Folsom David P, Lindamer Laurie, Montross Lori P, Hawthorne William, Golshan Shahrokh, Hough Richard, Shale John, Jeste Dilip V
Department of Psychiatry, University of California San Diego, San Diego, CA, USA.
Psychiatry Res. 2006 Nov 15;144(2-3):167-75. doi: 10.1016/j.psychres.2005.12.002. Epub 2006 Sep 15.
Administrative datasets can provide information about mental health treatment in real world settings; however, an important limitation in using these datasets is the uncertainty regarding psychiatric diagnosis. To better understand the psychiatric diagnoses, we investigated the diagnostic variability of schizophrenia and major depression in a large public mental health system. Using schizophrenia and major depression as the two comparison diagnoses, we compared the variability of diagnoses assigned to patients with one recorded diagnosis of schizophrenia or major depression. In addition, for both of these diagnoses, the diagnostic variability was compared across seven types of treatment settings. Statistical analyses were conducted using t tests for continuous data and chi-square tests for categorical data. We found that schizophrenia had greater diagnostic variability than major depression (31% vs. 43%). For both schizophrenia and major depression, variability was significantly higher in jail and the emergency psychiatric unit than in inpatient or outpatient settings. These findings demonstrate that the variability of psychiatric diagnoses recorded in the administrative dataset of a large public mental health system varies by diagnosis and by treatment setting. Further research is needed to clarify the relationship between psychiatric diagnosis, diagnostic variability and treatment setting.
行政数据集可以提供现实环境中精神卫生治疗的相关信息；然而，使用这些数据集的一个重要局限性在于精神科诊断存在不确定性。为了更好地理解精神科诊断，我们在一个大型公共精神卫生系统中调查了精神分裂症和重度抑郁症的诊断变异性。以精神分裂症和重度抑郁症作为两种对照诊断，我们比较了被记录为患有精神分裂症或重度抑郁症单一诊断的患者所获诊断的变异性。此外，对于这两种诊断，我们还比较了七种治疗环境下的诊断变异性。使用t检验分析连续数据，使用卡方检验分析分类数据。我们发现，精神分裂症的诊断变异性大于重度抑郁症（31%对43%）。对于精神分裂症和重度抑郁症，监狱和急诊精神科的变异性显著高于住院或门诊环境。这些发现表明，大型公共精神卫生系统行政数据集中记录的精神科诊断变异性因诊断和治疗环境而异。需要进一步研究以阐明精神科诊断、诊断变异性和治疗环境之间的关系。
