The lifetime prevalence of mental disorders: estimation, uses and limitations

Kramer, Morton; Korff, Michael Von; Kessler, Larry G.

doi:10.1017/s0033291700047310

Cited by 46 publications

(14 citation statements)

References 6 publications

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“…The 132 core studies provided from one to 13 prevalence estimates per study. Four studies [59,120,169,224] reported prevalence only within narrow age strata without providing an overall rate. These studies were not included in the discrete core analyses.…”

Section: Resultsmentioning

confidence: 99%

A Systematic Review of the Prevalence of Schizophrenia

et al. 2005

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BackgroundUnderstanding the prevalence of schizophrenia has important implications for both health service planning and risk factor epidemiology. The aims of this review are to systematically identify and collate studies describing the prevalence of schizophrenia, to summarize the findings of these studies, and to explore selected factors that may influence prevalence estimates.Methods and FindingsStudies with original data related to the prevalence of schizophrenia (published 1965–2002) were identified via searching electronic databases, reviewing citations, and writing to authors. These studies were divided into “core” studies, “migrant” studies, and studies based on “other special groups.” Between- and within-study filters were applied in order to identify discrete prevalence estimates. Cumulative plots of prevalence estimates were made and the distributions described when the underlying estimates were sorted according to prevalence type (point, period, lifetime, and lifetime morbid risk). Based on combined prevalence estimates, the influence of selected key variables was examined (sex, urbanicity, migrant status, country economic index, and study quality).A total of 1,721 prevalence estimates from 188 studies were identified. These estimates were drawn from 46 countries, and were based on an estimated 154,140 potentially overlapping prevalent cases. We identified 132 core studies, 15 migrant studies, and 41 studies based on other special groups. The median values per 1,000 persons (10%–90% quantiles) for the distributions for point, period, lifetime, and lifetime morbid risk were 4.6 (1.9–10.0), 3.3 (1.3–8.2), 4.0 (1.6–12.1), and 7.2 (3.1–27.1), respectively. Based on combined prevalence estimates, we found no significant difference (a) between males and females, or (b) between urban, rural, and mixed sites. The prevalence of schizophrenia in migrants was higher compared to native-born individuals: the migrant-to-native-born ratio median (10%–90% quantile) was 1.8 (0.9–6.4). When sites were grouped by economic status, prevalence estimates from “least developed” countries were significantly lower than those from both “emerging” and “developed” sites (p = 0.04). Studies that scored higher on a quality score had significantly higher prevalence estimates (p = 0.02).ConclusionsThere is a wealth of data about the prevalence of schizophrenia. These gradients, and the variability found in prevalence estimate distributions, can provide direction for future hypothesis-driven research.

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Section: Resultsmentioning

confidence: 99%

A Systematic Review of the Prevalence of Schizophrenia

et al. 2005

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“…Because of the low prevalence of 12-month MDD (.029) and lifetime MDD (.046), we report detailed results in online appendices e-Figures 1 and 2. We focus on past-year (vs. lifetime) MDD because within the context of a trial, the past-year measure captures MDD during a period that follows random assignment, preserving temporal order between exposure and outcome 31 . Moreover, results for past-year MDD have not been published within MTO.…”

Section: Design and Methodsmentioning

confidence: 99%

Differential Mental Health Effects of Neighborhood Relocation Among Youth in Vulnerable Families

Osypuk¹,

Tchetgen

Acevedo‐García

et al. 2012

Arch Gen Psychiatry

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Context Extensive observational evidence indicates youth in high-poverty neighborhoods exhibit poor mental health, although not all children may be affected similarly. Objective To use experimental evidence to assess whether gender and family health problems modify mental health effects of moving from high- to low-poverty neighborhoods. Design, Setting, Participants The Moving to Opportunity Study, a randomized controlled trial, enrolled volunteer low-income families in public housing in 5 U.S. cities from 1994–1997. We analyze 4–7 year outcomes among youth aged 12–19 (n=2829, 89% effective response rate). Intervention Families were randomized to control (remaining in public housing) or experimental (receiving government-funded rental subsidies to move into private apartments) groups. Intent-to-treat analyses included intervention interactions by gender and health vulnerability (defined as pre-randomization health/developmental limitations or disabilities among family members). Outcome measures Past-year psychological distress (K6), and Behavioral Problems Index (BPI). Supplemental analyses used past-year major depressive disorder (MDD). Results Male gender and family health vulnerability significantly adversely modified the intervention effect on K6 (gender: p=.02, health vulnerability: p=.002); male gender, but not health vulnerability, significantly adversely modified the intervention effect on BPI (gender: p=.01, health vulnerability: p=.17). Female adolescents without baseline health vulnerabilities were the only subgroup to benefit on any outcome (K6 (B= −0.21, 95% CI: (−0.34–−0.07), p=.003); MDD (Odds Ratio =0.42 (0.20–0.85) p=0.024). For male adolescents with health vulnerabilities, intervention was associated with worse K6 (B=.26, (0.09–0.44), p=.003) and BPI (B=.24 (0.09–0.40) p=.002). Neither females with health vulnerability, nor males without health vulnerability, experienced intervention benefits. Adherence-adjusted instrumental variable analysis found intervention effects twice as large. Patterns were similar for MDD but estimates were imprecise due to low prevalence. Conclusions Although some girls benefited, boys and adolescents from families with baseline health problems did not experience mental health benefits from housing mobility policies, and may need additional program supports.

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“…They depend not only on the limited reliability of present case finding and identifying techniques, but also on the distant memory of respondents’ (p. 92). This was echoed by Kramer et al (1980), who wrote that ‘Lifetime prevalence has been an exceptionally popular morbidity measure in epidemiological surveys of mental disorders. It is doubtful that this popularity is deserved’ (p. 429).…”

Section: Problems With Lifetime Prevalence As An Epidemiologic Parametermentioning

confidence: 99%

“…Kramer et al (1980) attempted to take mortality into account regarding lifetime prevalence, by using a life-table approach, and assuming various age-standardized mortality ratios for people with schizophrenia. Their results indicated that not taking mortality into account could lead to underestimates of lifetime prevalence at older ages.…”

Section: Possible Reasons For the Decline In Lifetime Prevalence Withmentioning

confidence: 99%

Has ‘lifetime prevalence’ reached the end of its life? An examination of the concept

Streiner

Patten

Anthony

et al. 2009

Int J Methods Psych Res

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Many cross-sectional surveys in psychiatric epidemiology report estimates of lifetime prevalence, and the results consistently show a declining trend with age for such disorders as depression and anxiety. In a closed cohort with no mortality, lifetime prevalence should increase or remain constant with age. For mortality to account for declining lifetime prevalence, mortality rates in those with a disorder must exceed those without a disorder by a sufficient extent that more cases would be removed from the prevalence pool than are added by new cases, and this is unlikely to occur across most of the age range. We argue that the decline in lifetime prevalence with age cannot be explained by period or cohort effects or be due to a survivor effect, and are likely due to a variety of other factors, such as study design, forgetting, or reframing. Further, because lifetime prevalence is insensitive to changes in treatment effectiveness or demand for services, it is a parameter that should be dropped from the lexicon of psychiatric epidemiology.

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The lifetime prevalence of mental disorders: estimation, uses and limitations

Cited by 46 publications

References 6 publications

A Systematic Review of the Prevalence of Schizophrenia

A Systematic Review of the Prevalence of Schizophrenia

Differential Mental Health Effects of Neighborhood Relocation Among Youth in Vulnerable Families

Has ‘lifetime prevalence’ reached the end of its life? An examination of the concept

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