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178 ACQ Volume 11, Number 3 2009 ACQuiring knowledge in speech, language and hearing
Research updates
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
reducing relapse.
References
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.
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
Mental health and stuttering
Lisa Iverach*
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:
* 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.