Background: This paper presents lifetime prevalences and estimated risks of DSM-IV psychiatric disorders from a community survey conducted in Sesto Fiorentino, Italy, using psychiatric interviewers with clinical experience and clinical instruments. Methods: Two thousand five hundred subjects aged 14 or more were randomly selected from the lists of 15 general practitioners (GPs) regardless of wheter or not they had consulted the GP. A three-phase design was adopted, with the GPs using the Mini International Neuropsychiatric Interview (MINI) for the first stage. All positive cases at the MINI and a probability sample of 123 negative cases were re-interviewed by psychiatrists or trained residents in psychiatry using the Florence Psychiatric Interview (FPI) at the second stage. During phase III, the subjects were administered the rating scales specific to the pathology detected by the FPI. Results: Two thousand three hundred and sixty-three subjects were interviewed (response rate 94.5%) by their own GP; 623 were found positive for any psychiatric disorder. The psychiatrists could re-interview 605 of these, along with a random sample of 123 negatives. Almost twenty-five percent (24.4%; 15.7% males, 31.7% females) of the population was found positive for any DSM-IV disorder during their lives. The most common diagnosis was major depressive episode, followed by anxiety not otherwise specified. Women had higher rates for most disorders. Conclusions: The prevalence rates for most of the disorders considered are generally comparable with the range identified by previous studies conducted in other Western countries, even though they were using different methodologies. Exceptions are represented by the high prevalence of residual categories and the lower prevalence of phobias.

Keywords:
Community, DSM-IV, Epidemiology, Lifetime prevalence
1.
Spitzer RL, Endicott J, Robins E: Research diagnostic criteria: Rationale and reliability. Arch Gen Psychiatry 1978;35:773–782.
2.
American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, ed 3. Washington, American Psychiatric Association, 1980.
3.
American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, ed 3 (revised). Washington, American Psychiatric Association, 1987.
4.
American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, ed 4. Washington, American Psychiatric Association, 1994.
5.
World Health Organization: The ICD-10 Classification of Mental and Behavioural Disorders: Diagnostic Criteria for Research. Geneva, World Health Organization, 1993.
6.
Goldberg D, Huxley P: Mental Illness in the Community: The Pathway to Psychiatric Care. London, Tavistock, 1980.
7.
Cohen P, Cohen J: The clinician’s illusion. Arch Gen Psychiatry 1984;41:1178–1182.
8.
Regier DA, Farmer ME, Rae DS, Locke BZ, Keith SJ, Judd LL, Goodwin FK: Comorbidity of mental disorders with alcohol and other drug abuse. Results from the Epidemiological Catchment Area (ECA) study. JAMA 1990;264:2511–2518.
9.
Galbaud du Fort G, Newman SC, Bland RC: Psychiatric comorbidity and treatment seeking. Sources of selection bias in the study of clinical populations. J Nerv Ment Dis 1993;181:467–474.
10.
Newman DL, Moffit TE, Caspi A, Silva PA: Comorbid mental disorders: Implications for treatment and sample selection. J Abnorm Psychol 1998;107:305–311.
11.
Weissman MM, Myers JK, Harding PS: Psychiatric disorders in a US urban community: 1975–1976. Am J Psychiatry 1978;135:459–462.
12.
Angst J, Dobler-Mikola A, Binder J: The Zurich study – A prospective epidemiological study of depressive, neurotic and psychosomatic syndromes. 1. Problem, methodology. Eur Arch Psychiatry Neurol Sci 1984;234:13–20.
13.
Faravelli C, Guerrini Degl’Innocenti B, Aiazzi L, Incerpi G, Pallanti S: Epidemiology of mood disorders: A community survey in Florence. J Affect Disord 1990;20:135–141.
14.
Faravelli C, Guerrini Degl’Innocenti B, Giardinelli L: Epidemiology of anxiety disorders in Florence. Acta Psychiatr Scand 1989;79:308–312.
15.
Faravelli C, Salvatori S, Galassi F, Aiazzi L, Drei C, Cabras P: Epidemiology of somatoform disorders: A community survey in Florence. Soc Psychiatry Psychiatr Epidemiol 1997;32:24–29.
16.
Spitzer RL: Psychiatric diagnosis: Are clinicians still necessary? Compr Psychiatry 1983;24:399–411.
17.
Brugha TS, Bebbington PE, Jenkins R: A difference that matters: Comparison of structured and semi-structured psychiatric diagnostic interviews in the general population. Psychol Med 1999;29:1013–1020.
18.
Helzer JE, Robins LN, McEvoy LT, Spitznagel EL, Stoltzman RK, Farmer A, Brockington IF: A comparison of clinical and Diagnostic Interview Schedule diagnoses. Arch Gen Psychiatry 1985;42:657–666.
19.
Anthony JC, Folstein M, Romanoski AJ, Von Korff MR, Nestadt GR, Chahal R, Merchant A, Hendricks Brown C, Shapiro S, Kramer M, Gruenberg EM: Comparison of the lay Diagnostic Interview Schedule and a standardized psychiatric diagnosis. Arch Gen Psychiatry 1985;42:667–675.
20.
Erdman HP, Klein MH, Greist JH, Bass SM, Bires JK, Machtinger PE: A comparison of the Diagnostic Interview Schedule and clinical diagnosis. Am J Psychiatry 1987;144:1477–1480.
21.
Brugha TS, Jenkins R, Taub N, Meltzer H, Bebbington PE: A general population comparison of the Composite International Diagnostic Interview (CIDI) and the Schedules for Clinical Assessment in Neuropsychiatry (SCAN). Psychol Med 2001;31:1001–1013.
22.
Wittchen HU, Ustun TB, Kessler RC: Diagnosing mental disorders in the community. A difference that matters? Psychol Med 1999;29:1021–1027.
23.
Lewis G, Pelosi AJ, Araya R, Dunn G: Measuring psychiatric disorder in the community: A standardized assessment for use by lay interviewers. Psychol Med 1992;22:465–486.
24.
Popper K: Logik der Forschung. Vienna, Springer, 1934.
25.
Kent G, Dalgleish M: Psychology and Medical Care. London, Baillière Tindall, 1996.
26.
Robins LN, Helzer JE, Croughan J, Radcliff KS: National Institute of Mental Health Diagnostic Interview Schedule: Its history, characteristics and validity. Arch Gen Psychiatry 1981;38:381–389.
27.
Robins LN, Wing JK, Wittchen HU, Helzer JE, Babor TF, Burke J, Farmer A, Jablenski A, Pickens R, Regier DA, Sartorius N, Towle L: The Composite International Diagnostic Interview. An epidemiologic instrument suitable for use in conjunction with different diagnostic systems and in different cultures. Arch Gen Psychiatry 1988;45:1069–1077.
28.
Grove WM, Andreasen NC, McDonald-Scott P, Keller MB, Shapiro RW: Reliability studies of psychiatric diagnosis: Theory and practice. Arch Gen Psychiatry 1981;38:408–413.
29.
Sheehan DV, Lecrubier Y, Sheehan KH, Amorim P, Janavs J, Weiller E, Hergueta T, Baker R, Dunbar GC: The Mini International Neuropsychiatric Interview (M.I.N.I.): The development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. J Clin Psychiatry 1998;59(suppl 20):22–33.
30.
First MB, Spitzer RL, Gibbon M, Williams JBW: User’s Guide for the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I). New York, American Psychiatric Press, 1997.
31.
Goodman WK, Price LH, Rasmussen SA, Mazure C, Fleischmann RL, Hill CL, Heninger GR, Charney DS: The Yale-Brown Obsessive Compulsive Scale. 1. Development, use, and reliability. Arch Gen Psychiatry 1989;46:1006–1011.
32.
Hamilton M: Development of a rating scale for primary depressive illness. Br J Soc Clin Psychol 1967;6:278–296.
33.
Faravelli C, Bartolozzi D, Paionni A, Cimminiello L, Fabbri C, Di Matteo C, Perone A, Serena A, Scarpato MA, Taberna A, D’Adamo D, Cecchi C, Di Primio C: The Florence Psychiatric Interview: Construction and preliminary validation. Psychiatr Network 1998; 1–2:78–91.
34.
Faravelli C, Bartolozzi D, Cimminiello L, Cecchi C, Cosci F, D’Adamo D, Di Matteo C, Di Primio C, Fabbri C, Lo Iacono B, Paionni A, Perone A, Rosi S, Scarpato MA, Serena A, Taberna A: The Florence Psychiatric Interview. Int J Methods Psychiatr Res 2001;10:157–171.
35.
Zimmermann C, Tansella M: Epidemiologia dei disturbi psichiatrici nella popolazione generale. Le esperienze e i risultati italiani. Epidemiol Psichiatr Soc 1994;3:5–14.
36.
Siciliani O, Burti L, Garzotto N, Siani R, Zimmermann-Tansella C: Salute mentale e disagio sociale e familiare a Verona-Sud. Riv Sper Freniatr Med Leg Alien Ment 1984;108(suppl):1123–1252.
37.
Zimmermann-Tansella C, Donini S, Ciommei AM, Siciliani O: Social factors associated with the use of psychotropic drugs: Alcohol abuse and minor psychiatric morbidity in the community. Acta Psychiatr Scand 1988;77:14–21.
38.
Zimmermann-Tansella C, Donini S, Ciommei AM, Siciliani O: Family factors associated with the use of psychotropic drugs, alcohol abuse and minor psychiatric morbidity in the community. Compr Psychiatry 1988;29:460–466.
39.
Tansella M, Williams P: The spectrum of psychiatric morbidity in a defined geographical area. Psychol Med 1989;19:765–770.
40.
Zimmermann-Tansella C, Donini S, Lattanzi M, Siciliani O, Turrina C, Wilkinson G: Life events, social problems and physical health status as predictors of emotional distress in men and women in the community. Psychol Med 1991;21:505–513.
41.
Zimmermann-Tansella C, Lattanzi M: The Ryle Marital Pattern Test as a predictor of symptoms of anxiety and depression in couples in the community. Soc Psychiatry Psychiatr Epidemiol 1991;26:221–229.
42.
Zimmermann-Tansella C, Donini S, Galvan U, Rizzetto A, Turrina C, Siciliani O, Wilkinson: Social support, adversities and emotional distress in an Italian community sample. J Clin Epidemiol 1993;46:65–75.
43.
Faravelli C, Incerpi G: Epidemiology of affective disorders in Florence. Preliminary results. Acta Psychiatr Scand 1985;72:331–333.
44.
Altamura AC, Carta MG, Carpiniello B, Piras A, Maccio MV, Marcia L: Lifetime prevalence of brief recurrent depression (results from a community survey). Eur Neuropsychopharmacol 1995;5(suppl 1):99–102.
45.
Carta MG, Carpiniello B, Kovess V, Porcedda R, Zedda A, Rudas N: Lifetime prevalence of major depression and dysthymia: Results of a community survey in Sardinia. Eur Neuropsychopharmacol 1995;5(suppl 1):103–107.
46.
Dubini A, Mannheimer R, Pancheri P: Depression in the community: Results of the first Italian survey. Int Clin Psychopharmacol 2001;16:49–53.
47.
Grabe HJ, Meyer C, Hapke U, Rumpf HJ, Freyberger HJ, Dilling H, John U: Somatoform pain disorder in the general population. Psychother Psychosom 2002;72:88–94.
48.
Politi PL, Prato Previde G, Torre E: Procedure multiple di individuazione del caso. Indagine su 2,069 soggetti maschi di 18 anni. Riv Sper Freniatr Med Leg Alien Ment 1988;18:904–913.
49.
Santonastaso P, Zanetti T, Sala A, Favaretto G, Vidotto G, Favaro A: Prevalence of eating disorders in Italy: A survey on a sample of 16-year-old female students. Psychother Psychosom 1996;65:158–62.
50.
Carpiniello B, Carta MG, Rudas N: Depression among elderly people. A psychosocial study of urban and rural populations. Acta Psychiatr Scand 1989;80:445–450.
51.
Binder J, Dobler-Mikola A, Angst J: A prospective epidemiological study of psychosomatic and psychiatric syndromes in young adults. Psychother Psychosom 1982;38:128–140.
52.
Carta MG, Carpiniello B, Morosini PL, Rudas N: Prevalence of mental disorders in Sardinia: A community study in an inland mining district. Psychol Med 1991;21:1061–1071.
53.
Morosini PL, Coppo P, Veltro F, Pasquini P: Prevalence of mental disorders in Tuscany: A community study in Lari (Pisa). Ann Ist Super Sanità 1992;28:547–552.
54.
Hinterhuber H, Hinterhuber IS: Malattie psichiatriche in regione rurale alpina: una indagine epidemiologica territoriale. Arch Psicol Neurol Psichiatr 1985;46:412–427.
55.
Goldman HH, Skodol AE, Lave TR: Revising Axis V for DSM-IV: A review of measures of social functioning. Am J Psychiatry 1992;149:1148–1156.
56.
Roy-Byrne P, Post RM, Uhde TW, Porcu T, Davis D: The longitudinal course of recurrent affective illness: Life chart data from research patients at the NIMH. Acta Psychiatr Scand 1985;71(suppl 317):1–34.
57.
Dunn G, Pickles A, Tansella M, Vazquez-Barquero JL: Two-phase epidemiological surveys in psychiatric research. Br J Psychiatry 1999;174:95–100.
58.
Dunn G, Everitt B: Clinical Biostatistics. An Introduction to Evidence-based Medicine. London, Edward Arnold, 1995.
59.
Matthews DE, Farewell VT: Using and Understanding Medical Statistics, ed 3. Basel, Karger, 1996.
60.
Robins LN, Regier DA: Psychiatric Disorders in America: The Epidemiological Catchment Area Study. New York, Free Press, 1991.
61.
Bland RC, Orn H, Newman SC: Lifetime prevalence of psychiatric disorders in Edmonton. Acta Psychiatr Scand 1988;77(suppl 338):24–32.
62.
Newman SC, Bland RC, Orn H: Morbidity risk of psychiatric disorders. Acta Psychiatr Scand 1988;77(suppl 338):50–56.
63.
Wells JE, Bushnell JA, Hornblow AR, Joyce PR, Oakley-Browne MA: Christchurch psychiatric epidemiology study. 1. Methodology and lifetime prevalence for specific psychiatric disorders. Aust NZ J Psychiatry 1989;23:315–326.
64.
Wittchen H-U, Essau CA, von Zerssen D, Krieg J-C, Zaudig M: Lifetime and six-month prevalence of mental disorders in the Munich Follow-Up Study. Eur Arch Psychiatry Clin Neurosci 1992;241:247–258.
65.
Kessler RC, McGonagle KA, Zhao S, Nelson CB, Hughes M, Eshleman S, Wittchen HU, Kendler KS: Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States: Results from the National Comorbidity Survey. Arch Gen Psychiatry 1994;51:8–19.
66.
Bijl RV, Ravelli A, van Zessen G: Prevalence of psychiatric disorder in the general population: Results of the Netherlands Mental Health Survey and Incidence Study (NEMESIS). Soc Psychiatry Psychiatr Epidemiol 1998;33:587–595.
67.
WHO International Consortium in Psychiatric Epidemiology: Cross-national comparisons of the prevalences and correlates of mental disorders. Bull World Health Organ 2000;78:413–426.
68.
Kringlen E, Torgersen S, Cramer V: A Norwegian psychiatric epidemiological study. Am J Psychiatry 2001;158:1091–1098.
69.
Bronisch T, Wittchen HU: Lifetime and 6-month prevalence of abuse and dependence of alcohol in the Munich Follow-up Study. Eur Arch Psychiatry Clin Neurosci 1992;241:273–282.
70.
De Girolamo G, Mazzi F, Morosini P, Polidori G, Reda V, Scarpino V, Serra G: La salute mentale in Italia: prevalenza dei disturbi mentali, caratteristiche dei disturbi ed uso dei servizi sanitari; in: Relazione sullo Stato Sanitario del Paese 2002 (RSSP 2002). Rome, Ministero della Salute, in press.
71.
Jenkins R, Lewis G, Bebbington P, Brugha T, Farrell M, Gill B, Meltzer H: The National Psychiatric Morbidity Surveys of Great Britain – initial findings from the Household survey. Psychol Med 1997;27:775–789.
© 2004 S. Karger AG, Basel
2004
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.