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Diagnosis was based on the World Health Organization's Composite International Diagnostic Elsa Peretti Sevillana pendant (CIDI) in conjunction with the DSM-III-R in the NCS9 and CIDI in conjunction with the fourth edition of DSM (DSM-IV) in the NCS-R.10 Diagnoses included anxiety disorders (e.g., panic disorder, generalized anxiety disorder, phobias, and posttraumatic stress disorder), mood disorders (e.g., major depression, dysthymia, and bipolar disorder), and substance-abuse disorders (e.g., alcohol and drug abuse and dependence). Interviews conducted for clinical reappraisal documented good concordance and conservative estimates of prevalence, as compared with diagnoses made by clinicians who were unaware of the responses given in the diagnostic interview.11,12 Twelve-month disorders were considered to be present if they had occurred at any time during the 12 months before the interview, even if the disorders had subsequently remitted with treatment.

Because the criteria of the DSM-III-R and of the DSM-IV differ too greatly to justify direct Atlas cube lock pendant of prevalence in the data from the NCS and NCS-R, the trend analysis was based on a recalibration of both surveys according to a summary rating of severity that was developed for the NCS-R and then applied (imputed) to the data from the NCS. This rating has been described in detail elsewhere.13 In brief, a serious disorder was defined as either one that met the 12-month criteria for schizophrenia, any other nonaffective psychosis, bipolar I disorder or bipolar II disorder, or substance dependence with a syndrome of physiological dependence, a suicide attempt or having a suicide plan in conjunction with a diagnosis of a disorder according to the Return to Tiffany Heart tag pendant of the NCS-R and DSM-IV, a self-report of "severe" impairment in role functioning in two or more areas owing to a mental disorder, or a self-reported functional impairment associated with a mental disorder consistent with a score of 50 or less according to the Global Assessment of Functioning Scale (scores range from 0 to 100, with higher scores indicating better functioning).14 A mental disorder that did not meet the criteria for a serious disorder was classified as a moderate or mild disorder on the basis of the subject's responses to disorder-specific questions on the Sheehan Disability Scales for the assessment of clinical severity.15

The imputation of scores for severity of disorder to cases included in the NCS was based on Elsa Peretti Butterfly Earrings calculated with the use of logistic-regression equations in the NCS-R in which symptom measures available in both surveys were used to predict the presence of a serious disorder in one respondent as compared with all other respondents, a serious-to-moderate disorder as compared with mild disorders in all other respondents, and the presence of any disorder as compared with no disorder. The accuracy of Atlas Cube Earrings was good with all three equations (area under the curve, 0.7 for a serious disorder, 0.8 for a serious-to-moderate disorder, and 0.8 for any disorder). The coefficients in these equations were used to generate predicted probabilities for each respondent included in both surveys for each nested outcome, and these probabilities, in turn, were used to impute discrete scores on the scale for severity (with a range from none to serious).