# 08 - Factors influencing health status or contact with # 01 - Reasons for contact with mental health servic # Reasons for contact with mental health services # 02 - Problems associated with relationships # Problems associated with relationships Clinical Descriptions and Diagnostic Requirements for ICD-11 Mental, Behavioural or Neurodevelopmental Disorders relate to recognized social determinants of mental health – that is, risk factors for the development, maintenance or moderation of symptoms of mental disorders across the lifespan. The categories in this list are ordered in a way that is intended to make the list useful to mental health professionals and does not correspond entirely to their ordering in ICD-11.7 Not all of the categories include brief descriptions or definitions; where they are provided, they are included in this section. Reasons for contact with mental health services Problems associated with relationships (See the section on relationship problems and maltreatment, p. 707.) Problems associated with interactions with spouse or partner Relationship distress with spouse or partner History of spouse or partner violence Problems associated with interpersonal interactions in childhood Caregiver–child relationship problem Loss of love relationship in childhood • Loss of love relationship in childhood refers to the loss of an emotionally close relationship, such as of a parent, a sibling, a very special friend or a loved pet, by death or permanent departure or rejection. See ICD-11 for Mortality and Morbidity Statistics (ICD-11 MMS) [website]. Geneva: World Health Organization; 2023 (https://ICD. who.int/browse11/l-m/en#/). QE51 QE51.0 QE51.1 QE52 QE52.0 QE52.1 Reasons for contact with mental health services | Problems associated with relationships # 03 - Problems associated with absence, loss or dea # Problems associated with absence, loss or death of others 735 Factors influencing health status or contact with health services particularly relevant to mental health services Problems associated with interpersonal interactions Note: relationship distress with spouse or partner and caregiver–child relationship problem should be documented using the categories provided in the section on relationship problems and maltreatment (p. 707). Problem associated with relationship with friend Problem associated with relationship with teachers or classmates Problem associated with relationship with people at work Problem associated with relationship with neighbours, tenant or landlord Problem associated with relationship with parents, in-laws or other family members Discord with counsellors Inadequate social skills Other specified problems associated with relationships Problems associated with relationships, unspecified Problems associated with absence, loss or death of others Absence of family member Disappearance or death of family member Loss or death of child Disappearance or death of other family member QE50 QE50.0 QE50.1 QE50.2 QE50.3 QE50.4 QE50.5 QE50.6 QE5Y QE5Z Reasons for contact with mental health services | Problems associated with absence, loss or death of others QE60 QE61 QE61.0 QE61.Y # 04 - Problems related to primary support group, in # Problems related to primary support group, including family circumstances Clinical Descriptions and Diagnostic Requirements for ICD-11 Mental, Behavioural or Neurodevelopmental Disorders Uncomplicated bereavement Note: uncomplicated bereavement refers to grief reactions experienced following the disappearance or death of a loved one. In contrast, QE61 Disappearance or death of family member and its subcategories refer to the event itself. Other specified problems associated with absence, loss or death of others Problems associated with absence, loss or death of others, unspecified Problems related to primary support group, including family circumstances Problems related to primary support group, including family circumstances Inadequate family support Disruption of family by separation or divorce Dependent relative needing care at home Problem related to primary support group, including family circumstance, unspecified QE6Y QE6Z QE70 Reasons for contact with mental health services | Problems related to primary support group QE62 QE70.0 QE70.1 QE70.2 QE70.Z # 05 - Problems associated with upbringing # Problems associated with upbringing 737 Factors influencing health status or contact with health services particularly relevant to mental health services Problems associated with upbringing Inadequate parental supervision or control • Inadequate parental supervision or control refers to a lack of parental knowledge of what the child is doing or where the child is; poor control; lack of concern, understanding or comprehension or lack of attempted intervention when the child is in risky situations. Parental overprotection Altered pattern of family relationships in childhood • Altered pattern of family relationships in childhood refers to the departure of a family member or arrival of a new person into a family, resulting in adverse change in child’s relationships – may include new relationship or marriage by a parent, death or illness of a parent, illness or birth of a sibling. Removal from home in childhood Institutional upbringing • Institutional upbringing refers to group foster care in which parenting responsibilities are largely taken over by some form of institution (such as residential nursery, orphanage or children’s home), or therapeutic care over a prolonged period in which the child is in a hospital, convalescent home or the like, without at least one parent living with the child. Inappropriate parental pressure or other abnormal qualities of upbringing • Inappropriate parental pressure or other abnormal qualities of upbringing refers to parents forcing the child to be different from the local norm – either sex-inappropriate (e.g. dressing a boy in girl’s clothes), age-inappropriate (e.g. forcing a child to take on responsibilities above their own age) or otherwise inappropriate (e.g. pressing the child to engage in unwanted or too difficult activities). Reasons for contact with mental health services | Problems associated with upbringing QE90 QE91 QE92 QE93 QE94 QE95 # 06 - Problems associated with harmful or traumatic # Problems associated with harmful or traumatic events Clinical Descriptions and Diagnostic Requirements for ICD-11 Mental, Behavioural or Neurodevelopmental Disorders Events resulting in loss of self-esteem in childhood • Events resulting in loss of self-esteem in childhood refers to events resulting in a negative self-reappraisal by the child, such as failure in tasks with high personal investment; disclosure or discovery of a shameful or stigmatizing personal or family event; or other humiliating experiences. Other specified problems associated with upbringing Problems associated with upbringing, unspecified Problems associated with harmful or traumatic events Personal experience of being a victim of crime or terrorism Exposure to disaster, war or other hostilities Personal history of maltreatment See the section on relationship problems and maltreatment, p. 707 Personal frightening experience in childhood Acute stress reaction See the section on disorders specifically associated with stress, p. 361, for the full CDDR. • Acute stress reaction refers to the development of transient emotional, somatic, cognitive or behavioural symptoms as a result of exposure to an event or situation (either short- or long-lasting) of an extremely threatening or horrific nature (e.g. natural or human-made disasters, combat, serious accidents, sexual violence, assault). Symptoms may include QE96 QE9Y QE9Z QE80 QE81 QE82 QE83 Reasons for contact with mental health services | Problems associated with traumatic events QE84 # 07 - Problems associated with social or cultural e # Problems associated with social or cultural environment 739 Factors influencing health status or contact with health services particularly relevant to mental health services autonomic signs of anxiety (e.g. tachycardia, sweating, flushing), being in a daze, confusion, sadness, anxiety, anger, despair, overactivity, inactivity, social withdrawal or stupor. The response to the stressor is considered to be normal given the severity of the stressor, and usually begins to subside within a few days after the event or following removal from the threatening situation. Other specified problems associated with harmful or traumatic events Problems associated with harmful or traumatic events, unspecified Problems associated with social or cultural environment Acculturation difficulty • Acculturation difficulty refers to problems resulting from the inability to adjust to a different culture or environment. Social role conflict Social exclusion or rejection • Social exclusion or rejection refers to exclusion and rejection on the basis of personal characteristics such as physical appearance, sexual orientation, gender identity and expression, illness or behaviour. Personal experience of being a target of perceived adverse discrimination or persecution • Target of perceived adverse discrimination or persecution refers to persecution or discrimination – real or perceived as reality by an individual – on the basis of membership in some group (such as defined by skin colour, religion, ethnic origin, sexual orientation, gender identity and expression) rather than personal characteristics. QE9Y QE9Z QE00 QE02 Reasons for contact with mental health services | Problems associated with social or cultural environment QE04 QE03 # 08 - Problems associated with employment or unempl # Problems associated with employment or unemployment Clinical Descriptions and Diagnostic Requirements for ICD-11 Mental, Behavioural or Neurodevelopmental Disorders Other specified problems associated with social or cultural environment Problems associated with social or cultural environment, unspecified Problems associated with employment or unemployment Problems associated with unemployment Problems associated with a change of job Problems associated with threat of job loss Problems with employment conditions Problem associated with uncongenial work Problem associated with stressful work schedule Other specified problem with employment conditions Occupational exposure to risk factors Burnout • Burnout is a syndrome conceptualized as resulting from chronic workplace stress that has not been successfully managed. It is characterized by three dimensions: feelings of energy depletion or exhaustion; increased mental distance from one’s job, or feelings of negativism or cynicism related to one’s job; and a sense of ineffectiveness and lack of accomplishment. Burnout refers specifically to phenomena in the occupational context and should not be applied to describe experiences in other areas of life. QE0Z QE0Y QD80 QD81 QD82 QD83 QD83.0 QD83.Y QD83.1 QD85 QD84 Reasons for contact with mental health services | Problems associated with employment or unemployment # 09 - Problems associated with education # Problems associated with education # 10 - Other reasons for contact with mental health # Other reasons for contact with mental health services 741 Factors influencing health status or contact with health services particularly relevant to mental health services Other specified problems associated with employment or unemployment Problems associated with employment or unemployment, unspecified Problems associated with education Problems associated with illiteracy or low-level literacy Problems associated with unavailable or unattainable education Problems with educational progress Other specified problems associated with education Problems associated with education, unspecified Other reasons for contact with mental health services Stress, not elsewhere classified Discussion of issues surrounding impending death Concern about or fear of medical treatment Person with feared complaint in whom no diagnosis is made QD8Y QD8Z QD90 QD91 Reasons for contact with mental health services | Problems associated with education | Other reasons for contact QE01 QA1A QA1B QA1C QD92 QD9Y QD9Z # 11 - Problems associated with health behaviours # Problems associated with health behaviours Clinical Descriptions and Diagnostic Requirements for ICD-11 Mental, Behavioural or Neurodevelopmental Disorders Concern about body appearance, unspecified Personality difficulty See the section on personality disorders and related traits, p. 553. • Personality difficulty refers to pronounced personality characteristics that may affect treatment or health services but do not rise to the level of severity to merit a diagnosis of personality disorder. Personality difficulty is characterized by longstanding difficulties (e.g. at least 2 years) in the individual’s way of experiencing and thinking about the self, others and the world. In contrast to personality disorder, these difficulties are manifested in cognitive and emotional experience and expression only intermittently (e.g. during times of stress) or at low intensity. The difficulties are associated with some problems in functioning, but these are insufficiently severe to cause notable disruption in social, occupational and interpersonal relationships, or may be limited to specific relationships or situations. Malingering • Malingering is the feigning, intentional production or significant exaggeration of physical or psychological symptoms, or intentional misattribution of genuine symptoms to an unrelated event or series of events when this is specifically motivated by external incentives or rewards such as escaping duty or work, mitigating punishment, obtaining medications or drugs, or receiving unmerited recompense such as disability compensation or personal injury damages award. Problems associated with health behaviours Hazardous substance use See the section on disorders due to substance use, p. 441. Hazardous alcohol use • Hazardous alcohol use refers to a pattern of alcohol use that appreciably increases the risk of harmful physical or mental health consequences – to the user or to others – to an extent QC30 QD3Z QE50.7 QE10 Reasons for contact with mental health services | Problems associated with health behaviours 743 Factors influencing health status or contact with health services particularly relevant to mental health services that warrants attention and advice from health professionals. The increased risk may be from the frequency of alcohol use, from the amount used on a given occasion, from risky behaviours associated with alcohol use or the context of use, or from a combination of these. The risk may be related to short-term effects of alcohol or to longer-term cumulative effects on physical or mental health or functioning. Hazardous alcohol use has not yet reached the level of having caused harm to physical or mental health of the user or others around the user. The pattern of alcohol use often persists in spite of awareness of increased risk of harm to the user or to others. Hazardous drug use • Hazardous drug use refers to a pattern of use of psychoactive substances other than nicotine or alcohol that appreciably increases the risk of harmful physical or mental health consequences – to the user or to others – to an extent that warrants attention and advice from health professionals. The increased risk may be from the frequency of substance use, from the amount used on a given occasion, from risky behaviours associated with substance use or the context of use, from a harmful route of administration, or from a combination of these. The risk may be related to short-term effects of the substance or to longer-term cumulative effects on physical or mental health or functioning. Hazardous drug use has not yet reached the level of having caused harm to physical or mental health of the user or others around the user. The pattern of drug use often persists in spite of awareness of increased risk of harm to the user or to others. Specify substance(s), if known: QE11.0 Hazardous use of opioids QE11.1 Hazardous use of cannabis QE11.2 Hazardous use of sedatives, hypnotics or anxiolytics QE11.3 Hazardous use of cocaine QE11.4 Hazardous use of stimulants, including amfetamines, methamfetamine and methcathinone QE11.5 Hazardous use of caffeine QE11.6 Hazardous use of MDMA or related drugs QE11.7 Hazardous use of dissociative drugs, including ketamine and PCP QE11.8 Hazardous use of other specified psychoactive substance QE11.9 Hazardous use of unknown or unspecified psychoactive substance QE11.Y Other specified hazardous drug use QE11.Z Hazardous drug use, unspecified Hazardous nicotine use • Hazardous nicotine use refers to a pattern of nicotine use that appreciably increases the risk of harmful physical or mental health consequences – to the user or to others – to an extent that warrants attention and advice from health professionals. Most often nicotine is consumed in the form of tobacco, but there are also other forms of nicotine delivery (e.g. nicotine vapour). Hazardous nicotine use has not yet reached the level of having caused harm to physical or mental health of the user or others around the user. The pattern of nicotine use often persists in spite of awareness of increased risk of harm to the user or to others. This category is not intended to include the use of nicotine replacement therapies under medical supervision when these are used as part of attempts to stop or reduce smoking. QE11 Reasons for contact with mental health services | Problems associated with health behaviours QE12 Clinical Descriptions and Diagnostic Requirements for ICD-11 Mental, Behavioural or Neurodevelopmental Disorders Other specified hazardous substance use Hazardous gambling or gaming See the section on disorders due to addictive behaviours, p. 506. Hazardous gambling or betting • Hazardous gambling or betting refers to a pattern of gambling or betting that appreciably increases the risk of harmful physical or mental health consequences to the individual or to others around this individual. The increased risk may be from the frequency of gambling or betting, from the amount of time spent on these activities or the context of gambling or betting, from the neglect of other activities and priorities, from risky behaviours associated with gambling or betting or its context, from the adverse consequences of gambling or betting, or from a combination of these. The pattern of gambling or betting often persists in spite of awareness of increased risk of harm to the individual or to others. Hazardous gaming • Hazardous gaming refers to a pattern of gaming, either online or offline that appreciably increases the risk of harmful physical or mental health consequences to the individual or to others around this individual. The increased risk may be from the frequency of gaming, from the amount of time spent on these activities, from the neglect of other activities and priorities, from risky behaviours associated with gaming or its context, from the adverse consequences of gaming, or from a combination of these. The pattern of gaming often persists in spite of awareness of increased risk of harm to the individual or to others. QE1Y QE21 QE22 Reasons for contact with mental health services | Hazardous gambling or betting # 12 - Contact with health services for counselling # Contact with health services for counselling 745 Factors influencing health status or contact with health services particularly relevant to mental health services Other problems associated with health behaviours Lack of physical exercise Problems with inappropriate diet or eating habits Problems with hygiene behaviours Problems with oral health behaviours Problems with sun exposure behaviour Problems with behaviours related to psychological health or well-being Problems with health literacy Problems with other specified health-related behaviours Problems with health-related behaviours, unspecified Contact with health services for counselling Contact with health services for dietary counselling or surveillance Contact with health services for alcohol use counselling or surveillance Contact with health services for drug use counselling or surveillance Contact with health services for tobacco use counselling QE20 QE23 QE24 QE2Z QE25 QE26 QE27 QE28 QE2Y QA10 QA12 QA13 QA11 Reasons for contact with mental health services | Other problems associated with health behaviours Clinical Descriptions and Diagnostic Requirements for ICD-11 Mental, Behavioural or Neurodevelopmental Disorders Contact with health services for human immunodeficiency virus counselling • Human immunodeficiency virus counselling can be defined as accessible HIV counselling services that meet the needs of clients and providers in an equitable and acceptable manner, within the resources available and in line with national guidelines. Counselling should increase knowledge of HIV prevention and should help the client to focus on solutions to risk reduction. Counselling related to sexuality Counselling related to sexual attitudes Counselling related to sexual behaviour and orientation or sexual relationships of the person Counselling related to sexual behaviour and orientation or sexual relationships of the person of third party Counselling related to combined sexual attitudes, sexual behaviour and sexual relationships Other specified counselling related to sexuality Counselling related to sexuality, unspecified Individual psychological or behavioural counselling Marital or couples counselling Family counselling Group counselling Contact with health services for other specified counselling Contact with health services for unspecified counselling QA15 QA15.0 QA14 QA15.1 QA15.2 QA15.3 QA15.Y QA15.Z QA16 QA17 QA18 QA19 QA1Y QA1Z Reasons for contact with mental health services | Other problems associated with health behaviours # 13 - Contact with health services for reasons asso # Contact with health services for reasons associated with reproduction # 14 - Problems associated with social insurance or # Problems associated with social insurance or welfare 747 Factors influencing health status or contact with health services particularly relevant to mental health services Contact with health services for reasons associated with reproduction8 Contact with health services for concerns about pregnancy Contact with health services for contraceptive management Contact with health services for medically assisted reproduction Problems associated with social insurance or welfare Insufficient social insurance support Insufficient social insurance support, aged Insufficient social insurance support, disability Insufficient social insurance support, unemployment Insufficient social insurance support, family support Insufficient social welfare support Insufficient social welfare support, child protection Insufficient social welfare support, protection against domestic violence Insufficient social welfare support, protection against homelessness Insufficient social welfare support, post prison services A detailed listing of categories in this section can be found at ICD-11 for Mortality and Morbidity Statistics (ICD-11 MMS) [website]. Geneva: World Health Organization; 2023 (https://ICD.who.int/browse11/l-m/en#/). QA20 QA21 QA30 QE30 QE30.0 QE30.1 QE30.2 QE30.4 QE31 QE31.0 QE31.1 QE31.2 QE31.3 Reasons for contact with mental health services | Problems associated with social insurance or welfare # 15 - Problems associated with the justice system # Problems associated with the justice system # 16 - Problems associated with finances # Problems associated with finances Clinical Descriptions and Diagnostic Requirements for ICD-11 Mental, Behavioural or Neurodevelopmental Disorders Other specified problems associated with social insurance or welfare Problems associated with social insurance or welfare, unspecified Problems associated with the justice system Problems associated with conviction in civil or criminal proceedings without imprisonment Problems associated with imprisonment and other incarceration Problems associated with release from prison Other specified problems associated with the justice system Problems associated with the justice system, unspecified Problems associated with finances Poverty Low income Other specified problems associated with finances Problems associated with finances, unspecified QE3Y QE3Z QE40 QE41 QE42 QD50 QD51 QD5Y QD5Z QE4Y QE4Z Reasons for contact with mental health services | Problems associated with the justice system/with finances # 17 - Problems associated with inadequate drinking # Problems associated with inadequate drinking-water or nutrition # 18 - Problems associated with the environment # Problems associated with the environment 749 Factors influencing health status or contact with health services particularly relevant to mental health services Problems associated with inadequate drinking-water or nutrition Problems associated with inadequate drinking-water Inadequate food Problems associated with drinking-water or nutrition, unspecified Problems associated with the environment Problems associated with the natural environment or human-made changes to the environment Problem associated with exposure to noise Problem associated with exposure to air pollution Problem associated with exposure to water pollution Problem associated with exposure to soil pollution Problem associated with exposure to exposure to radiation Problem associated with exposure to exposure to tobacco smoke Note: this refers to second-hand smoke, and not to tobacco use by the individual. Problem associated with inadequate access to electricity Problem associated with the natural environment or human-made changes to the environment, unspecified QD60 QD61 QD6Z QD70.1 QD70.3 QD70.4 QD70.5 QD70.6 QD70.2 QD70 QD70.0 QD70.Z Problems associated with inadequate drinking-water, nutrition or the environment Clinical Descriptions and Diagnostic Requirements for ICD-11 Mental, Behavioural or Neurodevelopmental Disorders Problems associated with housing Homelessness Inadequate housing Problem related to living in a residential institution Problem associated with housing, unspecified Other specified problems associated with the environment Problems associated with the environment, unspecified Reasons for contact with mental health services | Problems associated with the environment QD71 QD71.0 QD71.1 QD71.2 QD71.Z QD7Y QD7Z 751 Factors influencing health status or contact with health services particularly relevant to mental health services Factors influencing health status or contact with health services particularly relevant to mental health services Clinical Descriptions and Diagnostic Requirements for ICD-11 Mental, Behavioural or Neurodevelopmental Disorders