Quick Look: DSM-5 (online)

Introduction

The online version of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), is the exclusive product of APAP and is available only through their PsychiatryOnline (POL) platform as part of institutional subscription packages that include other APAP publications. Only DSM-5 is discussed in this review. Although the product is the same in all the packages where it is available, it was examined as part of both the DSM-5 Library and PsychiatryOnline Premium packages.

DSM-5 contains the medically-accepted definitions of mental disorders in the United States and is used for coding patient records, conducting clinical assessments and in legal contexts. It is considered an essential tool for health care professionals, researchers, administrators, and students, and is a basic library reference and learning tool in California community colleges (CCC) with programs and courses that utilize it.

With increasing demands for the convenience of online availability, it’s unsurprising that APAP began its POL service around 2010 to publish and provide online access to the DSM (current and predecessor volumes, DSM-III, DSM-IV and DSM-IV-TR) as well as its other ebooks and journals. Most CCC libraries, however, have continued purchasing, for a one-time charge, the print version of the DSM to support their curriculum because the high and recurring costs of an online subscription has put this out of reach for many. Nonetheless, in-library access restrictions resulting from the COVID-19 global pandemic have revealed just how essential remote access to this information is for students.

Cost

DSM-5 online is only available to academic libraries as part of a POL package (POL Premium, POL Core, and DSM-5 Library), as an annual renewable subscription with pricing “tiers” based upon FTE student numbers and institution type. There is also differentiation in cost by library type, for example with community colleges paying a lower rate than universities (details of each tier are published in APAP’s 2022 subscription catalog). Most California community colleges would fall into Tier 2 (single site Small Associates/Community college up to 9,999 FTE) with a few falling in Tier 3 (over 10,000 FTE).

Though the cost remains high relative to the print version, libraries with students requiring access to the DSM-5 (and any of the other APAP publications) may want to consider an online subscription particularly if on-site access barriers remain due to COVID-19 protocols. The DSM-5 Library (which contains four additional publications) is the least expensive of the three packages, though the price differences between them are minimal, particularly for small colleges. PsychiatryOnline Premium is the most expensive, but includes almost all APAP books and journals in addition to the DSM-5. Students in many lower division psychology courses are unlikely to need the other publications, but colleges with specialized programs that the additional content supports (e.g., training for paraprofessional addiction counselors) may want to consider a subscription to the larger package for a small additional charge.

Usability

Access is provided largely through the POL direct interface. However, connections are also possible via Single Sign-On, EZProxy and Primo VE.

The search interface is limited in scope and designed for medical students who are specializing in psychiatry, as well as for clinicians making diagnoses. Thus, users will see advertisements intended for medical professionals. It is not very user-friendly for undergraduates, though it has improved a bit over time. If a student conducts a search for “alcoholism”, “alcoholics” or “alcohol abuse,” for example, they will be directed to “Substance-Related and Addictive Disorders.” Thus, the system does start to teach, in a broad way, the difference between layperson language and that used by mental health professionals.

One disadvantage of the PsychiatryOnline Premium package, which contains many more publications, is that special instruction is required to show beginning psychology students how to search just the DSM-5 content and not be “led astray” by a system that wants to deliver everything. This should not be an issue for colleges that subscribe only to DSM-5 Library.

Usage statistics are available and are COUNTER5 compliant.

Output

Users may choose output to social media, such as Facebook and Twitter. There is also an email option. However, these methods only send a link, not the actual content. The best output methods are printing or to copy/paste results into another document . (A PDF output option was previously available, but is no longer.) Students may create individual profiles in POL under the institutional subscription, allowing them to save searches and “favorites.” Also, while citations can be exported to software such as Endnote and BibTex, which are typically not used by community college students, they cannot be exported to NoodleTools. The system does not create citations in American Psychological Association format (the other APA).

Accessibility

POL complies with Sec. 508 regulations and Americans with Disabilities Act (ADA) Title 3. The vendor VPAT, last updated July 2020, is available on their product website for institutions and indicates full or partial conformance with WCAG 2.0 and 2.1 levels A and AA.

Privacy

POL has a clear, plain-language privacy policy that appears to meet most of the criteria in the Library Freedom Project’s Vendor Privacy Audit. Specific mention is made of California’s privacy regulations. If a user chooses not to create a personal login for saving search history, their experience with POL will remain largely anonymous.

Support

Several years’ experience with APAP have shown the organization to be responsive through email and telephone to librarian inquiries. There are staff dedicated to the “institutional” side of APA’s business. The bulk of their transactions are with individual members of the practicing psychiatry community to sell guidebooks, journal subscriptions and continuing education.

Recommendation

Most community college libraries choose to purchase print copies of the DSM-5 due to the high cost of the online edition, which comes packaged with a significant amount of material not necessary for most lower division undergraduate coursework. However, ongoing access barriers to print materials resulting from the COVID-19 pandemic make the online option worth a fresh look. Of the three PsychiatryOnline packages containing the DSM-5, the least expensive DSM-5 Library is sufficient to meet the needs of most CCC psychology students. Colleges -- particularly those under 10,000 FTES -- that offer training and accreditation programs for addiction and other behavioral health paraprofessionals may want to consider paying a little more for PsychiatryOnline Premium to get additional content that supports these programs.