Impact of the DSM-IV to DSM-5 Changes on the National Survey on Drug Use and Health
The National Survey on Drug Use and Health (NSDUH) measurement of substance use disorders (SUD) and mental health issues are based on criteria provided in the Diagnostic and Statistical Manual of Mental Disorders (DSM), which was revised from DSM- IV to DSM-5 in 2013. The purpose of this report is twofold (1) to describe the changes in diagnostic criteria from DSM-IV to DSM-5, and (2) to evaluate the potential impact of the changes on NSDUH estimates using the best available evidence. Using 2002 to 2012 NSDUH data, this analysis reviewed the contribution of the individual items to the overall estimation of SUD. The report also compared the current DSM criteria for identifying mental disorders to criteria used in the Mental Health Surveillance Study (MHSS) clinical interview because the MHSS is the foundation for the NSDUH estimates of any mental illness (AMI) and serious mental illness (SMI). Evaluation of criteria changes for SUD indicates that current DSM-IV–based NSDUH estimates may underestimate DSM-5 diagnosed SUDs, depending on the substance being examined. The prevalence of single-item endorsement for SUDs indicates that alcohol, hallucinogens, and prescription pain relievers have the highest risk for misclassification of SUD resulting from unassessed criteria (i.e., substance craving). The DSM-IV–based MHSS criteria may provide an underestimate of DSM-5 disorders, which could lead to a higher rate of false negatives in the AMI and SMI algorithms used in NSDUH. The diagnostic changes from DSM-IV to DSM-5 for major depressive episode (MDE) are anticipated to have a minimal effect on NSDUH’s MDE prevalence rates for the general population. The NSDUH estimates of SUD, AMI, and SMI remain consistent with DSM-IV criteria and, to varying degrees, would need revision to be consistent with DSM-5 criteria however, the NSDUH questions regarding MDE may be sufficient for calculating MDE under both DSM-IV and DSM-5.