LAURA HELENA SILVEIRA GUERRA DE ANDRADE

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Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/23 - Laboratório de Psicopatologia e Terapêutica Psiquiátrica, Hospital das Clínicas, Faculdade de Medicina - Líder

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  • article 1852 Citação(ões) na Scopus
    Prevalence and Correlates of Bipolar Spectrum Disorder in the World Mental Health Survey Initiative
    (2011) MERIKANGAS, Kathleen R.; JIN, Robert; HE, Jian-Ping; KESSLER, Ronald C.; LEE, Sing; SAMPSON, Nancy A.; VIANA, Maria Carmen; ANDRADE, Laura Helena; HU, Chiyi; KARAM, Elie G.; LADEA, Maria; MEDINA-MORA, Maria Elena; ONO, Yutaka; POSADA-VILLA, Jose; SAGAR, Rajesh; WELLS, J. Elisabeth; ZARKOV, Zahari
    Context: There is limited information on the prevalence and correlates of bipolar spectrum disorder in international population-based studies using common methods. Objectives: To describe the prevalence, impact, patterns of comorbidity, and patterns of service utilization for bipolar spectrum disorder (BPS) in the World Health Organization World Mental Health Survey Initiative. Design, Setting, and Participants: Crosssectional, face-to-face, household surveys of 61 392 community adults in 11 countries in the Americas, Europe, and Asia assessed with the World Mental Health version of the World Health Organization Composite International Diagnostic Interview, version 3.0, a fully structured, lay-administered psychiatric diagnostic interview. Main Outcome Measures: Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) disorders, severity, and treatment. Results: The aggregate lifetime prevalences were 0.6% for bipolar type I disorder (BP-I), 0.4% for BP-II, 1.4% for subthreshold BP, and 2.4% for BPS. Twelve-month prevalences were 0.4% for BP-I, 0.3% for BP-II, 0.8% for subthreshold BP, and 1.5% for BPS. Severity of both manic and depressive symptoms as well as suicidal behavior increased monotonically from subthreshold BP to BP-I. By contrast, role impairment was similar across BP subtypes. Symptom severity was greater for depressive episodes than manic episodes, with approximately 74.0% of respondents with depression and 50.9% of respondents with mania reporting severe role impairment. Three-quarters of those with BPS met criteria for at least 1 other disorder, with anxiety disorders (particularly panic attacks) being the most common comorbid condition. Less than half of those with lifetime BPS received mental health treatment, particularly in low-income countries, where only 25.2% reported contact with the mental health system. Conclusions: Despite cross-site variation in the prevalence rates of BPS, the severity, impact, and patterns of comorbidity were remarkably similar internationally. The uniform increases in clinical correlates, suicidal behavior, and comorbidity across each diagnostic category provide evidence for the validity of the concept of BPS. Treatment needs for BPS are often unmet, particularly in low-income countries.
  • article 25 Citação(ões) na Scopus
    Twelve-month mental health service use in six countries of the Americas: A regional report from the World Mental Health Surveys
    (2020) BORGES, G.; AGUILAR-GAXIOLA, S.; ANDRADE, L.; BENJET, C.; CIA, A.; KESSLER, R. C.; OROZCO, R.; SAMPSON, N.; STAGNARO, J. C.; TORRES, Y.; VIANA, Maria Carmen; MEDINA-MORA, M. E.
    Aims. To provide cross-national data for selected countries of the Americas on service utilization for psychiatric and substance use disorders, the distribution of these services among treatment sectors, treatment adequacy and factors associated with mental health treatment and adequacy of treatment. Methods. Data come from data collected from 6710 adults with 12 month mental disorder surveys across seven surveys in six countries in North (USA), Central (Mexico) and South (Argentina, Brazil, Colombia, Peru) America who were interviewed 2001-2015 as part of the World Health Organization (WHO) World Mental Health (WMH) Surveys. DSM-IV diagnoses were made with the WHO Composite International Diagnostic Interview (CIDI). Interviews also assessed service utilization by the treatment sector, adequacy of treatment received and socio-demographic correlates of treatment. Results. Little over one in four of respondents with any 12 month DSM-IV/CIDI disorder received any treatment. Although the vast majority (87.1%) of this treatment was minimally adequate, only 35.3% of cases received treatment that met acceptable quality guidelines. Indicators of social-advantage (high education and income) were associated with higher rates of service use and adequacy, but a number of other correlates varied across survey sites. Conclusions. These results shed light on an enormous public health problem involving under-treatment of common mental disorders, although the problem is most extreme among people with social disadvantage. Promoting services that are more accessible, especially for those with few resources, is urgently needed.
  • article 604 Citação(ões) na Scopus
    Undertreatment of people with major depressive disorder in 21 countries
    (2017) THORNICROFT, Graham; CHATTERJI, Somnath; EVANS-LACKO, Sara; GRUBER, Michael; SAMPSON, Nancy; AGUILAR-GAXIOLA, Sergio; AL-HAMZAWI, Ali; ALONSO, Jordi; ANDRADE, Laura; BORGES, Guilherme; BRUFFAERTS, Ronny; BUNTING, Brendan; ALMEIDA, Jose Miguel Caldas de; FLORESCU, Silvia; GIROLAMO, Giovanni de; GUREJE, Oye; HARO, Josep Maria; HE, Yanling; HINKOV, Hristo; KARAM, Elie; KAWAKAMI, Norito; LEE, Sing; NAVARRO-MATEU, Fernando; PIAZZA, Marina; POSADA-VILLA, Jose; GALVIS, Yolanda Torres de; KESSLER, Ronald C.
    Background Major depressive disorder (MDD) is a leading cause of disability worldwide. Aims To examine the: (a) 12-month prevalence of DSM-IV MDD; (b) proportion aware that they have a problem needing treatment and who want care; (c) proportion of the latter receiving treatment; and (d) proportion of such treatment meeting minimal standards. Method Representative community household surveys from 21 countries as part of the World Health Organization World Mental Health Surveys. Results Of 51 547 respondents, 4.6% met 12-month criteria for DSM-IV MDD and of these 56.7% reported needing treatment. Among those who recognised their need for treatment, most (71.1%) made at least one visit to a service provider. Among those who received treatment, only 41.0% received treatment that met minimal standards. This resulted in only 16.5% of all individuals with 12-month MDD receiving minimally adequate treatment. Conclusions Only a minority of participants with MDD received minimally adequate treatment: 1 in 5 people in high-income and 1 in 27 in low-/lower-middle-income countries. Scaling up care for MDD requires fundamental transformations in community education and outreach, supply of treatment and quality of services.
  • article 24 Citação(ões) na Scopus
    Childhood generalized specific phobia as an early marker of internalizing psychopathology across the lifespan: results from the World Mental Health Surveys
    (2019) VRIES, Ymkje Anna de; AL-HAMZAWI, Ali; ALONSO, Jordi; BORGES, Guilherme; BRUFFAERTS, Ronny; BUNTING, Brendan; CALDAS-DE-ALMEIDA, Jose Miguel; CIA, Alfredo H.; GIROLAMO, Giovanni De; V, Rumyana Dinolova; ESAN, Oluyomi; FLORESCU, Silvia; GUREJE, Oye; HARO, Josep Maria; HU, Chiyi; KARAM, Elie G.; KARAM, Aimee; KAWAKAMI, Norito; KIEJNA, Andrzej; KOVESS-MASFETY, Viviane; LEE, Sing; MNEIMNEH, Zeina; NAVARRO-MATEU, Fernando; PIAZZA, Marina; SCOTT, Kate; HAVE, Margreet ten; TORRES, Yolanda; VIANA, Maria Carmen; KESSLER, Ronald C.; JONGE, Peter de; AGUILAR-GAXIOLA, Sergio; AL-KAISY, Mohammed Salih; ANDRADE, Laura Helena; BENJET, Corina; BROMET, Evelyn J.; ALMEIDA, Jose Miguel Caldas de; CARDOSO, Graca; CHATTERJI, Somnath; DEGENHARDT, Louisa; DEMYTTENAERE, Koen; GIROLAMO, Giovanni de; HINKOV, Hristo; HU, Chi-yi; KARAM, Aimee Nasser; LEPINE, Jean-Pierre; LEVINSON, Daphna; MCGRATH, John; MEDINA-MORA, Maria Elena; MOSKALEWICZ, Jacek; PENNELL, Beth-Ellen; POSADA-VILLA, Jose; SCOTT, Kate M.; SLADE, Tim; STAGNARO, Juan Carlos; STEIN, Dan J.; WHITEFORD, Harvey; WILLIAMS, David R.; WOJTYNIAK, Bogdan
    BackgroundSpecific phobia (SP) is a relatively common disorder associated with high levels of psychiatric comorbidity. Because of its early onset, SP may be a useful early marker of internalizing psychopathology, especially if generalized to multiple situations. This study aimed to evaluate the association of childhood generalized SP with comorbid internalizing disorders.MethodsWe conducted retrospective analyses of the cross-sectional population-based World Mental Health Surveys using the Composite International Diagnostic Interview. Outcomes were lifetime prevalence, age of onset, and persistence of internalizing disorders; past-month disability; lifetime suicidality; and 12-month serious mental illness. Logistic and linear regressions were used to assess the association of these outcomes with the number of subtypes of childhood-onset (<13years) SP.ResultsAmong 123,628 respondents from 25 countries, retrospectively reported prevalence of childhood SP was 5.9%, 56% of whom reported one, 25% two, 10% three, and 8% four or more subtypes. Lifetime prevalence of internalizing disorders increased from 18.2% among those without childhood SP to 46.3% among those with one and 75.6% those with 4+ subtypes (OR=2.4, 95% CI 2.3-2.5, p<0.001). Twelve-month persistence of lifetime internalizing comorbidity at interview increased from 47.9% among those without childhood SP to 59.0% and 79.1% among those with 1 and 4+ subtypes (OR=1.4, 95% CI 1.4-1.5, p<0.001). Respondents with 4+ subtypes also reported significantly more disability (3.5days out of role in the past month) than those without childhood SP (1.1days) or with only 1 subtype (1.8days) (B=0.56, SE 0.06, p<0.001) and a much higher rate of lifetime suicide attempts (16.8%) than those without childhood SP (2.0%) or with only 1 subtype (6.5%) (OR=1.7, 95% CI 1.7-1.8, p<0.001).ConclusionsThis large international study shows that childhood-onset generalized SP is related to adverse outcomes in the internalizing domain throughout the life course. Comorbidity, persistence, and severity of internalizing disorders all increased with the number of childhood SP subtypes. Although our study cannot establish whether SP is causally associated with these poor outcomes or whether other factors, such as a shared underlying vulnerability, explain the association, our findings clearly show that childhood generalized SP identifies an important target group for early intervention.
  • article 27 Citação(ões) na Scopus
    Disability Mediates the Impact of Common Conditions on Perceived Health
    (2013) ALONSO, Jordi; VILAGUT, Gemma; ADROHER, Nuria D.; CHATTERJI, Somnath; HE, Yanling; ANDRADE, Laura Helena; BROMET, Evelyn; BRUFFAERTS, Ronny; FAYYAD, John; FLORESCU, Silvia; GIROLAMO, Giovanni de; GUREJE, Oye; HARO, Josep Maria; HINKOV, Hristo; HU, Chiyi; IWATA, Noboru; LEE, Sing; LEVINSON, Daphna; LEPINE, Jean Pierre; MATSCHINGER, Herbert; MEDINA-MORA, Maria Elena; O'NEILL, Siobhan; HORMEL, J.; POSADA-VILLA, Jose A.; TAIB, Nezar Ismet; XAVIER, Miguel; KESSLER, Ronald C.
    Background: We examined the extent to which disability mediates the observed associations of common mental and physical conditions with perceived health. Methods and Findings: WHO World Mental Health (WMH) Surveys carried out in 22 countries worldwide (n = 51,344 respondents, 72.0% response rate). We assessed nine common mental conditions with the WHO Composite International Diagnostic Interview (CIDI), and ten chronic physical with a checklist. A visual analog scale (VAS) score (0, worst to 100, best) measured perceived health in the previous 30 days. Disability was assessed using a modified WHO Disability Assessment Schedule (WHODAS), including: cognition, mobility, self-care, getting along, role functioning (life activities), family burden, stigma, and discrimination. Path analysis was used to estimate total effects of conditions on perceived health VAS and their separate direct and indirect (through the WHODAS dimensions) effects. Twelve-month prevalence was 14.4% for any mental and 51.4% for any physical condition. 31.7% of respondents reported difficulties in role functioning, 11.4% in mobility, 8.3% in stigma, 8.1% in family burden and 6.9% in cognition. Other difficulties were much less common. Mean VAS score was 81.0 (SD = 0.1). Decrements in VAS scores were highest for neurological conditions (9.8), depression (8.2) and bipolar disorder (8.1). Across conditions, 36.8% (IQR: 31.2-51.5%) of the total decrement in perceived health associated with the condition were mediated by WHODAS disabilities (significant for 17 of 19 conditions). Role functioning was the dominant mediator for both mental and physical conditions. Stigma and family burden were also important mediators for mental conditions, and mobility for physical conditions. Conclusions: More than a third of the decrement in perceived health associated with common conditions is mediated by disability. Although the decrement is similar for physical and mental conditions, the pattern of mediation is different. Research is needed on the benefits for perceived health of targeted interventions aimed at particular disability dimensions.
  • article 44 Citação(ões) na Scopus
    The cross-national structure of mental disorders: results from the World Mental Health Surveys
    (2018) JONGE, Peter de; WARDENAAR, Klaas J.; LIM, Carmen C. W.; AGUILAR-GAXIOLA, Sergio; ALONSO, Jordi; ANDRADE, Laura Helena; BUNTING, Brendan; CHATTERJI, Somnath; CIUTAN, Marius; GUREJE, Oye; KARAM, Elie G.; LEE, Sing; MEDINA-MORA, Maria Elena; MOSKALEWICZ, Jacek; NAVARRO-MATEU, Fernando; PENNELL, Beth-Ellen; PIAZZA, Marina; POSADA-VILLA, Jose; TORRES, Yolanda; KESSLER, Ronald C.; SCOTT, Kate
    BackgroundThe patterns of comorbidity among mental disorders have led researchers to model the underlying structure of psychopathology. While studies have suggested a structure including internalizing and externalizing disorders, less is known with regard to the cross-national stability of this model. Moreover, little data are available on the placement of eating disorders, bipolar disorder and psychotic experiences (PEs) in this structure.MethodsWe evaluated the structure of mental disorders with data from the World Health Organization Composite International Diagnostic Interview, including 15 lifetime mental disorders and six PEs. Respondents (n = 5478-15 499) were included from 10 high-, middle- and lower middle-income countries across the world aged 18 years or older. Confirmatory factor analyses (CFAs) were used to evaluate and compare the fit of different factor structures to the lifetime disorder data. Measurement invariance was evaluated with multigroup CFA (MG-CFA).ResultsA second-order model with internalizing and externalizing factors and fear and distress subfactors best described the structure of common mental disorders. MG-CFA showed that this model was stable across countries. Of the uncommon disorders, bipolar disorder and eating disorder were best grouped with the internalizing factor, and PEs with a separate factor.ConclusionsThese results indicate that cross-national patterns of lifetime common mental-disorder comorbidity can be explained with a second-order underlying structure that is stable across countries and can be extended to also cover less common mental disorders.
  • article 15 Citação(ões) na Scopus
    Alcohol Abuse in Developed and Developing Countries in the World Mental Health Surveys: Socially Defined Consequences or Psychiatric Disorder?
    (2014) GLANTZ, Meyer D.; MEDINA-MORA, Maria Elena; PETUKHOVA, Maria; ANDRADE, Laura Helena; ANTHONY, James C.; GIROLAMO, Giovanni de; GRAAF, Ron de; DEGENHARDT, Louisa; DEMYTTENAERE, Koen; FLORESCU, Silvia; GUREJE, Oye; HARO, Josep Maria; HORIGUCHI, Itsuko; KARAM, Elie G.; KOSTYUCHENKO, Stanislav; LEE, Sing; LEPINE, Jean-Pierre; MATSCHINGER, Herbert; NEUMARK, Yehuda; POSADA-VILLA, Jose; SAGAR, Rajesh; STEIN, Dan J.; TOMOV, Toma; WELLS, J. Elisabeth; CHATTERJI, Somnath; KESSLER, Ronald C.
    BackgroundPrevious single country research has raised concerns that: (1) the DSM-IV diagnosis of alcohol abuse (AA) is met primarily through the hazardous use criterion related to drinking and driving and (2) that the hazardous use and social consequences AA criteria primarily reflect varying socioeconomic and cultural factors rather than psychiatric disorder. MethodsUsing representative cross-national data from the 21 countries in the World Mental Health surveys, adults meeting DSM-IV lifetime criteria for AA but not dependence from 10 developed (n=46,071) and 11 developing (n=49,761) countries were assessed as meeting AA with the hazardous use or the social consequences criteria. ResultsBetween 29.3% (developed) and 16.2% (developing) of respondents with AA met only the hazardous use criterion. AA cases with and without hazardous use were similar in age-of-onset, course, predictors, and psychopathological consequences in both developed and developing countries. Discussion and ConclusionsDespite some associations of the AA criteria with socioeconomic factors, the hazardous use and social consequences criteria were significantly associated with psychiatric predictors and sequelae. The findings indicate that these criteria reflect psychiatric disorder and are appropriate for inclusion as DSM-5 Alcohol Use Disorder criteria. Scientific SignificanceThese findings support a psychiatric rather than a sociocultural view of the hazardous use and social consequences symptoms and provide evidence that they are appropriate diagnostic criteria cross-nationally with utility in a wide range of socioeconomic environments. This suggests consideration for their adoption by ICD-11. Further research is needed on the implications of these results for prevention and treatment. (Am J Addict 2014;23:145-155)
  • article 51 Citação(ões) na Scopus
    The associations between psychotic experiences and substance use and substance use disorders: findings from the World Health Organization World Mental Health surveys
    (2018) DEGENHARDT, Louisa; SAHA, Sukanta; LIM, Carmen C. W.; AGUILAR-GAXIOLA, Sergio; AL-HAMZAWI, Ali; ALONSO, Jordi; ANDRADE, Laura H.; BROMET, Evelyn J.; BRUFFAERTS, Ronny; CALDAS-DE-ALMEIDA, Jose Miguel; GIROLAMO, Giovanni de; FLORESCU, Silvia; GUREJE, Oye; HARO, Josep M.; KARAM, Elie G.; KARAM, Georges; KOVESS-MASFETY, Viviane; LEE, Sing; LEPINE, Jean-Pierre; MAKANJUOLA, Victor; MEDINA-MORA, Maria E.; MNEIMNEH, Zeina; NAVARRO-MATEU, Fernando; PIAZZA, Marina; POSADA-VILLA, Jose; SAMPSON, Nancy A.; SCOTT, Kate M.; STAGNARO, Juan Carlos; HAVE, Margreet Ten; KENDLER, Kenneth S.; KESSLER, Ronald C.; MCGRATH, John J.
    Background and aims Prior research has found bidirectional associations between psychotic experiences (PEs) and selected substance use disorders. We aimed to extend this research by examining the bidirectional association between PEs and various types of substance use (SU) and substance use disorders (SUDs), and the influence of antecedent mental disorders on these associations. Design, setting, participants and measurements We used data from the World Health Organization World Mental Health surveys. A total of 30902 adult respondents across 18 countries were assessed for (a) six types of life-time PEs, (b) a range of types of SU and DSM-IV SUDs and (c) mental disorders using the Composite International Diagnostic Interview. Discrete-time survival analyses based on retrospective age-at-onset reports examined the bidirectional associations between PEs and SU/SUDs controlling for antecedent mental disorders. Findings After adjusting for demographics, comorbid SU/SUDs and antecedent mental disorders, those with prior alcohol use disorders [odds ratio (OR)=1.6, 95% confidence interval (CI)=1.2-2.0], extra-medical prescription drug use (OR=1.5, 95% CI=1.1-1.9), alcohol use (OR=1.4, 95% CI=1.1-1.7) and tobacco use (OR=1.3, 95% CI=1.0-1.8) had increased odds of subsequent first onset of PEs. In contrast, those with temporally prior PEs had increased odds of subsequent onset of tobacco use (OR=1.5, 95% CI=1.2-1.9), alcohol use (OR=1.3, 95% CI=1.1-1.6) or cannabis use (OR=1.3, 95% CI=1.0-1.5) as well as of all substance use disorders (ORs ranged between 1.4 and 1.5). There was a dose response relationship between both count and frequency of PEs and increased subsequent odds of selected SU/SUDs. Conclusions Associations between psychotic experiences (PEs) and substance use/substance use disorders (SU/SUDs) are often bidirectional, but not all types of SU/SUDs are associated with PEs. These findings suggest that it is important to be aware of the presence of PEs within those with SUDs or at risk of SUDs, given the plausibility that they may each impact upon the other.
  • article 89 Citação(ões) na Scopus
    Age of Onset and Lifetime Projected Risk of Psychotic Experiences: Cross-National Data From the World Mental Health Survey
    (2016) MCGRATH, John J.; SAHA, Sukanta; AL-HAMZAWI, Ali O.; ALONSO, Jordi; ANDRADE, Laura; BORGES, Guilherme; BROMET, Evelyn J.; BROWNE, Mark Oakley; BRUFFAERTS, Ronny; ALMEIDA, Jose M. Caldas de; FAYYAD, John; FLORESCU, Silvia; GIROLAMO, Giovanni de; GUREJE, Oye; HU, Chiyi; JONGE, Peter de; KOVESS-MASFETY, Viviane; LEPINE, Jean Pierre; LIM, Carmen C. W.; NAVARRO-MATEU, Fernando; PIAZZA, Maria; SAMPSON, Nancy; POSADA-VILLA, Jose; KENDLER, Kenneth S.; KESSLER, Ronald C.
    Background: Given the early age of onset (AOO) of psychotic disorders, it has been assumed that psychotic experiences (PEs) would have a similar early AOO. The aims of this study were to describe (a) the AOO distribution of PEs, (b) the projected lifetime risk of PEs, and (c) the associations of PE AOO with selected PE features. Methods: Data came from the WHO World Mental Health (WMH) surveys. A total of 31 261 adult respondents across 18 countries were assessed for lifetime prevalence of PE. Projected lifetime risk (at age 75 years) was estimated using a 2-part actuarial method. AOO distributions were described for the observed and projected estimates. We examined associations of AOO with PE type metric and annualized PE frequency. Results: Projected lifetime risk for PEs was 7.8% (SE = 0.3), slightly higher than lifetime prevalence (5.8%, SE = 0.2). The median (interquartile range; IQR) AOO based on projected lifetime estimates was 26 (17-41) years, indicating that PEs commence across a wide age range. The AOO distributions for PEs did not differ by sex. Early AOO was positively associated with number of PE types (F = 14.1, P <.001) but negatively associated with annualized PE frequency rates (F = 8.0, P <.001). Discussion: While most people with lifetime PEs have first onsets in adolescence or young adulthood, projected estimates indicate that nearly a quarter of first onsets occur after age 40 years. The extent to which late onset PEs are associated with (a) late onset mental disorders or (b) declining cognitive and/or sensory function need further research.
  • article 6 Citação(ões) na Scopus
    A global field study of the international classification of diseases (ICD-11) mood disorders clinical descriptions and diagnostic guidelines
    (2021) KOGAN, Cary S.; MAJ, Mario; REBELLO, Tahilia J.; KEELEY, Jared W.; KULYGINA, Maya; MATSUMOTO, Chihiro; ROBLES, Rebeca; HUANG, Jingjing; ZHONG, Na; CHAKRABARTI, Subho; FIGUEIRA, Maria Luisa; STEIN, Dan J.; STRAKOWSKI, Stephen M.; GARCIA-PACHECO, Jose A.; BURNS, Samantha; MONTOYA, Madeline; ANDRADE, Laura; AYUSO-MATEOS, Jose L.; ARANGO, Ivan; BALHARA, Yatan Pal Singh; BRYANT, Richard; COURNOS, Francine; PORTO, Jose Alberto Del; MEYER, Thomas D.; MEDINA-MORA, Maria-Elena; GUREJE, Oye; FIRST, Michael B.; GAEBEL, Wolfgang; KHOURY, Brigitte; KRASNOV, Valery N.; MARI, Jair de Jesus; MARUTA, Toshimasa; PIKE, Kathleen M.; ROBERTS, Michael C.; SHARAN, Pratap; ZHAO, Min; REED, Geoffrey M.
    Background: We report results of an internet-based field study evaluating the diagnostic guidelines for ICD-11 mood disorders. Accuracy of clinicians' diagnostic judgments applying draft ICD-11 as compared to the ICD10 guidelines to standardized case vignettes was assessed as well as perceived clinical utility. Methods: 1357 clinician members of the World Health Organization's Global Clinical Practice Network completed the study in English, Spanish, Japanese or Russian. Participants were randomly assigned to apply ICD11 or ICD-10 guidelines to one of eleven pairs of case vignettes. Results: Clinicians using the ICD-11 and ICD-10 guidelines achieved similar levels of accuracy in diagnosing mood disorders depicted in vignettes. Those using the ICD-11 were more accurate in identifying depressive episode in recurrent depressive disorder. There were no statistically significant differences detected across classifications in the accuracy of identifying dysthymic or cyclothymic disorder. Circumscribed problems with the proposed ICD-11 guidelines were identified including difficulties differentiating bipolar type I from bipolar type II disorder and applying revised severity ratings to depressive episodes. Clinical utility of ICD-11 bipolar disorders was found to be significantly lower than for ICD-10 equivalent categories. Limitations: Standardized case vignettes were manipulated to evaluate specific changes. The degree of accuracy of clinicians' diagnostic judgments may not reflect clinical decision-making with patients. Conclusions: Alignment of the ICD-11 with current research appears to have been achieved without sacrificing diagnostic accuracy or clinical utility though specific training may be necessary as ICD-11 is implemented worldwide. Areas in which the ICD-11 guidelines did not perform as intended resulted in further revisions.