Under-recognition and under-treatment of DSM-IV classified mood and anxiety disorders among disability claimants

Abstract

Purpose: This study aimed to examine under-recognition, under-treatment and severity of under-treated DSM-IV mood and anxiety disorders among disability claimants. Methods: In a representative sample of Dutch disability claimants (n = 346), registry codes certified according to the International Classification of Diseases 10th edition (ICD-10) by insurance physicians, were compared with classifications according to the Diagnostic Statistical Manual of Mental Disorders (DSM-IV) detected by the Composite International Diagnostic Interview (CIDI). Levels of ICD-10/DSM-IV agreement were assessed for mood and anxiety disorders in the total sample, and prevalence of recent DSM-IV mood and anxiety disorders in a pure ICD-10 somatic subgroup. Treatment and severity of under-treated DSM-IV mood and anxiety disorders were assessed in two subgroups of disability claimants with either an ICD-10 somatic or mental disorder as primary cause of disability, irrespective of any ICD-10 comorbidity. Results: Levels of ICD-10/DSM-IV agreement were poor (κ: 0.237 for mood and 0.260 for anxiety disorders). In the pure ICD-10 somatic subgroup, the prevalence of DSM-IV mood and anxiety disorders was 3.8% and 11.4%, respectively. In the ICD-10 somatic subgroup irrespective of any ICD-10 comorbidity, 45.2% (major depressive disorder), 80.0% (social phobia) and 53.3% (general anxiety disorder) were under-treated. In the ICD-10 mental subgroup, these percentages were 44.7%, 80.9% and 33.4%, respectively. In both of these subgroups, under-treated DSM-IV mood and anxiety disorders were predominantly serious in terms of impairment and disability. Conclusions: Serious mental disorders were found to be substantially under-diagnosed and under-treated among disability claimants. To optimize diagnosis and treatment of disabling mental disorder, medical professionals in insurance, occupational and in the health care sector should closely collaborate. For claimants with under-treated mental disorders, tailor-made multidisciplinary interventions are needed to promote return to work and to prevent permanent disability.

Implications for Rehabilitation

• To promote rehabilitation of disability claimants with mental disorders, insurance physicians should closely collaborate with professionals in primary, secondary and occupational health care.

• To rehabilitate claimants with hitherto under-diagnosed and under-treated serious mental disorders, tailor-made multidisciplinary interventions are needed.

• These multidisciplinary interventions should involve professionals in mental health care, occupational and revalidation medicine, and should be aimed at improvement of mental health, functioning and return-to-work.

• Anxiety disorder
• diagnosis
• disability claimants
• mood disorder
• treatment

Acknowledgements

We thank Prof. Ute Bültmann for reviewing an early draft of this article. The Research Center for Insurance Medicine AMC-UMCG-UWV-VUmc, in Amsterdam, is a joint initiative of the Academic Medical Center (AMC), University Medical Center Groningen (UMCG), Social Security Institute (UWV) and the VU University Medical Centre (VUmc).