‘Included in Diagnosis’. Proposal to include psychosocial adversities (life difficulties) that impact mental health in ICD and DSM diagnoses.

‘Included in Diagnosis’

Proposal to include psychosocial adversities that impact mental health in ICD and DSM diagnoses

Kate Allsopp and Peter Kinderman, from the University of Liverpool, recently published a commentary in The Lancet Psychiatry. In the article, the authors call for psychosocial adversities associated with mental health challenges to be listed alongside ICD-10 or DSM-5 diagnoses.


“Imagine if it were as serious to fail to document extreme poverty as it would be for a clinician to fail to identify severe depression,” suggest the authors.


The commentary was written in response to a systemic review conducted by Wagner Silva Ribeiro and colleagues finding an association between income inequality and mental illness. Many studies have suggested that adversity and poverty negatively impact mental health and cognition.


The authors write, “the United Nations Special Rapporteur characterizes mental health care not as a crisis of individual conditions, but as a crisis of social obstacles, which hinders individual rights.” The writers, therefore, conclude that “the circumstances that have given rise to distress should be formally recorded alongside the distress itself.”


Both the International Classification of Diseases (ICD) and Diagnostic and Statistical Manual of Mental Disorders (DSM) include descriptors about adversity (e.g., neglect, abandonment). However, these codes are seldom included in formal diagnoses. The authors suggest that the same codes used in a UK government program to reassess disability benefits (e.g., insufficient social support, inadequate housing, extreme poverty) be included in the diagnosis and routine data collection.


“Broadening routine data capture within UK National Health Service records could establish more inclusive, social, systemic, and psychologically comprehensive patterns of difficulties, which could target information regarding established social determinants of mental health problems, such as inequality, poverty, and trauma,” state the authors.’


The authors note that while it may not be clinicians’ role to resolve psychosocial adversities facing their clients, “as clinicians, we might be better able to serve our clients if we can use such data capture to apply more effective pressure on the political system and drive wider system reform.” Therefore, including psychosocial adversities in diagnosis not only contextualizes individuals’ distress but may facilitate policy change and social advocacy.


Allsopp, K., & Kinderman, P. (2017). A proposal to introduce formal recording of psychosocial adversities associated with mental health using ICD-10 codes. The Lancet Psychiatry4(9), 664-665. doi:10.1016/S2215-0366(17)30318-8 (Link)

Psychosocial Adversities Should be Included in Diagnosis

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