The WPA-WHO Global Survey of Psychiatrists' Attitudes Towards Mental Disorders Classification

Abstract

This article describes the results of the WPA-WHO Global Survey of 4,887 psychiatrists in 44 countries regarding their use of diagnostic classification systems in clinical practice, and the desirable characteristics of a classification of mental disorders. The WHO will use these results to improve the clinical utility of the ICD classification of mental disorders through the current ICD-10 revision process. Participants indicated that the most important purposes of a classification are to facilitate communication among clinicians and to inform treatment and management. They overwhelmingly preferred a simpler system with 100 or fewer categories, and over two-thirds preferred flexible guidance to a strict criteria-based approach. Opinions were divided about how to incorporate severity and functional status, while most respondents were receptive to a system that incorporates a dimensional component. Significant minorities of psychiatrists in Latin America and Asia reported problems with the cross-cultural applicability of existing classifications. Overall, ratings of ease of use and goodness of fit for specific ICD-10 categories were fairly high, but several categories were described as having poor utility in clinical practice. This represents an important focus for the ICD revision, as does ensuring that the ICD-11 classification of mental disorders is acceptable to psychiatrists throughout the world.

Keywords: Diagnostic and Statistical Manual of Mental Disorders (DSM); International Classification of Diseases (ICD); Mental disorders; classification; clinical utility; cross-cultural applicability.

Figure 1 Percentage of participating psychiatrists endorsing six response options for the single, most important purpose of a diagnostic classificatory system of mental disorders

Figure 2 Percentage of global ICD-10 and DSM-IV users endorsing four options for the best way to address severity in mental disorders classification systems

Figure 3 Percentage of global ICD-10 and DSM-IV users endorsing three options for diagnostic classification systems to conceptualize the relationship between diagnosis and functional status

Figure 4 Percentage of global ICD-10 and DSM-IV users endorsing four options for whether a diagnostic classification system should incorporate a dimensional component

Figure 5 Percentage of psychiatrists by global region indicating they mostly or completely agreed with the statement “The diagnostic system I use is difficult to apply across cultures, or when the patient/service user is of a different cultural or ethnic background from my own”

Figure 6 Percentage of psychiatrists by country and within WHO region, indicating that they saw the need in their countries for a national classification of mental disorders

Figure 7 Percentage of participating psychiatrists indicating that they used each of 44 ICD-10 diagnostic categories at least once a week in their day-to-day clinical practice, weighted by country

Figure 8 Average number of diagnostic categories used at least once per week, by country and within WHO region

Figure 9 Mean transformed “ease of use” ratings for ICD-10 categories, weighted by country, presented in order of frequency of use from left to right

Figure 10 Mean transformed “goodness of fit” ratings for ICD-10 categories, weighted by country, presented in order of frequency of use from left to right