Using multiple datasets to examine youth psychiatric diagnosis

描述（由申请人提供）：自1980年DSM- iii开发以来，通过其随后的修订（DSM- iii - r, DSM- iv）， DSM标准几乎被普遍接受为精神卫生专业诊断的基础。尽管这被广泛接受，但缺乏可用的经验数据来支持手册中包含的高度指定的诊断形式。添加、删除或以其他方式改变标准可能对疾病患病率、自然史或相关损害的影响尚未得到很好的研究。关于共病的问题，以及这种现象在多大程度上代表了错误的诊断界限，对共同前因的反应，或疾病之间的因果联系，几乎没有共识。最后，对儿童精神病学尤其重要的是，关于dsm定义的疾病在表达和意义上的发育差异的信息相对较少。建议的计划将编制和分析一个资料库，收录由16项青少年调查收集的诊断和症状资料，所有调查均使用与DSM相连结的DISC版本。整个数据库将包含约19,000名儿童和青少年的数据，其中约14,000名儿童和青少年的纵向数据可用。提案中概述的具体分析目标(检查诊断亚型和说明符的有效性；了解诊断界限和合并症；证明诊断阈值；研究个体症状标准的适当性；比较维度和分类定义)解决了该领域面临的最重要和最紧迫的诊断和分类问题，并将告知儿童和青少年精神病学的认识论基础。以一种具有成本效益的方式，该项目将提供一个独特的机会来解决许多问题，这些问题只能通过如此庞大的汇总数据集来回答，这些数据集具有明确定义的样本，并采用标准化、全面和透明的方法进行评估。汇总的数据也将为未来的研究提供宝贵的数据资源。公共卫生相关性：DSM已成为精神病诊断的既定标准，但手册中规定的许多类别和标准尚未基于经验数据或未经经验数据检验。拟议的项目将汇编和分析一个关于大约19 000名儿童和青少年的诊断和症状数据数据库，以解决目前和拟议的诊断类别和标准的有效性问题。该项目还将为解决需要用标准化、全面和透明的方法评估大量样本的研究问题提供宝贵的数据资源。

DESCRIPTION (provided by applicant): Since the development of DSM-III in 1980, and through its subsequent revisions (DSM-III-R, DSM-IV), DSM criteria have become almost universally accepted as a basis for diagnosis in the mental health professions. Despite this broad acceptance, there is a paucity of empirical data available that support the highly specified diagnostic formations embodied in manual. The impact that adding, removing, or otherwise altering criteria may have on disorder prevalence, natural history, or associated impairment has not been well studied. There is little consensus on the issue of comorbidity and the extent to which this phenomenon represents misplaced diagnostic boundaries, responses to common antecedents, or causal linkages between disorders. Finally, and especially important to child psychiatry, there is relatively little information available about developmental differences in the expression and significance of DSM-defined disorders. The proposed project would compile and analyze a database of diagnostic and symptom data collected by 16 investigations of youth, all of which used a DSM- linked version of the DISC. The total database would have data on approximately 19,000 children and adolescents -- longitudinal data is available on approximately 14,000 of these. The specific analytic aims outlined in the proposal (examining the validity of diagnostic subtypes and specifiers; understanding diagnostic boundaries and comorbidity; justifying diagnostic thresholds; studying the appropriateness of individual symptom criteria; comparing dimensional and categorical definitions) address the most important and pressing diagnostic and classification issues facing the field and will inform the epistemological underpinnings of child and adolescent psychiatric nosology. In a cost-efficient, manner this project will afford a unique opportunity to address many questions that can only be answered with such a large aggregated dataset with well-defined samples assessed with a standardized, comprehensive and transparent methodology. The aggregated data will also represent an invaluable data resource for future research. PUBLIC HEALTH RELEVANCE: The DSM has become the established standard for psychiatric diagnosis but many of the categories and criteria specified in the manual have not been based upon or tested with empirical data. The proposed project will compile and analyze a database of diagnostic and symptom data on approximately 19,000 children and adolescents to address the validity of current and proposed diagnostic categories and criteria. The project will also provide an invaluable data resource for addressing research questions that require large samples assessed with a standardized, comprehensive and transparent methodology.