New York University, New York City, NY, USA.
Health Aff (Millwood). 2013 May;32(5):984-93. doi: 10.1377/hlthaff.2011.0596. Epub 2013 Apr 24.
At stake in the May 2013 publication of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), are billions of dollars in insurance payments and government resources, as well as the diagnoses and treatment of millions of patients. We argue that the most recent revision process has missed social determinants of mental health disorders and their diagnosis: environmental factors triggering biological responses that manifest themselves in behavior; differing cultural perceptions about what is normal and what is abnormal behavior; and institutional pressures related to such matters as insurance reimbursements, disability benefits, and pharmaceutical marketing. In addition, the experts charged with revising the DSM lack a systematic way to take population-level variations in diagnoses into account. To address these problems, we propose the creation of an independent research review body that would monitor variations in diagnostic patterns, inform future DSM revisions, identify needed changes in mental health policy and practice, and recommend new avenues of research. Drawing on the best available knowledge, the review body would make possible more precise and equitable psychiatric diagnoses and interventions.
在 2013 年 5 月发布的《精神障碍诊断与统计手册》第五版（DSM-5）中，涉及到数十亿美元的保险支付和政府资源，以及数百万患者的诊断和治疗。我们认为，最近的修订过程忽略了心理健康障碍的社会决定因素及其诊断：触发生物反应的环境因素，这些反应表现为行为；不同文化对正常和异常行为的看法；以及与保险报销、残疾福利和药品营销等有关的制度压力。此外，负责修订 DSM 的专家缺乏一种系统的方法来考虑诊断水平上的人群变化。为了解决这些问题，我们提议成立一个独立的研究审查机构，该机构将监测诊断模式的变化，为未来的 DSM 修订提供信息，确定精神卫生政策和实践中需要做出的改变，并为新的研究途径提出建议。该审查机构将利用现有的最佳知识，使精神病学诊断和干预更加精确和公平。
