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. 2013;48(3):177-93.
doi: 10.1080/00207594.2013.804189. Epub 2013 Jun 10.

Psychologists' perspectives on the diagnostic classification of mental disorders: results from the WHO-IUPsyS Global Survey

Spencer C Evans  1 , Geoffrey M Reed, Michael C Roberts, Patricia Esparza, Ann D Watts, João Mendonça Correia, Pierre Ritchie, Mario Maj, Shekhar Saxena
Affiliations

Psychologists' perspectives on the diagnostic classification of mental disorders: results from the WHO-IUPsyS Global Survey

Spencer C Evans et al. Int J Psychol. 2013.

Abstract
in English, French, Spanish

This study examined psychologists' views and practices regarding diagnostic classification systems for mental and behavioral disorders so as to inform the development of the ICD-11 by the World Health Organization (WHO). WHO and the International Union of Psychological Science (IUPsyS) conducted a multilingual survey of 2155 psychologists from 23 countries, recruited through their national psychological associations. Sixty percent of global psychologists routinely used a formal classification system, with ICD-10 used most frequently by 51% and DSM-IV by 44%. Psychologists viewed informing treatment decisions and facilitating communication as the most important purposes of classification, and preferred flexible diagnostic guidelines to strict criteria. Clinicians favorably evaluated most diagnostic categories, but identified a number of problematic diagnoses. Substantial percentages reported problems with crosscultural applicability and cultural bias, especially among psychologists outside the USA and Europe. Findings underscore the priority of clinical utility and professional and cultural differences in international psychology. Implications for ICD-11 development and dissemination are discussed.

Cette étude porte sur les points de vue et les pratiques des psychologues en matière de systèmes de classification diagnostique des troubles mentaux et du comportement, afin d'aider à l'élaboration de la CIM-11 par l'Organisation mondiale de la santé (OMS). L'OMS et l'Union internationale des sciences psychologiques (IUPsyS) ont effectué une enquête multilingue de 2 155 psychologues de 23 pays recrutés par le biais de leurs associations de psychologie nationales. Soixante pour cent des psychologues du monde utilisent systématiquement un système de classification officiel, avec la CIM-10 utilisée le plus fréquemment par 51 % d'entre eux et le DSM-IV, par 44 %. Les psychologues considèrent que les plus importants objectifs de la classification sont de prendre des décisions de traitement éclairées et de faciliter la communication. Et, aussi, ils préfèrent des orientations diagnostiques flexibles à des critères stricts. Les cliniciens évaluent favorablement la plupart des catégories diagnostiques, mais identifient un certain nombre de diagnostics problématiques. Un pourcentage substantiel d'entre eux ont signalé des problèmes avec l'applicabilité transculturelle et les biais culturels. C'est surtout le cas avec les psychologues qui ne sont ni américains ni européens. Les résultats soulignent la priorité de l'utilité clinique et les différences culturelles et professionnelles en psychologie internationale. Les auteurs discutent des implications pour le développement de la CIM-11 et de sa diffusion.

Este estudio examina el punto de vista como también las prácticas de los psicólogos respecto de los sistemas de clasificación de diagnóstico para los trastornos mentales y conductuales, con el fin de informar el desarrollo del ICD-11 hecho por la Organización Mundial de la Salud (OMS). La OMS y la International Union of Psychological Science (IUPsyS) realizaron una encuesta multilingüística entre 2155 psicólogos provenientes de 23 países, reclutados a través de las asociaciones nacionales de psicólogos. El sesenta por ciento de los psicólogos utilizaba de rutina un sistema formal de clasificación, siendo el ICD-10 el sistema utilizado con mayor frecuencia (51 por ciento) y el DSM-IV utilizado el 44 por ciento. Según los psicólogos, el propósito más importante de la clasificación era para decidir sobre diferentes tratamientos, como también facilitar la comunicación, y preferían parámetros flexibles de diagnóstico en contraste con criterios estrictos. Los clínicos evaluaron de manera favorable a la mayor cantidad de categorías de diagnóstico, pero identificaron un número de diagnósticos problemáticos. Hubo un porcentaje substancial que dijo tener problemas con la aplicación transcultural y el sesgo cultural, especialmente entre los psicólogos fuera de los Estados Unidos y Europa. Los hallazgos enfatizan la prioridad de la utilidad clínica y las diferencias profesionales y culturales en la psicología internacional. Se analizan las implicaciones para el desarrollo y la difusión del ICD-11.

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Figures

Figure 1.
Figure 1.
Respondents’ views on “what is the single, most important purpose of diagnostic classification system.” Percentages are equally weighted by country. Unweighted percentages were relatively similar (from left to right: 38.7%, 15.5%, 33.4%, 3.3%, 4.6%, and 4.5%).
Figure 2.
Figure 2.
Clinicians’ opinions about what would be “the best way for a diagnostic system to conceptualize the relationship between diagnosis and functional status.” From left to right, the results for the overall sample are as follows: 28.7% (34.9% weighted), 48.2 % (46.8% weighted) 23.1% (18.4% weighted). Differences between ICD-10 and DSM-IV users are nonsignificant.
Figure 3.
Figure 3.
Clinicians’ views on whether to incorporate a dimensional component into a diagnostic classification system and why. From left to right, the results for the overall sample are as follows: 31.2% (34.1% weighted), 47.7% (49.1% weighted), 11.9% (9.6% weighted), 9.1% (7.2% weighted). Differences between ICD-10 and DSM-IV users are nonsignificant.
Figure 4.
Figure 4.
Percentages of respondents in each national subsample who indicated that they mostly/completely agreed with or responded yes to the above statements and question about (a) crosscultural problems, (b) US/European bias, and (c) the need for a national classification. Data from the Zimbabwean sample are not presented due to very low response on these items.
Figure 5.
Figure 5.
Percentages of clinicians who reported seeing persons with select ICD-10 diagnostic categories at least once a week. MBDs = mental and behavioral disorders (due to the use of a substance). PD = personality disorder.
Figure 6.
Figure 6.
Percentages of clinicians who reported seeing persons with select DSM-IV diagnostic categories at least once a week. PD — panic disorder. NEC — not elsewhere classified.
Figure 7.
Figure 7.
Clinicians’ unweighted mean ratings for the ease of use and goodness of fit of the ICD-10 diagnostic categories they see regularly. Categories are in order from most to least frequently seen, such that those toward the left were seen more often and therefore received more ratings, leading to more reliable estimates, than those near the right. MBDs — mental and behavioral disorders (due to the use of a substance).
Figure 8.
Figure 8.
Clinicians’ unweighted mean ratings for the ease of use and goodness of fit of the DSM-IV diagnostic categories they see regularly. Categories are in order from most to least frequently seen, such that those toward the left were seen more often and therefore received more ratings, leading to more reliable estimates, than those near the right.
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