Accuracy of reports of lifetime mental and physical disorders: results from the Baltimore Epidemiological Catchment Area study

Abstract

Importance: Our understanding of how mental and physical disorders are associated and contribute to health outcomes in populations depends on accurate ascertainment of the history of these disorders. Recent studies have identified substantial discrepancies in the prevalence of mental disorders among adolescents and young adults depending on whether the estimates are based on retrospective reports or multiple assessments over time. It is unknown whether such discrepancies are also seen in midlife to late life. Furthermore, no previous studies have compared lifetime prevalence estimates of common physical disorders such as diabetes mellitus and hypertension ascertained by prospective cumulative estimates vs retrospective estimates.

Objective: To examine the lifetime prevalence estimates of mental and physical disorders during midlife to late life using both retrospective and cumulative evaluations.

Design, setting, and participants: Prospective population-based survey (Baltimore Epidemiologic Catchment Area Survey) with 4 waves of interviews of 1071 community residents in Baltimore, Maryland, between 1981 and 2005.

Main outcomes and measures: Lifetime prevalence of selected mental and physical disorders at wave 4 (2004-2005), according to both retrospective data and cumulative evaluations based on 4 interviews from wave 1 to wave 4. RESULTS Retrospective evaluations substantially underestimated the lifetime prevalence of mental disorders as compared with cumulative evaluations. The respective lifetime prevalence estimates ascertained by retrospective and cumulative evaluations were 4.5% vs. 13.1% for major depressive disorder, 0.6% vs. 7.1% for obsessive-compulsive disorder, 2.5% vs. 6.7% for panic disorder, 12.6% vs. 25.3% for social phobia, 9.1% vs. 25.9% for alcohol abuse or dependence, and 6.7% vs. 17.6% for drug abuse or dependence. In contrast, retrospective lifetime prevalence estimates of physical disorders ascertained at wave 4 were much closer to those based on cumulative data from all 4 waves. The respective prevalence estimates ascertained by the 2 methods were 18.2% vs. 20.2% for diabetes, 48.4% vs. 55.4% for hypertension, 45.8% vs. 54.0% for arthritis, 5.5% vs. 7.2% for stroke, and 8.4% vs. 10.5% for cancer.

Conclusions and relevance: One-time, cross-sectional population surveys may consistently underestimate the lifetime prevalence of mental disorders. The population burden of mental disorders may therefore be substantially higher than previously appreciated.

Figure 1

Cumulative vs. retrospective lifetime prevalence of mental (left) and physical (right) disorders at each wave (%). OCD, obsessive-compulsive disorder.