, agreement analyses between different SUD diagnostic systems have largely been based in high-income countries and clinical samples rather than general population samples. We aimed to evaluate the prevalence of, and concordance between diagnoses using the ICD-11, The WHO's ICD 10th edition (ICD-10) and the Diagnostic and Statistical Manual of Mental Disorders, 4th and 5th editions (DSM-IV, DSM-5); the prevalence of disaggregated ICD-10 and ICD-11 symptoms; and variation in clinical features across diagnostic groups. Design: Cross-sectional household surveys. Setting: Representative surveys of the general population in 10 countries (Argentina, Australia, Brazil, Colombia, Iraq, Northern Ireland, Poland, Portugal, Romania and Spain) of the World Mental Health Survey Initiative. Participants: Questions about SUDs were asked of 12 182 regular alcohol users and 1788 cannabis users. Measurements: Each survey used the World Mental Health Survey Initiative version of the WHO Composite International Diagnostic Interview version 3.0 (WMH-CIDI). Findings: Among regular alcohol users, prevalence (95% confidence interval) of life-time ICD-11 alcohol harmful use and dependence were 21.6% (20.5–22.6%) and 7.0% (6.4–7.7%), respectively. Among cannabis users, 9.3% (7.4–11.1%) met criteria for ICD-11 harmful use and 3.2% (2.3–4.0%) for dependence. For both substances, all comparisons of ICD-11 with ICD-10 and DSM-IV showed excellent concordance (all κ ≥ 0.9). Concordance between ICD-11 and DSM-5 ranged from good (for SUD and comparisons of dependence and severe SUD) to poor (for comparisons of harmful use and mild SUD). Very low endorsement rates were observed for new ICD-11 feature for harmful use (‘harm to others’). Minimal variation in clinical features was observed across diagnostic systems. Conclusions: The World Health Organization's proposed International Classification of Diseases, 11th edition (ICD-11) classifications for substance use disorder diagnoses are highly consistent with the ICD 10th edition and the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV). Concordance between ICD-11 and the DSM 5th edition (DSM-5) varies, due largely to low levels of agreement for the ICD harmful use and DSM-5 mild use disorder. Diagnostic validity of self-reported ‘harm to others’ is questionable.

Original languageEnglish (US)
Pages (from-to)534-552
Number of pages19
JournalAddiction
Volume114
Issue number3
DOIs
StatePublished - Mar 1 2019

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International Classification of Diseases
Cannabis
Systems Analysis
Health Surveys
Mental Health
Alcohols
Guidelines
Substance-Related Disorders
Diagnostic and Statistical Manual of Mental Disorders
Global Health
Northern Ireland
Romania
Iraq
Colombia
Portugal
Argentina
Poland
Spain
Population
Brazil

Keywords

  • Alcohol
  • cannabis
  • diagnosis
  • DSM
  • ICD
  • substance use disorder
  • World Mental Health Surveys

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Psychiatry and Mental health

Cite this

Concordance between the diagnostic guidelines for alcohol and cannabis use disorders in the draft ICD-11 and other classification systems : analysis of data from the WHO's World Mental Health Surveys. / on behalf of the WHO World Mental Health Survey Collaborators.

In: Addiction, Vol. 114, No. 3, 01.03.2019, p. 534-552.

Research output: Contribution to journalArticle

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title = "Concordance between the diagnostic guidelines for alcohol and cannabis use disorders in the draft ICD-11 and other classification systems: analysis of data from the WHO's World Mental Health Surveys",
abstract = "Background and aims: The World Health Organization's (WHO's) proposed International Classification of Diseases, 11th edition (ICD-11) includes several major revisions to substance use disorder (SUD) diagnoses. It is essential to ensure the consistency of within-subject diagnostic findings throughout countries, languages and cultures. To date, agreement analyses between different SUD diagnostic systems have largely been based in high-income countries and clinical samples rather than general population samples. We aimed to evaluate the prevalence of, and concordance between diagnoses using the ICD-11, The WHO's ICD 10th edition (ICD-10) and the Diagnostic and Statistical Manual of Mental Disorders, 4th and 5th editions (DSM-IV, DSM-5); the prevalence of disaggregated ICD-10 and ICD-11 symptoms; and variation in clinical features across diagnostic groups. Design: Cross-sectional household surveys. Setting: Representative surveys of the general population in 10 countries (Argentina, Australia, Brazil, Colombia, Iraq, Northern Ireland, Poland, Portugal, Romania and Spain) of the World Mental Health Survey Initiative. Participants: Questions about SUDs were asked of 12 182 regular alcohol users and 1788 cannabis users. Measurements: Each survey used the World Mental Health Survey Initiative version of the WHO Composite International Diagnostic Interview version 3.0 (WMH-CIDI). Findings: Among regular alcohol users, prevalence (95{\%} confidence interval) of life-time ICD-11 alcohol harmful use and dependence were 21.6{\%} (20.5–22.6{\%}) and 7.0{\%} (6.4–7.7{\%}), respectively. Among cannabis users, 9.3{\%} (7.4–11.1{\%}) met criteria for ICD-11 harmful use and 3.2{\%} (2.3–4.0{\%}) for dependence. For both substances, all comparisons of ICD-11 with ICD-10 and DSM-IV showed excellent concordance (all κ ≥ 0.9). Concordance between ICD-11 and DSM-5 ranged from good (for SUD and comparisons of dependence and severe SUD) to poor (for comparisons of harmful use and mild SUD). Very low endorsement rates were observed for new ICD-11 feature for harmful use (‘harm to others’). Minimal variation in clinical features was observed across diagnostic systems. Conclusions: The World Health Organization's proposed International Classification of Diseases, 11th edition (ICD-11) classifications for substance use disorder diagnoses are highly consistent with the ICD 10th edition and the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV). Concordance between ICD-11 and the DSM 5th edition (DSM-5) varies, due largely to low levels of agreement for the ICD harmful use and DSM-5 mild use disorder. Diagnostic validity of self-reported ‘harm to others’ is questionable.",
keywords = "Alcohol, cannabis, diagnosis, DSM, ICD, substance use disorder, World Mental Health Surveys",
author = "{on behalf of the WHO World Mental Health Survey Collaborators} and Louisa Degenhardt and Chrianna Bharat and Raimondo Bruno and Glantz, {Meyer D.} and Sampson, {Nancy A.} and Luise Lago and Sergio Aguilar-Gaxiola and Jordi Alonso and Andrade, {Laura Helena} and Brendan Bunting and Caldas-de-Almeida, {Jose Miguel} and Cia, {Alfredo H.} and Oye Gureje and Karam, {Elie G.} and Mohammad Khalaf and McGrath, {John J.} and Jacek Moskalewicz and Sing Lee and Zeina Mneimneh and Fernando Navarro-Mateu and Sasu, {Carmen C.} and Kate Scott and Yolanda Torres and Vladimir Poznyak and Somnath Chatterji and Kessler, {Ronald C.}",
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month = "3",
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T1 - Concordance between the diagnostic guidelines for alcohol and cannabis use disorders in the draft ICD-11 and other classification systems

T2 - analysis of data from the WHO's World Mental Health Surveys

AU - on behalf of the WHO World Mental Health Survey Collaborators

AU - Degenhardt, Louisa

AU - Bharat, Chrianna

AU - Bruno, Raimondo

AU - Glantz, Meyer D.

AU - Sampson, Nancy A.

AU - Lago, Luise

AU - Aguilar-Gaxiola, Sergio

AU - Alonso, Jordi

AU - Andrade, Laura Helena

AU - Bunting, Brendan

AU - Caldas-de-Almeida, Jose Miguel

AU - Cia, Alfredo H.

AU - Gureje, Oye

AU - Karam, Elie G.

AU - Khalaf, Mohammad

AU - McGrath, John J.

AU - Moskalewicz, Jacek

AU - Lee, Sing

AU - Mneimneh, Zeina

AU - Navarro-Mateu, Fernando

AU - Sasu, Carmen C.

AU - Scott, Kate

AU - Torres, Yolanda

AU - Poznyak, Vladimir

AU - Chatterji, Somnath

AU - Kessler, Ronald C.

PY - 2019/3/1

Y1 - 2019/3/1

N2 - Background and aims: The World Health Organization's (WHO's) proposed International Classification of Diseases, 11th edition (ICD-11) includes several major revisions to substance use disorder (SUD) diagnoses. It is essential to ensure the consistency of within-subject diagnostic findings throughout countries, languages and cultures. To date, agreement analyses between different SUD diagnostic systems have largely been based in high-income countries and clinical samples rather than general population samples. We aimed to evaluate the prevalence of, and concordance between diagnoses using the ICD-11, The WHO's ICD 10th edition (ICD-10) and the Diagnostic and Statistical Manual of Mental Disorders, 4th and 5th editions (DSM-IV, DSM-5); the prevalence of disaggregated ICD-10 and ICD-11 symptoms; and variation in clinical features across diagnostic groups. Design: Cross-sectional household surveys. Setting: Representative surveys of the general population in 10 countries (Argentina, Australia, Brazil, Colombia, Iraq, Northern Ireland, Poland, Portugal, Romania and Spain) of the World Mental Health Survey Initiative. Participants: Questions about SUDs were asked of 12 182 regular alcohol users and 1788 cannabis users. Measurements: Each survey used the World Mental Health Survey Initiative version of the WHO Composite International Diagnostic Interview version 3.0 (WMH-CIDI). Findings: Among regular alcohol users, prevalence (95% confidence interval) of life-time ICD-11 alcohol harmful use and dependence were 21.6% (20.5–22.6%) and 7.0% (6.4–7.7%), respectively. Among cannabis users, 9.3% (7.4–11.1%) met criteria for ICD-11 harmful use and 3.2% (2.3–4.0%) for dependence. For both substances, all comparisons of ICD-11 with ICD-10 and DSM-IV showed excellent concordance (all κ ≥ 0.9). Concordance between ICD-11 and DSM-5 ranged from good (for SUD and comparisons of dependence and severe SUD) to poor (for comparisons of harmful use and mild SUD). Very low endorsement rates were observed for new ICD-11 feature for harmful use (‘harm to others’). Minimal variation in clinical features was observed across diagnostic systems. Conclusions: The World Health Organization's proposed International Classification of Diseases, 11th edition (ICD-11) classifications for substance use disorder diagnoses are highly consistent with the ICD 10th edition and the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV). Concordance between ICD-11 and the DSM 5th edition (DSM-5) varies, due largely to low levels of agreement for the ICD harmful use and DSM-5 mild use disorder. Diagnostic validity of self-reported ‘harm to others’ is questionable.

AB - Background and aims: The World Health Organization's (WHO's) proposed International Classification of Diseases, 11th edition (ICD-11) includes several major revisions to substance use disorder (SUD) diagnoses. It is essential to ensure the consistency of within-subject diagnostic findings throughout countries, languages and cultures. To date, agreement analyses between different SUD diagnostic systems have largely been based in high-income countries and clinical samples rather than general population samples. We aimed to evaluate the prevalence of, and concordance between diagnoses using the ICD-11, The WHO's ICD 10th edition (ICD-10) and the Diagnostic and Statistical Manual of Mental Disorders, 4th and 5th editions (DSM-IV, DSM-5); the prevalence of disaggregated ICD-10 and ICD-11 symptoms; and variation in clinical features across diagnostic groups. Design: Cross-sectional household surveys. Setting: Representative surveys of the general population in 10 countries (Argentina, Australia, Brazil, Colombia, Iraq, Northern Ireland, Poland, Portugal, Romania and Spain) of the World Mental Health Survey Initiative. Participants: Questions about SUDs were asked of 12 182 regular alcohol users and 1788 cannabis users. Measurements: Each survey used the World Mental Health Survey Initiative version of the WHO Composite International Diagnostic Interview version 3.0 (WMH-CIDI). Findings: Among regular alcohol users, prevalence (95% confidence interval) of life-time ICD-11 alcohol harmful use and dependence were 21.6% (20.5–22.6%) and 7.0% (6.4–7.7%), respectively. Among cannabis users, 9.3% (7.4–11.1%) met criteria for ICD-11 harmful use and 3.2% (2.3–4.0%) for dependence. For both substances, all comparisons of ICD-11 with ICD-10 and DSM-IV showed excellent concordance (all κ ≥ 0.9). Concordance between ICD-11 and DSM-5 ranged from good (for SUD and comparisons of dependence and severe SUD) to poor (for comparisons of harmful use and mild SUD). Very low endorsement rates were observed for new ICD-11 feature for harmful use (‘harm to others’). Minimal variation in clinical features was observed across diagnostic systems. Conclusions: The World Health Organization's proposed International Classification of Diseases, 11th edition (ICD-11) classifications for substance use disorder diagnoses are highly consistent with the ICD 10th edition and the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV). Concordance between ICD-11 and the DSM 5th edition (DSM-5) varies, due largely to low levels of agreement for the ICD harmful use and DSM-5 mild use disorder. Diagnostic validity of self-reported ‘harm to others’ is questionable.

KW - Alcohol

KW - cannabis

KW - diagnosis

KW - DSM

KW - ICD

KW - substance use disorder

KW - World Mental Health Surveys

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