72 participants 60% 50% % Participants 40% 30% 20% 10% 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% % Participants

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1 Hong Kong Psychological Society The WHO-IUPsyS Global Survey of Psychologists Attitudes Toward Mental Disorders Classification Results for the Hong Kong Psychological Society 72 participants Language of survey: English Data collected: 31 Jan Mar 2011 Number of members solicited: 301 Response rate: 23.9% Response time (minutes): - Mean = SD = Range = Currently seeing patients: 92.9% Licensed for assessment/treatment: - Independently: 94.3% - Under supervision: 4.3% Age (years): - Mean = SD = Range = Professional experience (years) - Mean = SD = Range = 1 40 Gender: % male % female 2 Patient Contact Hours Patient Contact Hours 6 5 Q6 - During a typical week, how many hours do you spend seeing patients? 55% 6 5 Q6 - During a typical week, how many hours do you spend seeing patients? % % ne 1 to 9 10 to to 40 More than 40 5% 2 1 ne 1 to 9 10 to to 40 More than Who Makes Diagnoses? Who Makes Diagnoses? Q39 - 'In the settings where you normally practice, who is responsible for making individual diagnoses? (Click on all responses that apply. If you practice in more than one setting, include all.)' 88% 45% 2 Psychologists Psychiatrists Other physicians 2% 3% Nurses Other 6 Q39 - 'In the settings where you normally practice, who is responsible for making individual diagnoses? (Click on all responses that apply. If you practice in more than one setting, include all.)' Psychologists Psychiatrists Other Nurses Other physicians 1

2 Psychologists Roles in Making Diagnoses Psychologists Roles in Making Diagnoses Q40 - 'In the one setting where you practice most, what role do you as a psychologist play in making individual diagnoses?' 8 I make diagnoses independently 17% I contribute to diagnostic formulations made by other health professionals 3% I have no active role in making a diagnosis Other Q40 - 'In the one setting where you practice most, what role do you as a psychologist play in making individual diagnoses?' I make diagnoses independently I contribute to diagnostic formulations made by other health professionals I have no active role in making a diagnosis Other 7 8 Use of Classification System Use of Classification System Q7 - 'As part of your day-to-day clinical work, how much of the time do you use a formal classification system for mental disorders, such as the ICD-10, the DSM-IV, the ICD-9 or ICD-9-CM, or a national classification?' 9% 11% 19% 61% Never Rarely Sometimes Often Almost always Q7 - 'As part of your day-to-day clinical work, how much of the time do you use a formal classification system for mental disorders, such as the ICD-10, the DSM-IV, the ICD-9 or ICD-9-CM, or a national classification?' Never Rarely Sometimes Often Almost always 9 10 Classification System Used Most Classification System Used Most Q8 - In your day-to-day clinical work, which classification system for mental disorders do you use most? 3% 97% ICD-10 DSM-IV ICD-9 Other Q8 - In your day-to-day clinical work, which classification system for mental disorders do you use most? ICD-10 DSM-IV ICD-9 Other

3 Familiarity with ICD-10 (Among Those Who Use Another System) Familiarity with ICD-10 (Among Those Who Use Another System) 6 5 Q38 - 'Which of the following best describes how familiar you are with the ICD-10 classification of mental and behavioural disorders?' [Does not include ICD-10 users] 51% 6 5 Q38 - 'Which of the following best describes how familiar you are with the ICD-10 classification of mental and behavioural disorders?' [Does not include ICD-10 users] % % 1% t at all familiar A little familiar Somewhat familiar Quite familiar 2 1 t at all familiar A little familiar Somewhat familiar Quite familiar Purpose of Classification Purpose of Classification 6 Q9 - From your perspective, which is the single, most important purpose of a diagnostic classificatory system? 55% 6 Q9 - From your perspective, which is the single, most important purpose of a diagnostic classificatory system? % Communication Communication Inform treatment between among and clinicians and clinicians management patients decisions 3% 1% 3% Facilitate Basis for Other research generating national health statistics 1 Communication Communication Inform treatment Facilitate Basis for between among and research generating clinicians and clinicians management national health patients decisions statistics Other Number of Categories Desired Number of Categories Desired Q10 - In clinical settings, how many diagnostic categories should a classificatory system contain to be most useful for mental health professionals? 3 62% 10 to to to 200 More than 200 6% 1% Q10 - In clinical settings, how many diagnostic categories should a classificatory system contain to be most useful for mental health professionals? 10 to to to 200 More than

4 Primary Care Classification Primary Care Classification Q11 - Primary care practitioners should have: Q11 - Primary care practitioners should have: % A modified/simpler classification system 46% The same classification system as specialist mental health professionals A modified/simpler classification system The same classification system as specialist mental health professionals Use by Other Mental Health Professionals Use by Other Mental Health Professionals Q12 - A diagnostic classification system should serve as a useful reference not only for psychiatrists but also for other mental health professionals (e.g., psychologists, social workers, psychiatric nurses). 7% 34% 59% Q12 - A diagnostic classification system should serve as a useful reference not only for psychiatrists but also for other mental health professionals (e.g., psychologists, social workers, psychiatric nurses) Understandable for n-professionals Understandable for n-professionals 5 4 Q13 - A diagnostic classification system should be understandable to service users, patient advocates, administrators, and other relevant people as well as to health professionals. 43% 5 4 Q13 - A diagnostic classification system should be understandable to service users, patient advocates, administrators, and other relevant people as well as to health professionals % 29% %

5 Strict Criteria vs. Flexible Guidance Strict Criteria vs. Flexible Guidance Q14 - For maximum utility in clinical settings, a diagnostic manual should contain: % Clear and strict diagnostic criteria 74% Flexible guidance that allows for cultural variation and clinical judgment Q14 - For maximum utility in clinical settings, a diagnostic manual should contain: Clear and strict diagnostic criteria Flexible guidance that allows for cultural variation and clinical judgment Severity Severity Q15 - The best way for a diagnostic system to address the concept of severity would be: 4 Q15 - The best way for a diagnostic system to address the concept of severity would be: % 34% 25% Subtypes based on number and severity of symptoms Subtypes based on functional impairment Separate severity t a necessary part axis for all diagnoses of diagnostic system Subtypes based on number and severity of symptoms Subtypes based on functional impairment Separate severity t a necessary part axis for all diagnoses of diagnostic system Functional Status Functional Status Q16 - What is the best way for a diagnostic system to conceptualize the relationship between diagnosis and functional status (e.g., impairment in self-care or occupational functioning)? 4 Disorder should not be diagnosed if no functional impairment 46% 15% Functional status should be Functional status should not part of diagnostic criteria be part of diagnostic criteria when necessary to infer presence of disorder Q16 - What is the best way for a diagnostic system to conceptualize the relationship between diagnosis and functional status (e.g., impairment in self-care or occupational functioning)? Disorder should not be diagnosed if no functional impairment Functional status should be Functional status should not part of diagnostic criteria be part of diagnostic criteria when necessary to infer presence of disorder

6 A Dimensional Component A Dimensional Component Q17 - Should a diagnostic system incorporate a dimensional component, where some disorders are rated on a scale rather than just as present or absent? 9%, insufficient research on reliability 15%, too complicated in clinical settings 22%, for more detailed and personalized diagnosis 54%, more accurate reflection of psychopathology Q17 - Should a diagnostic system incorporate a dimensional component, where some disorders are rated on a scale rather than just as present or absent?, insufficient research on reliability, too complicated in clinical settings, for more detailed and personalized diagnosis, more accurate reflection of psychopathology Reactions to Adverse Life Events Reactions to Adverse Life Events Q18 - Should the diagnosis of depression be assigned when the depressive symptoms are a proportionate response to an adverse life event (e.g., loss of job or home, divorce)? Q18 - Should the diagnosis of depression be assigned when the depressive symptoms are a proportionate response to an adverse life event (e.g., loss of job or home, divorce)? Usability Across Cultures Usability Across Cultures 6 5 Q19 - The diagnostic system I use is difficult to apply across cultures, or when the patient/service user is of a different cultural or ethnic background from my own. 52% 6 5 Q19 - The diagnostic system I use is difficult to apply across cultures, or when the patient/service user is of a different cultural or ethnic background from my own. 4 37% %

7 U.S. and European Bias U.S. and European Bias Q20 - The diagnostic system I use is problematic because it is over-embedded in U.S. and European culturally-derived concepts and values. 32% 54% 14% Q20 - The diagnostic system I use is problematic because it is over-embedded in U.S. and European culturally-derived concepts and values Problematic Categories Problematic Categories Q23 - 'Are there diagnostic categories with which you are especially dissatisfied, or that you believe are especially problematic in terms of their goodness of fit in clinical settings?' % 39 41% Q23 - 'Are there diagnostic categories with which you are especially dissatisfied, or that you believe are especially problematic in terms of their goodness of fit in clinical settings?' Removing and/or Moving Categories Q25 - Are there any specific diagnoses in that you feel should be removed or moved to another section? Removing and/or Moving Categories Q25 - Are there any specific diagnoses in that you feel should be removed or moved to another section? % 15%

8 Adding Categories Adding Categories Q27 - 'Are there any specific diagnostic categories that you feel should be added to the classification system for mental disorders?' % 43 29% Q27 - 'Are there any specific diagnostic categories that you feel should be added to the classification system for mental disorders?' Stigmatizing Terms Stigmatizing Terms Q29 - 'Do you think that any of the terms used in current diagnostic systems are stigmatizing in your language or cultural context?' % 18% Q29 - 'Do you think that any of the terms used in current diagnostic systems are stigmatizing in your language or cultural context?' Need for a National Classification System Q31 - Do you see the need in your country for a national classification of mental disorders (i.e., a country-specific classification that is not just a translation of ICD-10)? Need for a National Classification System Q31 - Do you see the need in your country for a national classification of mental disorders (i.e., a country-specific classification that is not just a translation of ICD-10)? % 21%

9 Average Rating (Transformed) Average Rating (Transformed) Average Rating (Transformed) Average Rating (Transformed) Frequency of Use Q34 - 'Of the DSM-IV diagnostic categories listed below, please indicate which ones you use once a week or more in your day-to-day clinical practice.' X (Delirium Due to General Medical Agoraphobia Without History of Panic Impulse Control Disorders t Elsewhere Mental Retardation (i.e., Intellectual Disability) Frequency of Use Q34 - 'Of the DSM-IV diagnostic categories listed below, please indicate which ones you use once a week or more in your day-to-day clinical practice.' X (Delirium Due to General Medical Condition) Agoraphobia Without History of Panic Disorder Impulse Control Disorders t Elsewhere Mental Retardation (i.e., Intellectual Disability) Ease Use Q35 - Ease of use of the DSM-IV diagnostic categories X (Delirium Due to General Medical Condition) Agoraphobia Without History of Panic Disorder Impulse Control Disorders t Elsewhere Mental Retardation (i.e., Intellectual Disability) Ease Use Q35 - Ease of use of the DSM-IV diagnostic categories X (Delirium Due to General Medical Condition) Agoraphobia Without History of Panic Disorder Impulse Control Disorders t Elsewhere Mental Retardation (i.e., Intellectual Disability) Goodness of Fit Q35 - Goodness of fit of the DSM-IV diagnostic categories X (Delirium Due to General Medical Agoraphobia Without History of Panic Impulse Control Disorders t Elsewhere Mental Retardation (i.e., Intellectual Goodness of Fit Q35 - Goodness of fit of the DSM-IV diagnostic categories X (Delirium Due to General Medical Condition) Agoraphobia Without History of Panic Disorder Impulse Control Disorders t Elsewhere Mental Retardation (i.e., Intellectual Disability) 9

10 Thank you for your participation and collaboration! 10