Using multiple datasets to examine youth psychiatric diagnosis

描述(由申请人提供)：自1980年开发DSM-III以来，通过其随后的修订(DSM-III-R、DSM-IV)，DSM标准几乎已成为精神卫生专业人员普遍接受的诊断依据。尽管得到了广泛的接受，但支持手册中包含的高度特定的诊断结构的经验数据仍然很少。增加、删除或以其他方式改变标准可能对疾病患病率、自然病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位的诊断界限、对共同先兆的反应或疾病之间的因果联系，几乎没有达成共识。最后，对儿童精神病学来说尤其重要的是，关于DSM定义的障碍的表达和意义的发育差异的可用信息相对较少。拟议的项目将汇编和分析由16项青年调查收集的诊断和症状数据数据库，所有这些调查都使用与需求侧管理挂钩的光盘版本。整个数据库将拥有大约19,000名儿童和青少年的数据--其中大约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(审查诊断亚型和指标的有效性；了解诊断界限和共病；证明诊断阈值合理；研究个别症状标准的适当性；比较维度和分类定义)解决该领域面临的最重要和最紧迫的诊断和分类问题，并将为儿童和青少年精神病病因学的认识论基础提供信息。以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，这些问题只能用如此庞大的汇总数据集来回答，这些数据集具有明确的样本，并通过标准化、全面和透明的方法进行评估。汇总的数据也将是未来研究的宝贵数据资源。公共卫生相关性：DSM已成为精神病学诊断的既定标准，但手册中规定的许多类别和标准都没有基于经验数据或用经验数据进行测试。拟议的项目将汇编和分析约19 000名儿童和青少年的诊断和症状数据数据库，以处理当前和拟议的诊断类别和标准的有效性。该项目还将为解决需要用标准化、全面和透明方法评估的大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.