ACQ_Vol_11_no_3_2009

Research updates

Mental health and stuttering Lisa Iverach*

significantly worse for adults with mental health disorders when compared with those with no mental health disorders. In fact, only those adults without a mental health disorder maintained treatment gains for six months. These results indicate that treatment outcomes are less successful for adults who stutter who have mental health disorders. Clinical implications This is the first body of research to show that stuttering is associated with a greatly increased risk for a range of mental health disorders, including the potential for these disorders to significantly impact the ability to maintain fluency after speech restructuring treatment. These results highlight the importance of addressing mental health disorders in combination with speech treatment in order to facilitate the best possible outcomes. They also suggest future lines of research for improving treatment responsiveness and American Psychiatric Association (2000). Diagnostic and statistical manual of mental disorders (Rev. 4th ed.). Washington, DC: Author. Craig, A. (2003). Clinical psychology and neurological disability: Psychological therapies for stuttering. Clinical Psychologist , 7 , 93–103. Iverach, L., Jones, M., O’Brian, S., Block, S., Lincoln, M., Harrison, E., et al. (2009). The relationship between mental health disorders, stuttering severity and treatment outcome among adults who stutter. Journal of Fluency Disorders , 34 , 29–43. Iverach, L., O’Brian, S., Jones, M., Block, S., Lincoln, M., Harrison, E., et al. (in press). Prevalence of anxiety disorders among adults seeking speech therapy for stuttering. Journal of Anxiety Disorders . Loranger, A. W., Janca, A., & Sartorius, N. (1997). Assessment and diagnosis of personality disorders: The ICD-10 International Personality Disorder Examination (IPDE) . Cambridge: Cambridge University Press. Stein, M. B., Baird, A., & Walker, J. R. (1996). Social phobia in adults with stuttering. American Journal of Psychiatry , 153 , 278–280. World Health Organization (1993). The ICD-10 classification of mental and behavioural disorders: Diagnostic criteria for research . Geneva: Author. World Health Organization (1997). CIDI – Auto Version 2.1: Computerised Version of the Composite International Diagnostic Interview (CIDI), Core Version 2.1: Manual . Geneva: Author. Correspondence to: Lisa Iverach PhD Candidate Australian Stuttering Research Centre, The University of Sydney PO Box 170, Lidcombe NSW 1825, Australia phone: (02) 9351 9061 fax: (02) 9351 9392 email: l.iverach@usyd.edu.au reducing relapse. References

Recent literature has suggested that adults who stutter may be at an increased risk for developing psychological problems (Craig, 2003), yet no previous studies have assessed mental health status in stuttering populations. Therefore, the Australian Stuttering Research Centre has undertaken a program of research aimed at investigating the psychological impact of stuttering, including the assessment of mental health disorders among adults who stutter. Assessing mental health In order to assess mental health status, adults who stutter completed a battery of psychological measures during their initial assessment for speech restructuring treatment, 1 including: (1) Composite International Diagnostic Interview (CIDI-Auto-2.1) (World Health Organization, 1997); and (2) International Personality Disorders Examination Questionnaire (IPDEQ) (Loranger, Janca, & Sartorius, 1997). The CIDI-Auto-2.1 is a standardized computer interview designed to comprehensively assess and diagnose mental health disorders according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) (American Psychiatric Association, 2000) and the International Classification of Diseases (ICD-10) (World Health Organization, 1993). The IPDEQ is a self-report measure designed to screen for nine ICD-10 personality disorders. Both measures were used to screen for mental health disorders in the Australian National Survey of Mental Health and Well-Being (ANSMHWB) of 10,641 adults. Prevalence of anxiety disorders In an initial study (Iverach, O’Brian et al., in press), the rate of anxiety disorders among 92 adults seeking treatment for stuttering was compared with the rate for 920 age- and gender- matched controls from the ANSMHWB. Adults in the stuttering group were found to demonstrate six to seven-fold increased odds of meeting criteria for a diagnosis of any ICD-10 or DSM-IV anxiety disorder, as well as 16 to 34-fold increased odds of meeting criteria for a diagnosis of social phobia. This high prevalence of anxiety disorders was unexpected, and indicates the potential for adults seeking treatment for stuttering to experience debilitating anxiety. It also corroborates previous evidence of a high rate of social phobia among adults who stutter (Stein, Baird, & Walker, 1996). Mental health and treatment outcome In a further study (Iverach, Jones et al., 2009), the presence of mental health disorders, including anxiety, mood and personality disorders, was assessed among 64 adults seeking treatment for stuttering. Post-treatment outcomes, including stuttering frequency (%SS) and situation avoidance, were * Contributing Authors: Mark Jones, Susan O’Brian, Susan Block, Michelle Lincoln, Elisabeth Harrison, Sally Hewat, Angela Cream, Ross Menzies, Mark Onslow and Ann Packman 1 Participating research sites included: (1) Australian Stuttering Research Centre, The University of Sydney; (2) School of Human Communication Sciences, La Trobe University; (3) Discipline of Speech Pathology, The University of Sydney; (4) Department of Linguistics, Macquarie University; (5) School of Humanities and Social Science, University of Newcastle; (6) Royal Prince Alfred Hospital, Sydney; (7) Stuttering Treatment and Research Trust, Auckland, New Zealand.

Lisa Iverach

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ACQ Volume 11, Number 3 2009

ACQ uiring knowledge in speech, language and hearing