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4327.0 - National Survey of Mental Health and Wellbeing: Users' Guide, 2007  
Latest ISSUE Released at 11:30 AM (CANBERRA TIME) 11/02/2009   
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COMPARISON OF DIAGNOSTIC ASSESSMENT CRITERIA


OVERVIEW

This chapter provides broad information on the differences in the diagnostic assessment criteria used for the 1997 and 2007 surveys. The comparisons are segmented by the classification used for diagnosis (ICD-10 or DSM-IV), the major groups of mental disorders (Anxiety, Affective and Substance Use) and each selected mental disorder. As the emphasis is on comparing differences between the two surveys, not all assessment criteria are mentioned for each disorder. A summary of the full diagnostic assessment criteria used for the 2007 survey is provided in Chapter 3.


COMPARISON OF ICD-10 DIAGNOSTIC ASSESSMENT CRITERIA

This segment provides an overview of the differences between the 1997 and 2007 diagnostic assessment criteria according to the WHO International Classification of Diseases, Tenth Revision (ICD-10).


ICD-10 ANXIETY DISORDERS

The comparison includes the following Anxiety disorders:


Panic Disorder

Recurrent unexpected panic attacks

The survey assesses the presence of attacks which are not consistently associated with a specific situation or object. The attacks often occur spontaneously (ie unpredictable) and are not associated with marked exertion or with exposure to dangerous or life threatening situations.

In 1997, the survey asked about 14 symptoms that may have occurred during attacks. Only four symptoms needed to be endorsed in order to continue further into the module. In 2007, people were asked about 16 symptoms and six of these needed to be endorsed in order to continue further into the module.

Hierarchy rules

The 1997 hierarchical version of the disorder contained an exclusion criterion to ensure that the Panic Attacks did not occur exclusively during a mood disorder. In 2007, hierarchy rules were not applied. Therefore, comparisons with the 1997 survey should be based on the non-hierarchy version of the disorder.

Agoraphobia

Fear or avoidance of places or situations

Both surveys assessed whether there was a marked and consistently manifested fear in or avoidance of at least two of a number of places or situations. In 1997, the survey assessed a person's reaction/s to the following four places or situations:
  • being outside the home alone;
  • travelling in a bus, train or car;
  • being in a crowd or standing in line; and
  • being in a public place, like a shop.

In comparison, the 2007 survey assessed a person's reactions to 11 places or situations. This included an expanded version of the above question on fear of 'being in a public place, like a shop':
  • using public transportation;
  • standing in a line in a public place;
  • being in a department store, shopping centre, or supermarket;
  • being in a movie theatre, auditorium, lecture hall, or church; and
  • being in a restaurant or any other public place.

For a list of the situations included in 2007 diagnostic assessment criteria see 'Agoraphobia' in Chapter 3.

In 1997, it was also possible to meet this criterion for diagnosis if a person endorsed the following:
  • in the 12 months prior to interview they had often avoided the situation/s because of their fear; and
  • between the first time and last time, they experienced strong fear and/or avoidance whenever they encountered the situation/s or thought they would have to encounter the situation/s.

Symptoms of a panic attack

In 1997, the survey assessed whether symptoms were restricted to or predominated in the feared situations or when thinking about them. The criterion was assessed through questions about 'attacks of fear' that had occurred, where all of a sudden the person felt frightened, anxious or very uneasy (ie panic attacks). A person had to endorse symptoms of a panic attack in order to meet criteria for diagnosis of Agoraphobia. In 2007, panic attacks were not considered in the diagnosis.

Hierarchy rules

The 1997 diagnosis contained an exclusion criterion to ensure that the Agoraphobia did not occur exclusively during a mood disorder or within a period of OCD. In 2007, hierarchy rules were not applied. Therefore, comparisons with the 1997 survey should be based on the non-hierarchy version of the disorder.

Social Phobia

Fear of social situations

The survey assesses the presence of either a marked fear or marked avoidance of being the focus of attention, or being in situations where there is fear of behaving in a way that will be embarrassing or humiliating.

The 1997 survey asks about reactions to the following six social situations (plus an 'other' situation) in the 12 months prior to interview:
  • eating or drinking where someone could watch;
  • talking to people because they might have nothing to say or might sound foolish;
  • writing while someone watches;
  • taking part or speaking in a meeting or class;
  • going to a party or social outing; or
  • speaking in public.

In comparison, the 2007 survey asks about 13 specific social or performance situations, as well as an 'other' situation at the time in the person's lifetime when they felt very shy, afraid or uncomfortable with other people or in social situations. For a list of the situations included in the 2007 diagnostic assessment criteria see 'Social Phobia' in Chapter 3.

Level of interference

The survey assesses whether there has been significant emotional distress due to the symptoms of fear and/or avoidance. It also assesses if there is recognition that the symptoms or avoidance are excessive or unreasonable.

In 1997, people were asked three questions about whether their fear/avoidance of situations where they could be the centre of attention had:
      1 - been excessive (ie much stronger than in other people);
      2 - been unreasonable (ie much stronger than it should have been); or
      3 - made them very upset.

People had to endorse Part 3, as well as either of the other two parts.

In 2007, the survey assessed this criterion through a greater number of questions. Two of the questions also attempted to quantify the level of distress. One question asked about the number of reactions to the feared situation and the other question asked how strongly the person's fear would be if faced with the situation now (not at all, mild, moderate, severe or very severe).

Symptoms of a panic attack

In 1997, the survey assessed whether symptoms were restricted to or predominated in the feared situations or when thinking about them. The criterion was assessed through questions about 'attacks of fear' that had occurred, where all of a sudden the person felt frightened, anxious or very uneasy (ie panic attacks). A person had to endorse symptoms of a panic attack in order to meet criteria for diagnosis of Social Phobia. In 2007, panic attacks were not considered in the diagnosis.

Hierarchy rules

The 1997 diagnosis contained an exclusion criterion to ensure that the Social Phobia did not occur exclusively during a mood disorder. In 2007, hierarchy rules were not applied. Therefore, comparisons with the 1997 survey should be based on the non-hierarchy version of the disorder.

Generalised Anxiety Disorder (GAD)

Symptoms and persistence

The survey assessed whether there has been a period of at least six months with prominent tension, worry and feelings of apprehension about everyday events and problems.

In 1997, people were asked whether they had a period of a month or more when most of the time they felt worried, tense or anxious, about everyday problems such as work or family. This question referred to the 12 months prior to interview.

In comparison, the 2007 survey assessed the time in a person's lifetime when they were:
  • a 'worrier'; or
  • much more nervous or anxious than most other people; or
  • experiencing a period lasting one month or longer when they were anxious or worried on most days.

To elicit responses to the sorts of things that people were anxious or worried about during this time frame, the 2007 survey used a prompt card containing 26 possible responses, as well as up to three 'other' responses. The categories of response included:
  • diffuse worries (eg everything);
  • personal problems (eg finances, social life);
  • phobic and obsessive-compulsive situations (eg agoraphobia - leaving home alone after a divorce, compulsions - repetitive handwashing);
  • networking problems (eg being away from home or apart from loved ones); or
  • societal problems (eg crime/violence, the environment - global warming).

Hierarchy rules

Both surveys contain exclusion criteria to ensure that the symptoms are not attributed to Panic Disorder, Social Phobia or OCD. The 1997 survey also includes an exclusion for symptoms attributed to Agoraphobia.

Obsessive Compulsive Disorder (OCD)

Recognition of symptoms

The survey assesses the recognition of either obsessions or compulsions through the endorsement of the following four parts:
      1 - symptoms are acknowledged as originating in the person's own mind and are not imposed by outside persons or influences;
      2 - symptoms are repetitive and unpleasant. At least one obsession or compulsion exists that is acknowledged as excessive or unreasonable;
      3 - the person tries to resist the thought/s or act/s. At least one obsession or compulsion exists that is unsuccessfully resisted; and
      4 - carrying out the thought/s or act/s is not in itself pleasurable.

In 2007, the fourth part was assessed only for compulsions, whereas in 1997 this part was assessed for both obsessions and compulsions. Therefore, in 2007 if a person had only obsessions, the fourth part was not considered in the assessment of this criterion, but if they had only compulsions it was.

Level of interference

The survey assesses whether a person's obsessions or compulsions:
  • caused distress; or
  • interfered with their social or individual functioning, usually by wasting time.

In 2007, both of these parts were assessed separately, but combined attributes from both obsessions and compulsions. The survey also attempts to quantify the amount of interference that the disorder has had on a person's life, based on either:
  • their lifetime. For example, the amount to which the unpleasant thoughts/repeated behaviours ever interfered with work, social life, or personal relationships (not at all, a little, some, a lot or extremely); or
  • the 12 months prior to the survey interview. The level of interference was assessed through questions similar to those on lifetime interference, as well as across four different domains. The number of days the person was totally unable to function during that time frame was also assessed.

In 1997, this criterion was not split into parts, but consisted of one question which was assessed separately for both obsessions and compulsions. People were asked whether in the 12 months prior to interview thinking about the ideas (obsessions) or having to do the behaviours (compulsions):
  • interfered with their life or work;
  • caused difficulty with their relatives or friends; or
  • upset them a great deal.

Exclusion criteria

The survey contains exclusion criteria to ensure that the symptoms are not attributed to other mental disorders, such as schizophrenia and related disorders, or mood disorders. The 2007 survey assessed this criterion only in relation to depression by asking whether the symptoms only occurred within episodes of depression. Therefore, the exclusion is based on self-reported information about times when the person was feeling sad or depressed. Whereas, the 1997 survey assessed this criterion in relation to diagnosed mood disorders (eg depression).

Additionally, in 1997 the survey assessed whether the obsessions or compulsions were restricted to pre-occupations with other specific disorders, including:
  • eating disorders and body dysmorphia;
  • substance use;
  • trichotillomania (an uncontrollable desire to pull out your own body hair); and
  • hypochondriasis.

Hierarchy rules

In the 1997 survey, it is possible to separate people with only OCD from those who have OCD regardless of any other disorders, through the hierarchy rules. In the 2007 survey, OCD is non-hierarchical, which means the diagnosis always excludes people who reported that their obsessions or compulsions occurred during episodes of depression. Therefore, comparisons with the 1997 survey should be based on the non-hierarchy version of the disorder.

Diagnosis

In 1997, in order to meet the diagnosis for OCD, a person must have met all criteria for obsessions only or all criteria for compulsions only. In 2007, the diagnostic assessment does not distinguish between obsessions and compulsions for the different sub/criteria, but instead combines the two components. Therefore, a person may not have met diagnosis if they had been assessed solely on the existence of their obsessions or compulsions.

Post-Traumatic Stress Disorder (PTSD)

Responses to a traumatic event

The survey assesses the responses a person exhibits after being exposed to a stressful event or situation (either short or long lasting) of exceptionally threatening or catastrophic nature, which is likely to cause pervasive distress in almost anyone.

In 2007, a larger number of traumatic events were provided to the respondent for consideration. However, in 1997 a number of other types of event may have been considered, but remained unreported as they were included as an 'other extremely stressful or upsetting event'. Some of the new traumatic events included in 2007 were:
  • being an unarmed civilian in a place where there was a war, revolution, military coup or invasion;
  • being a refugee - fleeing from a home country to a foreign country/place to escape danger or persecution;
  • being stalked - followed or having someone keep track of activities in a way that made them feel they were in serious danger;
  • doing something that accidentally led to the serious injury or death of another person; or
  • purposefully causing serious injury, torture or the death of another person.

Some of the traumatic events experienced in relation to a loved one in 2007 may also have remained unreported in 1997. For example, in 1997 people were asked whether they had ever suffered a great shock because one of the traumatic events listed had happened to someone close to them, while in 2007 people were specifically asked:
  • whether someone very close to them had died unexpectedly (eg killed in an accident, murdered, committed suicide or had a fatal heart attack at a young age);
  • whether a child had ever had a life-threatening illness or injury; or
  • whether someone close to them had ever had an extremely traumatic experience, such as being kidnapped, tortured or raped.

Additionally, some types of events were specifically excluded from the 1997 survey, these included:
  • bereavement;
  • chronic illness;
  • business loss; and
  • marital or family conflict.

A number of these events, including bereavement and relationship breakdown, were included in 2007 as an 'other extremely traumatic or life-threatening event' and were considered in the diagnosis of PTSD.

Persistence of symptoms

As part of the diagnosis for PTSD, 'persistence' was assessed in relation to three groups of reactions:
  • the persistent remembering or 'reliving' of the traumatic event;
  • actual or preferred avoidance of circumstances resembling or associated with the traumatic event (not present before the trauma); and
  • an inability to recall some important aspects of the period of exposure or persistent symptoms of increased psychological sensitivity or arousal (not present before the trauma).

The 1997 survey assessed the persistence of symptoms through the types of reactions experienced during the 12 months prior to interview. In comparison, the 2007 survey assessed the persistence of symptoms based on whether types of reactions occurred at some point during a person's lifetime following a traumatic event.

In 2007, people may not have been asked about the persistence of symptoms in the 12 months prior to interview due to a sequencing error. For a DSM-IV diagnosis of PTSD a person had to endorse a number of symptoms from each of the three groups of reactions (above) in order to be asked the 12-month questions. Although these endorsements were not required for an ICD-10 diagnosis of PTSD, people who did not endorse the required number of symptoms were not asked the 12-month questions.

Level of interference

The survey assesses whether the reaction/s to the traumatic event caused clinically significant distress or impairment. The 2007 survey attempts to quantify the amount of interference that the disorder has had on a person's life, based on reactions during their lifetime, such as the amount of:
  • disruption or interference with their normal, daily life - not at all, a little, some, a lot, extremely; or
  • distress caused - none, mild, moderate, severe, very severe.

In 1997, the survey only asked people whether the reactions had stopped them from 'going to a party, social event, or meeting'.

Diagnosis

In 2007, the assessment of a lifetime diagnosis is based on a person's 'worst' traumatic event and symptoms of any traumatic event are considered for the 12 months prior to interview. Whereas in 1997, the assessment of a 12-month diagnosis relates only to a person's 'worst' traumatic event, for which they may not have had any symptoms in the relevant time period and therefore would not have met criteria for diagnosis.


ICD-10 AFFECTIVE DISORDERS

The comparison includes the following Affective disorders:
Bipolar Affective Disorder has not been included, as the assessment was considered to be consistent between the 1997 and 2007 surveys.

Prevalence rates

A problem was identified in the 1997 survey instrument which meant that responses from people who indicated that they had not been abnormally happy or excited, but had been unusually irritable in the Mania module, were not included in the diagnosed population that was output from the survey file. As a result, prevalence rates for hypomania, mania or bipolar affective disorder were not published. Therefore, it is likely that the 1997 published data slightly underestimates the prevalence of affective disorders.

Depressive Episode

Diagnosis

Depressive episode consists of three different types of episode:
Severe Depressive Episode

The 2007 diagnosis of Severe Depressive Episode is equivalent to the 1997 diagnosis of:
  • Severe depressive episode without psychotic symptoms; plus
  • Recurrent depressive episode - Severe - without psychotic symptoms.

Moderate Depressive Episode

The 2007 diagnosis of Moderate Depressive Episode is equivalent to the 1997 diagnosis of:
  • Moderate depressive episode with somatic symptoms; plus
  • Moderate depressive episode without somatic symptoms; plus
  • Recurrent depressive episode - Moderate - with somatic symptoms; plus
  • Recurrent depressive episode - Moderate - without somatic symptoms.

Mild Depressive Episode

The 2007 diagnosis of Minor Depressive Episode is equivalent to the 1997 diagnosis of:
  • Mild depressive episode with somatic symptoms; plus
  • Mild depressive episode without somatic symptoms; plus
  • Recurrent depressive episode - Mild - with somatic symptoms; plus
  • Recurrent depressive episode - Mild - without somatic symptoms.

Presence of symptoms

The survey assesses the presence of the following symptoms, of which, at least two (for mild and moderate) or three (for severe) must have been present:
  • depressed mood to a degree that is definitely abnormal for the individual, which is present for most of the day and almost every day, largely uninfluenced by circumstances, and sustained for at least two weeks;
  • loss of interest or pleasure in activities that are normally pleasurable; or
  • decreased energy or increased fatigability.

To assess the first symptom, the 2007 survey asks about periods of time lasting two weeks or longer when a person's mood was most severe and frequent and how often their emotional distress was so severe that nothing could cheer them up (often, sometimes, rarely, never). In comparison, the 1997 survey assesses this symptom by asking about periods of feeling sad, empty or depressed in the 12 months prior to interview that have lasted two weeks or longer when nearly every day the person felt this way for most of the day.

In the assessment of the second symptom, the 2007 survey includes an additional question asking whether the person lost the ability to take pleasure in having good things happen to them, like winning something or being praised or complimented.

For a full description of the 2007 diagnostic assessment criteria see 'Depressive Episode' in Chapter 3.

Presence of additional symptoms

There were minor changes to questions which assessed the presence of additional symptoms. For example, in 2007 the assessment of the loss of confidence and self-esteem required that the symptom be present nearly every day during the episode whereas, the 1997 survey required that the symptom be present at some time during the episode. In 2007, the assessment of whether a person talked or moved more slowly than normal or was restless or jittery required the changes to have been noticed by other people, whereas in 1997 these changes were simply observed by the respondent.

Dysthymia

Duration of episodes

The survey assesses the duration of episodes through two parts:
      1 - whether there has been a period of at least two years of constant or constantly recurring depressed mood; and
      2 - whether intervening periods of normal mood rarely last for longer than a few weeks.

In the 1997 survey, there was a separate set of questions related specifically to Dysthymia, which meant that the duration of symptoms could be specifically measured. Whereas, in 2007 there were no specific questions for Dysthymia, rather, the diagnostic assessment was based on questions included throughout the Depression module.

In 1997, both parts of episode duration were assessed, based on:
  • whether a person had ever had two years or more in their life when they felt depressed or sad most days, even if they felt okay sometimes; and
  • whether any period like that had ever lasted two years without an interruption of two full months when they felt okay.

In 2007, the first part of the criterion was not operationalised, so the duration of two or more years was assessed only through Part 2. The questions relating to duration in the 2007 survey simply asked for the longest continuous number of years where the person felt they were in an episode 'most days'. While the definition for the end of an episode (ie when the person no longer has the problems for two weeks in a row) is provided earlier in the diagnostic module, this was not reiterated when the duration questions were asked. This possibly allows for short breaks within an episode to not be considered.

Hierarchy rules

The survey contained exclusion criteria to ensure that the person's symptoms did not meet the criteria for other disorders. The exclusions varied between the two surveys, but both excluded a diagnosis of Dysthymia if a person had experienced episodes of Hypomania.

In 1997, a person was excluded from a diagnosis of Dysthymia if they met the criteria for Mild Depressive Episode or the onset of Dysthymia occurred after the onset of Mild Depression. The 2007 survey was more restrictive in this criteria, excluding a person from a diagnosis of Dysthymia if they:
  • met the criteria for Major or Moderate Depressive Episode; or
  • the onset of Dysthymia was less than the onset of the Major/Moderate Depressive Episode; or
  • the onset of Dysthymia was greater than the recency of the Major/Moderate Depressive Episode; or
  • the persistence of Dysthymia was greater than the persistence of the Major/Moderate Depressive Episode.

Hypomania

Hierarchy rules

The 1997 survey contained an exclusion criterion to ensure that episodes of Hypomania did not occur exclusively within episodes of Mania, Bipolar Affective Disorder or Depressive Episodes (Mild/Moderate/Severe). Whereas, the 2007 survey excluded a diagnosis of Hypomania only if it occurred within episodes of Mania.

Mania

The 1997 survey assessed whether Mania occurred with or without psychotic symptoms. However, the 2007 survey did not assess the presence of psychotic symptoms. Therefore, to compare the overall diagnosis, Mania with and without psychotic symptoms would need to be combined for 1997.

Frequency and persistence of symptoms

The survey assesses whether the person:
  • had a mood which was predominantly elevated, expansive or irritable and definitely abnormal for the individual concerned; and
  • if the mood change was prominent and sustained for at least a week (unless it was severe enough to require hospital admission).

In 1997, the first part of the criteria was assessed by asking people whether in the 12 months prior to interview they had a period of a least four days when they were so happy or excited they got into trouble, or their family or friends worried about it, or a doctor said they were manic. Whereas, in 2007 people were asked if they ever had periods lasting four days or longer where:
  • they felt much more excited and full of energy than usual;
  • their minds went too fast;
  • they talked a lot;
  • they were very restless or unable to sit still; or
  • they sometimes did things that were unusual for them, such as driving too fast or spending too much money.

Presence of symptoms

The survey assesses the presence of nine different symptoms. A person was required to have at least three of the following symptoms (four if their mood was merely irritable) in order to meet criteria for diagnosis:
      01 - increased activity or physical restlessness;
      02 - increased talkativeness;
      03 - flight of ideas or the subjective experience of thoughts racing;
      04 - loss of normal social inhibitions resulting in behaviour which is inappropriate to the circumstances;
      05 - decreased need for sleep;
      06 - inflated self-esteem or grandiosity;
      07 - distractability or constant changes in activity or plans;
      08 - behaviour which is foolhardy or reckless and whose risks the person does not recognise; or
      09 - marked sexual energy or sexual indiscretions.

The 2007 survey asks the person to consider their worst episode (or if this is not identifiable, their most recent episode) regarding changes in behaviour. The 1997 survey refers to a period of at least four days that has occurred in the 12 months prior to interview.

There were also some differences in question wording between the two surveys. For example, to assess the second symptom, both surveys asked people whether they talked a lot more than usual or felt a need to keep talking all the time, but the 1997 survey also asked whether the person 'talked so fast that people said they couldn't understand'. To assess the eighth symptom, the 1997 survey focuses on money issues, such as spending sprees or financial trouble. Whereas, the 2007 survey included questions about driving too fast, staying out all night and casual/unsafe sexual behaviours, as well as issues with money.

Level of interference

The survey also assesses whether there was severe interference with a person's functioning in daily living.

The 2007 survey attempts to quantify the amount of interference that the disorder has had on a person's life, based on either:
  • their lifetime. For example, the amount to which the episode/s ever interfered with work, social life, or personal relationships (not at all, a little, some, a lot or extremely) and how often during the episode/s they were unable to carry out daily activities because of being very excited and full of energy/irritable or grouchy (often, sometimes, rarely or never); or
  • the 12 months prior to the survey interview. The level of interference was assessed across four different domains, as well as by the number of days the person was totally unable to function during that time frame.

In 1997, this criterion was implied through the behaviours outlined in 'presence of symptoms' (see above). Therefore, as part of the diagnosis, a person only had to report three or four symptoms from those listed earlier. Whereas, the 2007 survey required people to have had the behaviours and also a specified level of interference on daily life.


ICD-10 SUBSTANCE USE DISORDERS

The comparison includes the following Substance Use disorders:
For both surveys, the following concepts are also compared:
Alcohol Use

For both surveys, a person must have had at least 12 standard drinks in a year, in order to be asked subsequent questions about the frequency of drinking. The frequency of drinking questions then determine whether a person is asked more questions about their alcohol use.

In 2007, the 12 standard drinks could have been at any time in the person's life prior to the interview, as the question seeks the age when the person first started drinking at least 12 standard drinks in a year. In comparison, the 1997 survey asks whether the person consumed at least 12 drinks in the 12 months prior to interview.

Frequency of behaviour

In 2007, in order to be asked subsequent questions about alcohol use a person had to endorse that they:
  • Drank nearly every day or 3-4 days per week; or
  • Drank 1-2 days per week or 1-3 days per month and had at least 3 standard drinks on the days when they drank.

People who reported that they drank 'less than once a month' were not included and were skipped to the next survey topic.

In 1997, in order to be asked subsequent questions about alcohol use a person had to endorse that they had more than 3 standard drinks on the days when they drank in the 12 months prior to interview. People who reported that they drank 'less than once a month' were still asked subsequent questions, as long as they drank more than 3 drinks on the days when they drank.

Alcohol Harmful Use

The survey assesses whether there is clear evidence that substance use was responsible for (or substantially contributed to) physical or psychological harm, including impaired judgement or dysfunctional behaviour, which may have led to disability or had adverse consequences for interpersonal relationships.

The 1997 survey assessed this criterion by asking people whether they ever had any of the following medical problems:
  • liver disease or hepatitis;
  • stomach disease or vomiting blood;
  • tingling feet or numbness;
  • memory problems;
  • pancreatitis; or
  • any other disease.

It also asked whether people ever had any of the following emotional or psychological problems:
  • being uninterested in usual activities;
  • being depressed;
  • being suspicious or distrustful of others; or
  • having strange thoughts.

Although the 1997 survey was primarily concerned with assessing symptoms in the 12 months prior to interview, this criterion assesses symptoms that occurred at some point in the person's lifetime.

The 2007 survey assessed this criterion by asking people whether their substance use ever affected them by:
  • frequently interfering with their responsibilities at home, work or school; or
  • causing arguments or other serious or repeated problems with their family, friends, neighbours or co-workers.

It also assessed whether there was a time in the person's life when they were often under the influence and could get hurt, such as driving or operating machinery and whether they were more than once arrested or stopped by police because of drink driving or drunken behaviour.

Alcohol Dependence Syndrome

The survey assesses whether three or more of the following symptoms occurred together for at least one month, or if persisting for periods of less than one month, then whether they occurred together repeatedly within a 12-month period. There are six symptoms used to assess this criterion, including:
  • compulsion to take the substance;
  • inability to cut down or control substance use;
  • withdrawal symptoms;
  • increased consumption of the substance to reach the desired effect;
  • preoccupation with the substance; and
  • persistence with substance use despite harmful consequences.

The third symptom, withdrawal, assesses the presence of either:
      A - the characteristic withdrawal syndrome for the substance; or
      B - use of the same (or a closely related) substance to relieve or avoid withdrawal symptoms.

The assessment for Part A was more restrictive in 1997, requiring the endorsement of three or more different withdrawal-related symptoms, from a list of 10. People were asked whether any of the following problems had occurred in the 12 months prior to interview, after quitting or cutting down on their drinking:
  • having the shakes (eg hands trembling);
  • sweating;
  • having nausea or vomiting;
  • feeling their heart beating fast;
  • feeling more restless than usual;
  • having headaches;
  • having more trouble sleeping than usual;
  • feeling weak;
  • seeing, hearing, or feeling things that others could not; or
  • having a seizure.

In 2007, Part A was assessed through one question, by asking people whether they had ever experienced any symptoms like fatigue, headaches, diarrhoea, the shakes or emotional problems after they had stopped, cut down or went without drinking.

Both surveys assessed Part B in a similar way. For the 1997 survey, the inclusion of Part B may have counteracted the restrictiveness of Part A, as the endorsement of Part B meant a person was asked subsequent questions, the same as if they had endorsed Part A.

Drug Use

For both surveys, a person must have endorsed either:
  • the misuse of prescription medication/s; or
  • the use of illicit drugs.

The misuse of prescription medication includes using medicine in larger amounts or for longer than prescribed. Misuse also includes using medication to get high, relax, make the person feel better, more active or alert or using medication without the recommendation of a health professional. The use of illicit drugs includes:
  • cannabinoids (eg marijuana);
  • stimulants (eg amphetamines);
  • sedatives (eg tranquillisers); or
  • opioids (eg heroin).

Frequency of behaviour

In 2007, a person must have endorsed that they either misused prescription medication or used illicit drugs more than five times in their lifetime in order to be asked subsequent questions about drug use. The use of lifetime rather than 12 months, as well as the more extensive list of medications/drugs means that more people may have been included in subsequent questions.

In 1997, a person must have endorsed that they either misused/used medication/drugs more than five times in the 12 months prior to interview in order to be asked subsequent questions about drug use. There were also differences in the lists of medications and drugs which people could select from. In 1997, there were a smaller number of prescription medications (eg the stimulants attenta, concerta, dexamphetamine, modavigil and stattera are not included) and some differences in the types of illicit drugs (eg the stimulants methamphetamine, ice, base and cocaine are not included).

Other Substance Harmful Use

Level of interference

The survey assesses whether there is clear evidence that substance use was responsible for (or substantially contributed to) physical or psychological harm, including impaired judgement or dysfunctional behaviour, which may have led to disability or had adverse consequences for interpersonal relationships.

The 1997 survey assessed this criterion by asking people whether in the 12 months prior to interview they had any of the following medical problems:
  • accidental overdose;
  • a persistent cough;
  • a seizure;
  • an infection;
  • hepatitis;
  • abscesses;
  • HIV or AIDS;
  • heart trouble; or
  • an injury.

It also asked whether people had any of the following emotional or psychological problems in the 12 months prior to interview:
  • being uninterested in usual activities;
  • being depressed;
  • being suspicious or distrustful of others; or
  • having strange thoughts.

The 2007 survey assessed this criterion by asking people whether their substance use ever affected them by:
  • frequently interfering with their responsibilities at home, work or school; or
  • causing arguments or other serious or repeated problems with their family, friends, neighbours or co-workers.

It also assessed whether there was a time in the person's life when they were often under the influence and could get hurt, such as driving or operating machinery and whether they were more than once arrested or stopped by police because of driving under the influence or their behaviour while high.

Other Substance Dependence Syndrome

The survey assesses whether three or more of the following symptoms occurred together for at least one month, or if persisting for periods of less than one month, then whether they occurred together repeatedly within a 12-month period. There are six symptoms used to assess this criterion, including:
  • compulsion to take the substance;
  • inability to cut down or control substance use;
  • withdrawal symptoms;
  • increased consumption of the substance to reach the desired effect;
  • preoccupation with the substance; and
  • persistence with substance use despite harmful consequences.

The 1997 survey assesses the fifth symptom, preoccupation with the substance, by asking about obtaining, using and recovering from use of the substance. People were asked whether in the 12 months prior to interview they had given up or greatly reduced important activities so that they could use a substance for a whole month, or several times over two months. People were also asked if they spent a lot of their time using, getting, or getting over the effects of their substance use.

In comparison, the 2007 survey assesses the preoccupation with the substance by asking whether a person ever had times:
  • of several days or more when they spent so much time using or recovering from the effects of using that they had little time for anything else; and
  • lasting a month or longer when they gave up or greatly reduced important activities (eg sports, work, seeing friends or family) because of their substance use.


COMPARISON OF DSM-IV DIAGNOSTIC ASSESSMENT CRITERIA

This segment provides an overview of the differences between the 1997 and 2007 diagnostic assessment criteria according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV).


DSM-IV ANXIETY DISORDERS

The comparison includes the following Anxiety disorders:
Panic Disorder

Recurrent unexpected panic attacks

The survey assesses the presence of attacks which are not consistently associated with a specific situation or object. The attacks often occur spontaneously (ie unpredictable) and are not associated with marked exertion or with exposure to dangerous or life threatening situations.

In 1997, the survey asked whether a person 'more than once had an attack ... which was totally unexpected'. In 2007, a person must have had at least three 'out of the blue' attacks and experienced Panic Attacks (as determined by a separate algorithm).

Hierarchy rules

The 1997 hierarchical version of the disorder contained an exclusion criterion to ensure that the Panic Attacks did not occur exclusively within a period of OCD or Social Phobia. In 2007, hierarchy rules were not applied for this disorder.

Agoraphobia with/without Panic Disorder

Fear or avoidance of places or situations

The survey assesses whether fear or avoidance was experienced in relation to several types of places or situations where the person:
  • felt it would be difficult (or embarrassing) to escape if they had an unexpected problem; and
  • felt they might not be able to get help if they had an unexpected problem.

The 1997 survey assessed a person's reaction/s to the following four places or situations:
  • being outside the home alone;
  • travelling in a bus, train or car;
  • being in a crowd or standing in line; and
  • being in a public place, like a shop.

In comparison, the 2007 survey assessed a person's reactions to 11 places or situations. This included an expanded version of the above question on fear of 'being in a public place, like a shop':
  • using public transportation;
  • standing in a line in a public place;
  • being in a department store, shopping centre, or supermarket;
  • being in a movie theatre, auditorium, lecture hall, or church; and
  • being in a restaurant or any other public place.

For a list of the situations included in the 2007 diagnostic assessment criteria see 'Agoraphobia' in Chapter 3.

To meet the 1997 criteria, a person was only required to fear of one of four situations, whereas the 2007 criteria required a person to fear at least two of 11 situations.

Symptoms of fear or avoidance

The survey assesses the person's reactions or feelings towards certain places or situations through three separate components:
  • avoidance (eg travel is restricted);
  • enduring situations with marked distress or with anxiety about having a Panic Attack or panic-like symptoms; or
  • requiring the presence of a companion.

In 1997 the first two components were assessed using one question and the last component consisted of two questions. In 2007, there were additional questions asked for the first and second components. The first component includes an additional question to assess whether the person has ever been housebound. The second component included 16 questions to assess the person's reactions or feelings towards being in a situation such as a crowd, public place or travelling. The reactions could have included feeling dizzy or faint, having trouble breathing normally, having a dry mouth or sweating.

Hierarchy rules

The 1997 diagnosis contained an exclusion criterion to ensure that the Agoraphobia did not occur exclusively within an episode of Social Phobia or OCD. The exclusion criterion in the 2007 diagnosis was for the presence of Separation Anxiety. However, as this disorder was not collected, the exclusion does not apply.

Agoraphobia without Panic Disorder

Fear of developing symptoms

The survey assesses the presence of a fear of developing panic-like symptoms (eg dizziness or diarrhoea).

In 1997, this criterion was exclusively concerned as to whether Agoraphobia was present or not. In 2007, the criteria considered both the presence of Agoraphobia and the fear of panic-like symptoms, including:
  • fear that the respondent would feel nauseous, have diarrhoea, or have stomach discomfort;
  • fear that they would have a panic attack;
  • fear that they might have a heart attack or some other emergency; or
  • fear that they might become physically ill or be unable to get help.

The criteria to assess the presence of Panic Disorder is consistent across both surveys. However, comparability of the criteria is dependent on the comparability of the diagnosis of Panic Disorder (see the diagnostic assessment criteria in Chapter 3).

Social Phobia

Fear of social situations

The survey assesses the presence of a marked and persistent fear of one or more social or performance situations in which the person is exposed to unfamiliar people or to possible scrutiny by others. It also assesses whether the person fears they will act in a way (or show anxiety symptoms) that will be humiliating or embarrassing.

The 1997 survey asks about reactions to the following six social situations (plus an 'other' situation):
  • eating or drinking where someone could watch;
  • talking to people because they might have nothing to say or might sound foolish;
  • writing while someone watches;
  • taking part or speaking in a meeting or class;
  • going to a party or social outing; or
  • speaking in public.

In comparison, the 2007 survey asks about 13 specific social or performance situations, as well as an 'other' situation. For a list of the situations included in the 2007 diagnostic assessment criteria see 'Social Phobia' in Chapter 3.

Response to the feared situation

The survey assesses whether the person's exposure to the feared social situation almost invariably provokes anxiety.

In 2007, this was assessed through one question about any reaction to a social situation during the person's lifetime. In 1997, this criterion was assessed for the 12 months prior to interview. Additionally, in 1997 people were asked a series of questions about their types of reactions, including heart pounding, sweating or shortness of breath.

Symptoms of fear or avoidance

The survey assesses whether the person takes action to avoid social or performance situations, or else endures these situations with intense anxiety or distress.

In 1997, the anxiety symptoms (eg heart pounding, sweating, shortness of breath) were assessed in the previous criterion (response to the feared situation). Whereas, the 2007 survey assesses these symptoms in this separate criterion.

Level of interference

The 2007 survey attempts to quantify the amount of interference that the disorder has had on a person's life, based on either:
  • their lifetime. For example, the amount to which the fear/avoidance ever interfered with work, social life, or personal relationships (not at all, a little, some, a lot or extremely); or
  • the 12 months prior to the survey interview. The level of interference was assessed across four different domains, as well as by the number of days the person was totally unable to function during that time frame.

In 1997, the survey simply asked people whether the disorder interfered with their life or activities 'a lot'.

Duration of symptoms

In 2007, there was an additional criterion that assessed the duration of symptoms for people aged under and over 18 years. The length of duration of symptoms varies by age group. In 1997, the scope of the survey was persons aged 18 years and over, therefore this criterion did not apply.

Generalised Anxiety Disorder (GAD)

Symptoms and persistence

In 2007, the survey assessed symptoms and persistence through three separate criteria, with each of the following assessed individually:
      1 - excessive anxiety and worry (apprehensive expectation);
      2 - occurring more days than not for at least six months; and
      3 - relating to a number of events or activities (such as work or school performance).

In comparison, the 1997 survey assessed these criteria as a whole and did not directly assess Part 1, but instead considered it to be implied through responses to the other parts.

Symptoms caused by other disorders

The survey assesses whether the focus of the anxiety and worry is confined to other specific disorders, or is a more generalised worry.

The 1997 survey considers only whether the worry was exclusively about the person's 'own symptoms, weight or drugs'. The 2007 survey considers a larger number of factors, including the person's:
  • mental health;
  • substance use;
  • social phobias;
  • agoraphobia;
  • specific phobias;
  • obsessions; and
  • compulsions.

As well as their reactions to:
  • being away from home; and
  • being apart from loved ones.

Exclusion criteria

The diagnosis of GAD contained exclusion criteria which assessed whether the worry was due to:
      1 - a physiological cause (eg drug abuse, medication);
      2 - a general medical condition (eg hyperthyroidism); or
      3 - occurred exclusively during a mood disturbance (eg an affective disorder).

In both surveys, the presence of a physiological cause excluded a person from diagnosis, regardless of whether the disorder was assessed with or without hierarchy.

In 2007, Criterion 3 was based on a predetermined diagnosis of an affective disorder, including Major Depressive Episode, Minor Depressive Episode, Dysthymia, and Mania. In 1997, this criterion was not dependent on the diagnosis of an affective disorder, but instead considered the person's subjective responses, such as whether their worry occurred only during periods of feeling sad.

Hierarchy rules

In 2007 the existence of GAD solely during a mood disturbance was considered only for the 'with' hierarchy version of the disorder. Whereas in 1997, people were excluded from both the with and without hierarchy versions of the disorder.

Obsessive-Compulsive Disorder (OCD)

Recognition of symptoms

The survey assesses the recognition of either obsessions or compulsions in three parts:
      1 - the presence of recurrent and persistent thoughts, impulses or images. It also considers whether at some time during the disturbance, these were intrusive and inappropriate and whether they caused marked anxiety or distress;
      2 - whether the thoughts, impulses or images were not simply excessive worries about real-life problems; and
      3 - whether the person has attempted to ignore or suppress their symptoms, or to neutralise them with some other thought or action.

In 2007, people were asked specific questions about four 'common' obsessions and also if they had 'any other' disturbing thoughts that were recurrent. In 1997 people were asked more general questions, using examples, rather than being specifically 'obsession-based'.

In 2007, each of the three parts were directly assessed, whereas in 1997 only Part 1 was directly assessed and the remaining parts were considered to have been assessed 'implicitly' by the first.

Level of interference

The survey assesses whether a person's obsessions or compulsions:
  • caused marked distress;
  • were time consuming and took more than one hour a day; and
  • significantly interfered with their normal routine, occupations (or academic) functioning, or usual social activities or relationships.

In 2007, each of these components were assessed separately, but combined attributes from both obsessions and compulsions. In 1997, this criterion was not split into three components, but instead was assessed separately for both obsessions and compulsions.

In 2007, the survey also attempts to quantify the amount of interference that the disorder has had on a person's life, based on either:
  • their lifetime. For example, the amount to which the unpleasant thoughts/repeated behaviours ever interfered with work, social life, or personal relationships (not at all, a little, some, a lot or extremely); or
  • the 12 months prior to the survey interview. The level of interference was assessed through questions similar to those on lifetime interference, as well as across four different domains. The number of days the person was totally unable to function during that time frame was also assessed.

In 1997, the survey only asked people whether the thoughts/behaviours had interfered with their life or work, or caused difficulty with relatives or friends.

Exclusion criteria

The survey assesses whether the obsessions or compulsions were restricted to pre-occupations with other specific disorders. For example, the pre-occupation with food in the presence of an eating disorder.

The 2007 survey assessed this criterion only in relation to depression by asking whether the symptoms only occurred within an episode of depression. Whereas, the 1997 survey assessed this criterion in relation to:
  • depression;
  • eating disorders and body dysmorphia;
  • substance use;
  • trichotillomania (an uncontrollable desire to pull out your own body hair); and
  • hypochondriasis.

Diagnosis

In 1997, in order to meet the diagnosis for OCD, a person must have met all criteria for obsessions only or all criteria for compulsions only. In 2007, the diagnostic assessment does not distinguish between obsessions and compulsions for the different sub/criteria, but instead combines the two components. Therefore, a person may not have met diagnosis if they had been assessed solely on the existence of their obsessions or compulsions.

Post-Traumatic Stress Disorder (PTSD)

Responses to a traumatic event

The survey assesses the responses a person exhibits after being exposed to a traumatic event through both:
  • experiencing, witnessing, or being confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others; and
  • the response involving intense fear, helplessness, or horror.

In 2007, a larger number of traumatic events were provided to the respondent for consideration. However, in 1997, a number of other types of event may have been considered, but remained unreported as they were included as an 'other extremely stressful or upsetting event'. Some of the new traumatic events included in 2007 were:
  • being an unarmed civilian in a place where there was a war, revolution, military coup or invasion;
  • being a refugee - fleeing from a home country to a foreign country/place to escape danger or persecution;
  • being stalked - followed or having someone keep track of activities in a way that made them feel they were in serious danger;
  • doing something that accidentally led to the serious injury or death of another person; or
  • purposefully causing serious injury, torture or the death of another person.

Some of the traumatic events experienced in relation to a loved one in 2007 may also have remained unreported in 1997. For example, in 1997 people were asked whether they had ever suffered a great shock because one of the traumatic events listed had happened to someone close to them, while in 2007 people were specifically asked:
  • whether someone very close to them had died unexpectedly (eg killed in an accident, murdered, committed suicide or had a fatal heart attack at a young age);
  • whether a child had ever had a life-threatening illness or injury; or
  • whether someone close to them had ever had an extremely traumatic experience, such as being kidnapped, tortured or raped.

Additionally, some types of events were specifically excluded from the 1997 survey, these included:
  • bereavement;
  • chronic illness;
  • business loss; and
  • marital or family conflict.

A number of these events, including bereavement and relationship breakdown, were included in 2007 as an 'other extremely traumatic or life-threatening event' and were considered in the diagnosis of PTSD.

Persistence of symptoms

As part of the diagnosis for PTSD in 2007, 'persistence' was assessed in relation to three groups of reactions:
      1 - the traumatic event being persistently re-experienced;
      2 - the persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness (not present before the trauma); and
      3 - persistent symptoms of increased arousal (also not present before the trauma).

In 2007, the frequency of the 'persistent' symptoms is assessed based on these three groups of reactions and quantified as:
  • symptoms from each group occurred at least 1-2 times per month for a lifetime diagnosis; and
  • symptoms from any group were present in the 12 months prior to interview for a 12-month diagnosis.
  • In 1997, the 'persistence' of the reactions was implied by the number of reactions experienced over the 12 months prior to interview, and not how frequently the symptoms occurred.

Duration of the disturbance

The survey assesses the duration of the disturbance (reaction/s to the traumatic event) and whether the 'persistent' symptoms lasted for more than one month.

In 2007, people had to experience symptoms from each of the three groups of reactions (see persistence of symptoms) for more than one month. Whereas in 1997, people were asked how long they continued to have any of the symptoms, with the time frame ranging from less than one week to more than one year.

Level of interference

The survey assesses whether the disturbance (reaction/s to the traumatic event) caused clinically significant distress or impairment in social, occupational or other important areas of functioning. The 2007 survey attempts to quantify the amount of interference that the disorder has had on a person's life, based on either:
  • their lifetime. For example, the amount to which the reactions disrupted or interfered with their normal, daily life (not at all, a little, some, a lot, extremely); or
  • the 12 months prior to the survey interview. The level of interference was assessed across four different domains, as well as the number of days the person was totally unable to function during that time frame.

In 1997, the survey only asked people whether the reactions had stopped them from 'going to a party, social event, or meeting'.


DSM-IV AFFECTIVE DISORDERS

The comparison includes the following Affective disorders:
Prevalence rates

A problem was identified in the 1997 survey instrument which meant that responses from people who indicated that they had not been abnormally happy or excited, but had been unusually irritable in the Mania module, were not included in the diagnosed population that was output from the survey file. As a result, prevalence rates for hypomania, mania or bipolar affective disorder were not published. Therefore, it is likely that the 1997 published data slightly underestimates the prevalence of affective disorders.

Major Depressive Episode

Level of interference

The survey assesses whether the symptoms caused clinically significant distress or impairment in social, occupational or other important areas of functioning. The 2007 survey attempts to quantify the amount of interference that the disorder has had on a person's life, based on either:
  • their lifetime. For example, the amount to which the episode/s ever interfered with work, social life, or personal relationships (not at all, a little, some, a lot or extremely) and how often during the episode/s they were unable to carry out daily activities because of sadness/discouragement/lack of interest (often, sometimes, rarely or never); or
  • the 12 months prior to the survey interview. The level of interference was assessed across four different domains, as well as by the number of days the person was totally unable to function during that time frame.

In 1997, the survey simply asked people:
  • whether the episode/s interfered with their life or activities 'a lot'; and
  • whether the episode/s had 'seriously interfered' with their ability to look after their home, their family or self, or their ability to work.

Exclusion criteria

The 1997 survey contained an exclusion criterion to ensure that the symptoms exhibited were not part of a Mixed Episode (ie a mixture of Major Depression and Mania). The criterion was applied to the full diagnosis and was not part of any hierarchical structure. The presence of a Mixed Episode was not assessed in 2007, therefore this exclusion does not apply.

Major Depressive Disorder

Hierarchy rules

The 2007 survey contained an exclusion criterion which was applied to the 'with hierarchy' version of the disorder. The criterion ensured that there had never been a Manic Episode or Hypomanic Episode. As the 2007 survey did not assess Mixed Episode, only the other two types of episode could be excluded. In 1997, the criterion was used for the full diagnosis and was not part of any hierarchical structure.

Minor Depressive Disorder

The 2007 survey assessed the presence of a number of symptoms to diagnose Minor Depressive Disorder. In 1997 the criteria for this disorder were not assessed.

Recurrent Brief Depression

The 2007 survey assessed the presence of a number of symptoms to diagnose Recurrent Brief Depression. In 1997 the criteria for this disorder were not assessed.

Dysthymic Disorder

Duration of episodes

The survey contains two criteria which assess the duration of episodes:
      1 - whether there has been a period of at least two years where the person has been in a depressed mood for most of the day, for more days than not and indicated by either subjective account or observation by others; and
      2 - whether during the two year period the person had never been without symptoms for more than two months at a time.

In 1997, both aspects of episode duration were assessed based on:
  • whether a person had ever had two years or more in their life when they felt depressed or sad most days, even if they felt okay sometimes; and
  • whether any period like that had ever lasted two years without an interruption of two full months when they felt okay.

In 2007, Criterion 1 was not operationalised and the duration of two or more years was assessed only through Criterion 2. Additionally, the questions relating to duration in the 2007 survey simply asked for the longest continuous number of years where the person felt they were in an episode 'most days'. While the definition for the end of an episode (ie when the person no longer has the problems for two weeks in a row) is provided earlier in the diagnostic module, this was not reiterated when the duration questions were asked. This possibly allows for short breaks within an episode to not be considered.

Hierarchy rules

There were two exclusion criteria to ensure that the person had:
  • no episodes of Major Depression during the first two years of the symptoms; and
  • never experienced a Manic Episode, Hypomanic Episode, or Mixed Episodes (ie a mixture of Major Depression and Mania).

In 2007, these two criteria were only part of the 'with hierarchy' version of the diagnosis. However, the presence of a Mixed Episode was not assessed. In 1997, both criteria were used for the full diagnosis and were not part of any hierarchical structure.

Hypomanic Episode

Level of interference

Whether there is an unequivocal change in functioning, that is uncharacteristic of the person, when not symptomatic.

The 2007 survey determines the level of interference that the disorder has had on a person's life, based on the questions used for Mania (see Manic Episode). In 1997, this criterion was not directly assessed, but instead the change in functioning was deemed to be 'implicit' in the symptom-based questions. Those questions assessed the symptoms that persisted and were present to a significant degree during the period of mood disturbance.

Manic Episode

Level of interference

Whether the mood disturbance was sufficiently severe to cause marked impairment in occupational functioning or in usual social activities or relationships with others, or to necessitate hospitalisation to prevent harm to self or others, or there are psychotic features.

The 2007 survey attempts to quantify the amount of interference that the disorder has had on a person's life, based on either:
  • their lifetime. For example, the amount to which the episode/s ever interfered with work, social life, or personal relationships (not at all, a little, some, a lot or extremely) and how often during the episode/s they were unable to carry out daily activities because of being very excited and full of energy/irritable or grouchy (often, sometimes, rarely or never); or
  • the 12 months prior to the survey interview. The level of interference was assessed across four different domains, as well as by the number of days the person was totally unable to function during that time frame.

In 1997, the survey simply asked people whether the symptoms interfered with their life or activities 'a lot'.

Exclusion criteria

The 1997 survey contained an exclusion criterion to ensure that the symptoms exhibited were not part of a Mixed Episode (ie a mixture of Major Depression and Mania). The criterion was applied to the full diagnosis and was not part of any hierarchical structure. The presence of a Mixed Episode was not assessed in 2007, therefore this exclusion does not apply.

Bipolar I Disorder

Note: Bipolar I and Bipolar II are mutually exclusive.

In 1997, the diagnosis was based on the presence of Manic Episodes plus the absence of Major Depressive Episodes. Whereas, in 2007 the diagnosis was based solely on the presence of Manic Episodes. The presence or absence of Depression was not assessed.

Bipolar II Disorder

Note: Bipolar I and Bipolar II are mutually exclusive.

In 1997, the diagnosis was based on the presence of both Major Depressive Episodes and Hypomanic Episodes and the person never having had a Manic Episode or Mixed Episode. In 2007, the diagnosis was based on the presence of either:
  • Mania (excited episodes) and Major Depressive Episode; or
  • Hypomania (with episodes lasting 14 days or longer) and Major Depressive Episode with the person never having had a Manic Episode.

Level of interference

The diagnosis for Bipolar II contains criteria which assess whether the symptoms caused clinically significant distress or impairment in social, occupational or other important areas of functioning.

In 1997, the distress or impairment was assessed individually for Mania, Depression, and Mixed Episodes and was therefore implicit in the Bipolar diagnoses. In 2007, the interference is reassessed for Bipolar and is restricted to symptoms associated with Manic Episodes. Additionally, a person required a score of 7 or higher in at least one of the four Sheehan Disability Scale domains for a diagnosis of Mania. Whereas, they only required a score of 4 or higher in at least one of the four Sheehan Disability Scale domains for a diagnosis of Bipolar. Information on the Sheehan Disability Scale is provided in Chapter 6.


DSM-IV SUBSTANCE USE DISORDERS

The comparison includes the following Substance Use disorders:
For both surveys, the following concepts are also compared:
Alcohol Use

For both surveys, a person must have had at least 12 standard drinks in a year, in order to be asked subsequent questions about the frequency of drinking. The frequency of drinking questions then determine whether a person is asked more questions about their alcohol use.

In 2007, the 12 standard drinks could have been at any time in the person's life prior to the interview, as the question seeks the age when the person first started drinking at least 12 standard drinks in a year. In comparison, the 1997 survey asks whether the person consumed at least 12 drinks in the 12 months prior to interview.

Frequency of behaviour

In 2007, in order to be asked subsequent questions about alcohol use a person had to endorse that they:
  • Drank nearly every day or 3-4 days per week; or
  • Drank 1-2 days per week or 1-3 days per month and had at least 3 standard drinks on the days when they drank.

People who reported that they drank 'less than once a month' were not included and were skipped to the next survey topic.

In 1997, in order to be asked subsequent questions about alcohol use a person had to endorse that they had more than 3 standard drinks on the days when they drank in the 12 months prior to interview. People who reported that they drank 'less than once a month' were still asked subsequent questions, as long as they drank more than 3 drinks on the days when they drank.

Alcohol Abuse

Level of interference

The survey assesses whether there is a maladaptive pattern of substance use leading to clinically significant impairment or distress, as manifested by one (or more) symptoms occurring within a 12-month period. There are four symptoms used to assess this criterion, with the fourth referring to continued substance use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the substance.

In 2007, the fourth symptom was asked as a two-part question, whereas in 1997 the symptom was asked about in only one question. Apart from this difference, there were some small changes to question wording that are considered to be minor.

Alcohol Dependence

The survey assesses whether there is a maladaptive pattern of substance use leading to clinically significant impairment or distress, as manifested by three (or more) symptoms occurring at any time in the same 12-month period. There are seven symptoms used to assess this criterion, with some symptoms containing more than one characteristic. The second symptom relates to withdrawal and assesses the presence of either:
      A - the characteristic withdrawal syndrome for the substance; or
      B - use of the same (or a closely related) substance to relieve or avoid withdrawal symptoms.

The assessment for Part A was more restrictive in 1997, requiring the endorsement of two or more different withdrawal-related symptoms, from a list of 10. People were asked whether any of the following problems had occurred in the 12 months prior to interview, after quitting or cutting down on their drinking:
  • having the shakes (eg hands trembling);
  • having more trouble sleeping than usual;
  • being more nervous than usual;
  • feeling more restless than usual;
  • sweating;
  • feeling their heart beating fast;
  • having nausea or vomiting;
  • seeing, hearing, or feeling things that others could not; or
  • having a seizure.

In 2007, Part A was assessed through one question, by asking people whether they had ever experienced any symptoms like fatigue, headaches, diarrhoea, the shakes or emotional problems after they had stopped, cut down or went without drinking.

Both surveys assessed Part B in a similar way. For the 1997 survey, the inclusion of Part B may have counteracted the restrictiveness of Part A, as the endorsement of Part B meant a person was asked subsequent questions, the same as if they had endorsed Part A.

Drug Use

For both surveys, a person must have endorsed either:
  • the misuse of prescription medication/s; or
  • the use of illicit drugs.

The misuse of prescription medication includes using medicine in larger amounts or for longer than prescribed. Misuse also includes using medication to get high, relax, make the person feel better, more active or alert or using medication without the recommendation of a health professional. The use of illicit drugs includes:
  • cannabinoids (eg marijuana);
  • stimulants (eg amphetamines);
  • sedatives (eg tranquillisers); or
  • opioids (eg heroin).

Frequency of behaviour

In 2007, a person must have endorsed that they either misused prescription medication or used illicit drugs more than five times in their lifetime in order to be asked subsequent questions about drug use. The use of lifetime rather than 12 months, as well as the more extensive list of medications/drugs means that more people may have been included in subsequent questions.

In 1997, a person must have endorsed that they either misused/used medication/drugs more than five times in the 12 months prior to interview in order to be asked subsequent questions about drug use. There were also differences in the lists of medications and drugs which people could select from. In 1997, there were a smaller number of prescription medications (eg the stimulants attenta, concerta, dexamphetamine, modavigil and stattera were not included) and some differences in the types of illicit drugs (eg the stimulants methamphetamine, ice, base and cocaine were not included).

Substance Abuse

There were some small changes to question wording that are considered to be minor.

Substance Dependence

The survey assesses whether there is a maladaptive pattern of substance use leading to clinically significant impairment or distress, as manifested by three (or more) symptoms occurring at any time in the same 12-month period. There are seven symptoms used to assess this criterion, with the fourth referring to the persistent desire or unsuccessful efforts to cut down or control substance use.

In 2007, the fourth symptom was asked as a single question, whereas in 1997 this symptom was asked in two separate questions. Apart from this difference, there were some small changes to question wording that are considered to be minor.


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