Hidden psychiatric morbidity in a vocational programme for people with intellectual disability.
One in three adults with ID in vocational programs has a diagnosable psychiatric disorder—screen with standardized tools even when no overt symptoms are reported.
01Research in Context
What this study did
Heavey et al. (2000) checked every adult in a model vocational center for hidden mental-health problems.
They used full DSM-III-R interviews, not just staff guesses.
The center served adults with intellectual disability who seemed stable enough to work.
What they found
One in three adults met criteria for a real psychiatric disorder.
Half of these cases had never been spotted before.
Three in ten had a diagnosis but were getting poor or no treatment.
How this fits with other research
Rojahn et al. (2012) later showed the Brief Symptom Inventory works as a quick screener, giving you a five-minute tool instead of the long DSM interview.
Aman et al. (2002) built on the same worry by testing the Spanish PAS-ADD-10 interview; they found it was easy to give but still missed some diagnoses, so the hunt for better tools continued.
Coe et al. (1997) had already warned that half of adults with learning disabilities show personality problems; L et al. simply widen the lens to mood, anxiety, and psychotic disorders in a work setting.
Why it matters
If you run day programs or job sites, do not trust "no problem" reports. Build a brief, valid screener like the BSI into annual plans. Catch the hidden third who need real treatment so they can stay employed and out of crisis.
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02At a glance
03Original abstract
The aim of the present study was to assess the point-prevalence of psychiatric disorders according to DSM-III-R criteria and the hidden morbidity in individuals with intellectual disability working in a vocational setting. The present study was carried out in a vocational centre in Southern Spain which is considered to be a model for social integration. One hundred and thirty workers with intellectual disability were interviewed by two experienced clinicians using the Assessment and Information Rating Profile, DSM-III-R criteria, and the General Assessment of Functioning and Clinical Global Impression scales. The point-prevalence of psychiatric morbidity, hidden morbidity and treatment adequacy were estimated. Morbidity was hidden (i.e. not previously diagnosed) in 50% of psychiatric cases. Forty-two (32.3%) subjects had a psychiatric diagnosis with the following distribution: schizophrenia (17.7%), other psychotic disorders (9.23%), mood disorders (4.61%), adaptive disorders (2.31%), anxiety disorders (1.54%) and other psychiatric disorders (6.15%). Treatment was judged inadequate in 30% of subjects. The point-prevalence of psychiatric problems in a vocational setting in Spain was similar to that found in other environments. Hidden morbidity was similar to that found in primary care. The present study highlights the need for standardized instruments for psychiatric assessment in non-clinical settings as well as specific training in this area.
Journal of intellectual disability research : JIDR, 2000 · doi:10.1046/j.1365-2788.2000.00272.x