The American Psychiatric Association will be releasing later this month the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the association’s comprehensive guide that sets the classification, diagnosis, and treatment of mental disorders across the U.S. and the world. In an analysis and commentary by researchers at the Columbia University Mailman School of Public Health and Columbia University Medical School, the authors argue that the revision process for the DSM-5 missed some crucial population-level and social determinants of mental health disorders and their diagnosis. The article is online in the journal Health Affairs.
Some of these factors include environmental factors triggering biological responses that manifest in behavior; differing cultural perceptions in defining normal and abnormal behaviors; and institutional pressures, such as insurance reimbursements, disability benefits, and pharmaceutical marketing. Billions of dollars in insurance payments and the accurate diagnoses and treatment of patients could be at stake according to the authors.
To address future DSM revisions, the authors propose the formation of an independent, multidisciplinary task force. The commentary outlines how this task force would operate.
“As the DSM evolves, we must ensure the accuracy of psychiatric diagnoses and their equitable use in health care by systematically reviewing and applying the lessons in the population health and social science literature,” said the authors. “Our proposed independent review body has the potential to improve the DSM and its revision process, as well as contributing to better diagnosis and treatment of mental disorders.”
Columbia co-authors are Dr. Zoe Donaldson, Robert Wood Johnson Health and Society Scholar postdoctoral researcher, Dr. Bruce G. Link, professor of epidemiology and professor of sociomedical sciences, Dr. Peter S. Bearman, Jonathan R. Cole professor of the social sciences, Dr. Kim Hopper, professor of clinical sociomedical sciences, Dr. Lisa M. Bates, assistant professor of epidemiology, Dr. Keely Cheslack-Postava, psychiatric epidemiology training fellow, Dr. Kristin Harper, Robert Wood Johnson Health and Society Scholar, Dr. Gina Lovasi, assistant professor of epidemiology, and Dr. Julien O. Teitler associate professor of social work and sociology. Additional coauthors include Dr. Helena B. Hansen, assistant professor of psychiatry at New York University, Dr. Seth M. Holmes, assistant professor or health and social behavior at the University of California, Berkeley, and Dr. Kristen W. Springer, associate professor at Rutgers University.
The research was funded by the Robert Wood Johnson Health and Society Scholars program.