An Exploratory Case Study of the Types of Resources Black Boys Use to Support Their Mental Health.

Black adolescent boys experience mental health challenges because of their exposure to a greater frequency and severity of psychosocial stressors. This study used a sample of Black boys at a high school in southeastern Michigan as a case study to understand the types of resources Black boys might use to support their mental health. After conducting a rigorous analysis of the study data using a rapid and an accelerated data reduction technique, four themes helped us answer the question: What kinds of mental health support resources are Black boys using? Four themes emerged from our analysis: online resources, community and trusted individuals, self-reliance, and additional needs. This case study is a springboard for further work to tailor a mental health education and support intervention, such as the YBMen Project, for Black boys and for building additional support amid the multiple crises occurring that impact their mental health and safety. Findings have implications for future research, practice, and policy to improve the mental health of Black boys in high school.

Prevalence, Severity and Burden of Post-Traumatic Stress Disorder in Black Men and Women Across the Adult Life span.

Objectives: To examine post-traumatic stress disorder (PTSD) among Black adults in younger, middle, and older ages. Methods: Using nationally representative data from the National Survey of American Life, we estimated lifetime and 12-month prevalence of PTSD in Black men and women ages 18-34, 35-49, and 50+. We determined PTSD persistence and severity by age group, then associations of PTSD with socio-economic status, chronic stress, and racial discrimination in middle age. Results: The lifetime prevalence of PTSD was higher in Black women/men ages 18-34 (prevalence=14.0%/6.3%) and 35-49 (12.8%/4.6%) versus 50 and older (8.7%/5.1%). Those ages 35-49 were more likely than younger/older Black adults to have severe interference in work, relationships, and activities domains. In middle age, PTSD was associated with unemployment, lower education, poverty, and stress in Black men, and unemployment, divorce, poverty, stress, and discrimination in Black women. Discussion: Black women experience a disproportionate burden of PTSD in middle age.

Mechanisms of Cardiometabolic Health Outcomes and Disparities: What Characteristics of Chronic Stressors are Linked to HPA-Axis Dysregulation?

Objectives: Chronic stressors are associated with cardiometabolic health conditions and disparities. Mechanisms linking stressors and health remain poorly understood. Methods: Two cohort studies (Cardiac Rehabilitation And The Experience [CREATE] and Tracking Risk Identification for Adult Diabetes [TRIAD]) with harmonized variables were used to examine relationships between six types of chronic stressors in adulthood and Hypothalamic-Pituitary-Adrenal (HPA) axis dysregulation, as indicated by blunted diurnal cortisol slopes, which are stress-sensitive biomarkers implicated in cardiometabolic health (merged N = 213, mean age 61, 18% Black). A secondary aim was to explore whether these chronic stressors accounted for Black-White disparities in HPA axis regulation. Results: Some chronic stressors were linked to HPA axis dysregulation, with recent stressors most salient (b = 0.00353, SE = 0.00133, p = .008). Black-White disparities in HPA axis regulation persisted after controlling for racial differences in chronic stressors, which reduced the disparity 11.46%. Discussion: Chronic stressors in adulthood may increase risk for HPA axis dysregulation and associated cardiometabolic health outcomes but may not be a key factor in racial disparities.

Persistence, Impairment, Disability and Unmet Treatment of Lifetime and 12-Month Anxiety Disorders in Black Men and Women, 50 Years of Age and Older.

Objectives: To examine anxiety disorders in aging Black adults. Methods: Using nationally representative data from the National Survey of American Life, we estimated lifetime/12-month prevalence of anxiety disorders in Black men and women, age 50+ (N = 1561). Disorder-specific persistence and severity, functional impairment, and mental health service utilization were investigated using multivariate regressions. Results: Black men and women who met criteria for anxiety disorders (lifetime prevalence=12.4%/18.3% in men/women) also demonstrated persistent disorders (percent meeting criteria = 40.3%-61.2%). Those with a 12-month anxiety disorder (6.2%/10.5% of men/women) typically reported severe task interference (38.3%-85.7%). Those with any 12-month anxiety disorder, compared to those without, experienced greater impairment in days out of role, work, family burden, cognition and, in women, mobility (p's < .05). Only 47.0%/65.2% of Black men/women with any lifetime anxiety disorder used mental health services. Discussion: Despite low prevalence, older Blacks with anxiety disorders experience substantial mental health burden in middle age and later.

An Online Behavioral Health Intervention Promoting Mental Health, Manhood, and Social Support for Young Black Men: The YBMen Project.

Conventional definitions of mental health, manhood, and social support create barriers to accessing behavioral health care for Black men ages 18 to 30. Targeted behavioral health interventions sensitive to culture, social norms, and gender that circumvent these barriers are desperately needed to improve access and integrated care for this group. This article reports mixed methods findings from the 2017 iteration of the Young Black Men, Masculinities, and Mental Health (YBMen) project, a social media-based, psychoeducational program that promotes mental health, progressive definitions of manhood, and sustainable social support for Black men. Young Black men (n = 350) across two universities in the Midwest completed baseline surveys on their mental health, definitions of manhood, and social support. Forty of the men participated in the YBMen intervention and at postintervention reported experiencing fewer depressive symptoms on the Patient Health Questionnaire (PHQ-9, Z = -2.05, p < .01) and the Gotland Male Depression Scale (GMDS; Z = -1.76, p < .05). There were also changes on the Conformity to Masculine Norms Inventory (CMNI) for Self-Reliance (Z = -0.34, p = .26) and Heterosexual Self-Presentation (Z = -0.18, p = .59), though these changes were not statistically significant. A qualitative review of postintervention interviews revealed participants' appreciation of the YBMen project and its influence on their mental health, manhood, and social support. Programmatic efforts that support the behavioral health, positive development, and social relationships of Black men translate into positive families, communities, and experiences as they live, learn, love, and work over the life course.

Ethnic and Gender Differences in Help Seeking for Substance Disorders Among Black Americans.

This paper uses the National Survey of American Life (NSAL) to examine within group differences regarding help-seeking for substance disorders among a US sample of African American and Caribbean Black men and women. We examined ethnic and gender differences in the type of providers sought for substance disorder treatment, as well as reasons for avoiding treatment. Results indicate that overall, few ethnic differences exist; however, African Americans are more likely than Caribbean Blacks to seek help from human service professionals (including a religious or spiritual advisor) and from informal sources of treatment such as self-help groups. Black men with a substance disorder were more likely to see a psychiatrist than Black women. Findings regarding reasons for avoiding treatment suggest that there may be a need to provide better education about the utility of substance disorder treatment, even before problems reach a high level of severity.

Substance Abuse Among Blacks Across the Diaspora.

BACKGROUND: Lower rates of substance abuse are found among Black Americans compared to Whites, but little is known about differences in substance abuse across ethnic groups within the black population. OBJECTIVES: We examined prevalence rates of substance abuse among Blacks across three geographic regions (US, Jamaica, Guyana). The study also sought to ascertain whether length of time, national context and major depressive episodes (MDE) were associated with substance abuse. METHODS: We utilized three different data sources based upon probability samples collected in three different countries. The samples included 3,570 African Americans and 1,621 US Caribbean Black adults from the 2001-2003 National Survey of American Life (NSAL). An additional 1,142 Guyanese Blacks and 1,176 Jamaican Blacks living in the Caribbean region were included from the 2005 NSAL replication extension study, Family Connections Across Generations and Nations (FCGN). Mental disorders were based upon DSM-IV criteria. For the analysis, we used descriptive statistics, chi-square, and multivariate logistic regression analytic procedures. RESULTS: Prevalence of substance abuse varied by national context, with higher rates among Blacks within the United States compared to the Caribbean region. Rates of substance abuse were lower overall for women, but differ across cohorts by nativity and length of time in the United States, and in association with major depressive episode. CONCLUSIONS: The study highlights the need for further examination of how substance abuse disparities between US-based and Caribbean-based populations may become manifested.

Prevalence of DSM-IV intermittent explosive disorder in Black adolescents: Findings from the National Survey of American Life, Adolescent Supplement.

Little is known about the epidemiology of Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM­IV) intermittent explosive disorder (IED) in adolescents, and no information is currently available regarding the relationship between race/ethnicity and IED among Black youth in the United States. Using the World Health Organization World Mental Health Composite International Diagnostic Interview (Adolescent Version), we estimated the prevalence, severity, and disability of IED in a national, probability sample of African American and Caribbean Black youth (ages 13­17) from the National Survey of American Life, Adolescent Supplement. Face-to-face surveys of 810 African American and 360 Caribbean Black youth were conducted between 2001 and 2003. We calculated lifetime and 12-month diagnoses of IED using diagnostic algorithms based on DSM­IV and assessed IED disability using a modified Sheehan Disability Scale. Overall findings indicated lifetime and 12-month IED prevalence rates of 9.2% and 7.0%, respectively. Lifetime prevalence rates of IED were 9.0% for African American and 12.4% for Caribbean Black teens. Within the past 12 months, 6.7% of African American and 11.5% of Caribbean Black adolescents met diagnostic criteria for IED. Lifetime and 12-month IED were associated with anxiety disorders. In addition, few teens with lifetime IED received any treatment. Findings are consistent with recent evidence that intermittent explosive disorder may be more common than previously considered, especially among adolescents. Significant acts of aggression and impairment are associated with IED, and low treatment rates indicate that more research on this disorder and intervention options is warranted.

The mental health of US Black women: the roles of social context and severe intimate partner violence.

OBJECTIVE: Black women continue to have rates of mental health conditions that can be negative for their well-being. This study examined the contribution of social and contextual factors and severe physical intimate partner violence on the mental health of US Black women (African-American and Caribbean Black). SETTING: Data were largely collected via in-person community interviews at participants' homes. PARTICIPANTS: We studied 3277 African-American and Black Caribbean women from the 2001-2003 National Survey of American Life (NSAL), the largest and most complete sample of Blacks residing in the USA. PRIMARY AND SECONDARY OUTCOMES: Key outcomes included an array of psychiatric disorders based on the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). RESULTS: Bivariate results revealed noticeably high rates of any anxiety disorder, post-traumatic stress disorder, any substance disorder, alcohol abuse disorder, suicide ideation and attempts, and any overall mental disorder among African-American women relative to Caribbean Black women. Multiple social and contextual factors were associated with various mental disorders among both sets of Black women in multivariate models, with the most consistent associations found for severe physical intimate partner violence. Everyday discrimination was associated with anxiety disorders (95% AOR=2.08 CI 1.23 to 3.51), eating disorders (95% AOR=2.69 CI 1.38 to 5.22), and any disorder (95% AOR=2.18 CI 1.40 to 3.40), while neighbourhood drug problems contributed to mood (95% AOR=1.19 CI 1.04 to 1.36), substance disorders (95% AOR=1.37 CI 1.11 to 1.69) and any disorder (95% AOR=1.18 CI 1.03 to 1.34). CONCLUSIONS: Severe physical intimate partner violence, discrimination, and to a lesser extent, neighbourhood problems are important predictors of Black women's health, findings that inform intervention and clinical services tailored to meet the needs of Black women from diverse ethnic and cultural backgrounds.

Urban vs Rural Residence and the Prevalence of Depression and Mood Disorder Among African American Women and Non-Hispanic White Women.

IMPORTANCE: There is a paucity of research among African Americans and rural residents. Little is known about the association between urbanicity and depression or about the interaction of urbanicity, race/ethnicity, and sex on depression and mood disorder prevalence. OBJECTIVE: To examine the interaction of urbanicity and race/ethnicity on lifetime and 12-month major depressive disorder (MDD) and mood disorder prevalence for African American women and non-Hispanic white women. DESIGN, SETTING, AND PARTICIPANTS: The US National Survey of American Life data were used to examine the interaction of urbanicity and race/ethnicity on lifetime and 12-month diagnoses of DSM-IV MDD and mood disorder among female respondents, who included noninstitutionalized African American, Caribbean black, and non-Hispanic white women in the United States between February 2001 and June 2003. Participants included 1462 African American women and 341 non-Hispanic white women recruited from the South because all suburban and rural National Survey of American Life respondents resided in this region. Bivariate multiple logistic regression and adjusted prevalence analyses were performed. Urban, suburban, or rural location (assessed via Rural-Urban Continuum Codes), self-reported race/ethnicity, and sociodemographic factors (age, education, household income, and marital status) were included in the analysis. MAIN OUTCOMES AND MEASURES: Lifetime and 12-month MDD and mood disorder assessed via the World Mental Health Composite International Diagnostic Interview. RESULTS: Compared with urban African American women, rural African American women had a significantly lower odds of meeting criteria for lifetime (odds ratio [OR], 0.39; 95% CI, 0.23-0.65) and 12-month (OR, 0.29; 95% CI, 0.18-0.46) MDD and for lifetime (F = 0.46; 95% CI, 0.29-0.73) and 12-month (F = 0.42; 95% CI, 0.26-0.66) mood disorder. However, the interaction of urbanicity and race/ethnicity suggested that rural non-Hispanic white women had a significantly higher odds of meeting criteria for lifetime (OR, 2.76; 95% CI, 1.22-6.24) and 12-month (OR, 9.48; 95% CI, 4.65-19.34) MDD and for lifetime (OR, 2.27; 95% CI, 1.06-4.87) and 12-month (OR, 5.99; 95% CI, 3.01-11.94) mood disorder than rural African American women. Adjusted prevalence analyses revealed significantly lower rates of lifetime (4.2%) and 12-month (1.5%) MDD among rural African American women than their urban counterparts (10.4% vs 5.3%; P ≤ .01). The same pattern was found for mood disorder, with rural African American women experiencing significantly lower rates of lifetime (6.7%) and 12-month (3.3%) mood disorder when compared to urban African American women (13.9% vs 7.6%; P ≤ .01) Conversely, rural non-Hispanic white women had significantly higher rates of 12-month MDD (10.3%) and mood disorder (10.3%) than their urban counterparts (3.7% vs 3.8%; P ≤ .01). CONCLUSIONS AND RELEVANCE: Rural residence differentially influences MDD and mood disorder prevalence among African American women and non-Hispanic white women. These findings offer a first step toward understanding the cumulative effect of rural residence and race/ethnicity on women's depression prevalence, suggesting the need for further research in this area.

Discrimination and social anxiety disorder among African-Americans, Caribbean blacks, and non-Hispanic whites.

The present study investigated the relationship between discrimination and social anxiety disorder (SAD) in a sample of African-Americans, Caribbean blacks, and non-Hispanic whites using the National Survey of American Life, the most comprehensive study of psychopathology among American blacks to date (N = 6082). Previous work has highlighted a strong association between discrimination and mental health symptoms (Keith, Lincoln, Taylor, and Jackson [Sex Roles 62:48-59, ]; Kessler, Mickelson, and Williams [J Health Soc Behav 40:208-230, 1999]; Soto, Dawson-Andoh, and BeLue [J Anxiety Disord 25:258-265, ]). However, few studies have examined the effects of particular types of discrimination on specific anxiety disorders or among different black subgroups. In this study, logistic regression analyses indicated that everyday but not major experiences of discrimination are associated with SAD for African-Americans, Caribbean blacks, and non-Hispanic whites. This study adds to the extant literature by demonstrating that specific types of discrimination may be uniquely associated with SAD for different ethnic/racial groups.

"Their depression is something different . . . it would have to be": findings from a qualitative study of black women's perceptions of depression in black men.

This study reports findings from the Black Women's Perceptions of Black Men's Depression (BWP) study, which included eight focus groups with Black women (N = 46) from southeastern Michigan. Four themes illustrated the impressions of Black women from different socioeconomic backgrounds: Black men's depression is a cultured and gendered phenomenon, the role of Black women in Black men's depression, intergenerational differences with how depression is handled by Black men, and the need (and ways) to reach Black men with depression resources. Results underscore not only the importance of understanding the kind of depression in Black men that meets criteria described by the Diagnostic and Statistical Manual of Mental Disorders (DSM) but also the psychological distress that may coexist with (or be separate from) DSM depression. Implications for interventions that educate, diagnose, and treat depression in Black men are discussed.

Major depressive disorder among older African Americans, Caribbean blacks, and non-Hispanic whites: secondary analysis of the National Survey of American Life.

BACKGROUND: Previous epidemiological and clinical research on mental disorders has treated Blacks as a homogenous group and yet Blacks of Caribbean descent and African Americans differ with respect to ethnicity, national heritage, living circumstances, and immigration status. The purpose of this article is to examine the prevalence of major depressive disorder (MDD) among African Americans, Caribbean Blacks, and non-Hispanic whites aged 50 and older with data on psychiatric and physical comorbidity, mental illness severity, and service use. METHODS: Secondary analysis of data from the National Survey of American Life, a national household probability sample of African Americans, Caribbean Blacks, and non-Hispanic Whites in the United States, were used (n = 1,950). The response rate was 72.3%. RESULTS: Controlling for age, the lifetime prevalence rate of MDD was 12.1% and the 12-month rate was 5.2%. Older Whites and Caribbean Blacks had significantly higher lifetime prevalence than African Americans but 12-month rates were similar across the three groups. Rates of co-occurring psychiatric disorders and physical conditions were high and were similar for African Americans, Caribbean Blacks, and Whites. Most older adults had either moderate or severe 12-month MDD and most talked to at least one professional, most frequently a family doctor, psychiatrist, or other mental health professional. CONCLUSION: MDD among older adults is highly prevalent, often associated with other psychiatric disorders or chronic physical conditions, and is associated with high overall mental illness severity. Differences among older Blacks highlight the need for further research on this population to ensure appropriate treatment is being provided to these groups.

Panic disorder among African Americans, Caribbean blacks and non-Hispanic whites.

INTRODUCTION: This study investigated co-morbidities, level of disability, service utilization and demographic correlates of panic disorder (PD) among African Americans, Caribbean blacks and non-Hispanic white Americans. METHODS: Data are from the National Survey of American Life (NSAL) and the National Comorbidity Survey-Replication (NCS-R). RESULTS: Non-Hispanic whites are the most likely to develop PD across the lifespan compared to the black subgroups. Caribbean blacks were found to experience higher levels of functional impairment. There were no gender differences found in prevalence of PD in Caribbean blacks, indicating that existing knowledge about who is at risk for developing PD (generally more prevalent in women) may not be true among this subpopulation. Furthermore, Caribbean blacks with PD were least likely to use mental health services compared to African Americans and non-Hispanic whites. CONCLUSION: This study demonstrates that PD may affect black ethnic subgroups differently, which has important implications for understanding the nature and etiology of the disorder.

Religious involvement and DSM-IV 12-month and lifetime major depressive disorder among African Americans.

This study explores relationships between lifetime and 12-month DSM-IV major depressive disorder and religious involvement within a nationally representative sample of African American adults (n = 3,570). MDD was assessed using the DSM-IV World Mental Health Composite International Diagnostic Interview. Multivariate findings indicate that reading religious materials were positively associated with 12-month (odds ratio [OR], 1.14; 95% confidence interval [CI], 1.001-1.29) and lifetime (OR, 1.12; 95% CI, 1.03-1.21) MDD, religious service attendance was inversely associated with 12-month and lifetime MDD, and religious coping was inversely associated with 12-month MDD (OR, 0.75, 95% CI, 0.57-0.99). Findings are discussed in relation to the role of religion for African American mental health, prior research on the effects of religious involvement on physical and mental health, and theoretical and conceptual models of religion-health connections that specify multiple and often divergent pathways (e.g., prevention and resource mobilization) by which diverse forms of religious involvement impact mental health.

Lessons learned from the clinical reappraisal study of the Composite International Diagnostic Interview with Latinos.

Given recent adaptations of the World Health Organization's World Mental Health Composite International Diagnostic Interview (WMH-CIDI), new methodological studies are needed to evaluate the concordance of CIDI diagnoses with clinical diagnostic interviews. This paper summarizes lessons learned from a clinical reappraisal study done with US Latinos. We compare CIDI diagnoses with independent clinical diagnosis using the World Mental Health Structured Clinical Interview for DSM-IV (WMH-SCID 2000). Three sub-samples stratified by diagnostic status (CIDI positive, CIDI negative, or CIDI sub-threshold for a disorder) based on nine disorders were randomly selected for a telephone re-interview using the SCID. We calculated sensitivity, specificity, and weight-adjusted Cohen's kappa. Weighted 12 month prevalence estimates of the SCID are slightly higher than those of the CIDI for generalized anxiety disorder, alcohol abuse/dependence, and drug abuse/dependence. For Latinos, CIDI-SCID concordance at the aggregate disorder level is comparable, albeit lower, to other published reports. The CIDI does very well identifying negative cases and classifying disorders at the aggregate level. Good concordance was also found for major depressive episode and panic disorder. Yet, our data suggests that the CIDI presents problems for assessing post-traumatic stress disorder (PTSD) and generalized anxiety disorder (GAD). Recommendations on how to improve future versions of the CIDI for Latinos are offered.

Obsessive-compulsive disorder among African Americans and blacks of Caribbean descent: results from the National Survey of American Life.

BACKGROUND: There is limited research regarding the nature and prevalence of obsessive-compulsive disorder (OCD) among various racial and ethnic subpopulations within the United States, including African Americans and blacks of Caribbean descent. Although heterogeneity within the black population in the United States has largely been ignored, notable differences exist between blacks of Caribbean descent and African Americans with respect to ethnicity, national heritage, and living circumstances. This is the first comprehensive examination of OCD among African Americans and blacks of Caribbean descent. METHODS: Data from the National Survey of American Life, a national household probability sample of African Americans and Caribbean blacks in the United States, were used to examine rates of OCD among these groups. RESULTS: Lifetime and 12-month OCD prevalence estimates were very similar for African Americans and Caribbean blacks. Persistence of OCD and rates of co-occurring psychiatric disorders were very high and also similar between African American and Caribbean black respondents. Both groups had high levels of overall mental illness severity and functional impairment. Use of services was low for both groups, particularly in specialty mental health settings. Use of anti-obsessional medications was also rare, especially among the Caribbean black OCD population. CONCLUSIONS: OCD among African Americans and Caribbean blacks is very persistent, often accompanied by other psychiatric disorders, and is associated with high overall mental illness severity and functional impairment. It is also likely that very few blacks in the United States with OCD are receiving evidence-based treatment and thus considerable effort is needed to bring treatment to these groups.

Prevalence and distribution of major depressive disorder in African Americans, Caribbean blacks, and non-Hispanic whites: results from the National Survey of American Life.

CONTEXT: Little is known about the relationship between race/ethnicity and depression among US blacks. OBJECTIVE: To estimate the prevalence, persistence, treatment, and disability of depression in African Americans, Caribbean blacks, and non-Hispanic whites in the National Survey of American Life. DESIGN: A slightly modified adaptation of the World Health Organization World Mental Health version of the Composite International Diagnostic Interview. SETTING: National household probability samples of noninstitutionalized African Americans, Caribbean blacks, and non-Hispanic whites in the United States conducted between February 2, 2001, and June 30, 2003. PARTICIPANTS: A total of 3570 African Americans, 1621 Caribbean blacks, and 891 non-Hispanic whites aged 18 years and older (N = 6082). MAIN OUTCOME MEASURES: Lifetime and 12-month diagnoses of DSM-IV major depressive disorder (MDD), 12-month mental health services use, and MDD disability as quantified using the Sheehan Disability Scale and the World Health Organization's Disability Assessment Schedule II. RESULTS: Lifetime MDD prevalence estimates were highest for whites (17.9%), followed by Caribbean blacks (12.9%) and African Americans (10.4%); however, 12-month MDD estimates across groups were similar. The chronicity of MDD was higher for both black groups (56.5% for African Americans and 56.0% for Caribbean blacks) than for whites (38.6%). Fewer than half of the African Americans (45.0%) and fewer than a quarter (24.3%) of the Caribbean blacks who met the criteria received any form of MDD therapy. In addition, relative to whites, both black groups were more likely to rate their MDD as severe or very severe and more disabling. CONCLUSIONS: When MDD affects African Americans and Caribbean blacks, it is usually untreated and is more severe and disabling compared with that in non-Hispanic whites. The burden of mental disorders, especially depressive disorders, may be higher among US blacks than in US whites.

Clinical calibration of DSM-IV diagnoses in the World Mental Health (WMH) version of the World Health Organization (WHO) Composite International Diagnostic Interview (WMHCIDI).

An overview is presented of the rationale, design, and analysis plan for the WMH-CIDI clinical calibration studies. As no clinical gold standard assessment is available for the DSM-IV disorders assessed in the WMH-CIDI, we adopted the goal of calibration rather than validation; that is, we asked whether WMH-CIDI diagnoses are 'consistent' with diagnoses based on a state-of-the-art clinical research diagnostic interview (SCID; Structured Clinical Interview for DSM-IV) rather than whether they are 'correct'. Consistency is evaluated both at the aggregate level (consistency of WMH-CIDI and SCID prevalence estimates) and at the individual level (consistency of WMH-CIDI and SCID diagnostic classifications). Although conventional statistics (sensitivity, specificity, Cohen's kappa) are used to describe diagnostic consistency, an argument is made for considering the area under the receiver operator curve (AUC) to be a more useful general-purpose measure of consistency. In addition, more detailed analyses are used to evaluate consistency on a substantive level. These analyses begin by estimating prediction equations in a clinical calibration subsample, with WMH-CIDI symptom-level data used to predict SCID diagnoses, and using the coefficients from these equations to assign predicted probabilities of SCID diagnoses to each respondent in the remainder of the sample. Substantive analyses then investigate whether estimates of prevalence and associations when based on WMH-CIDI diagnoses are consistent with those based on predicted SCID diagnoses. Multiple imputation is used to adjust estimated standard errors for the imprecision introduced by SCID diagnoses being imputed under a model rather than measured directly. A brief illustration of this approach is presented in comparing the precision of SCID and predicted SCID estimates of prevalence and correlates under varying sample designs.