Jensen-Doss Amanda, Youngstrom Eric A, Youngstrom Jennifer Kogos, Feeny Norah C, Findling Robert L
Department of Psychology, University of Miami.
Department of Psychology, University of North Carolina at Chapel Hill.
J Consult Clin Psychol. 2014 Dec;82(6):1151-62. doi: 10.1037/a0036657. Epub 2014 Apr 28.
Diagnoses play an important role in treatment planning and monitoring, but extensive research has shown low agreement between clinician-generated diagnoses and those from structured diagnostic interviews. However, most prior studies of agreement have not used research diagnoses based on gold standard methods, and researchers need to identify characteristics of diagnostically challenging clients. This study examined agreement between youth diagnoses generated through the research-based LEAD (Longitudinal, Expert, and All Data) standard to clinician diagnoses.
Participants were 391 families seeking outpatient community mental health services for youths ages 6-18 (39.1% female, 88.2% African American). Youths and parents completed research interviews and clinic diagnoses were extracted from clinic records. LEAD diagnoses synthesized results of the Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime (KSADS-PL) and the youth's developmental, family, and psychiatric history.
Agreement between the LEAD and chart diagnoses was low, not exceeding "poor" agreement for most diagnostic categories (κs = .10-.46, median = .37). Disagreement was largely driven by missed diagnoses, although clinicians also did assign extra diagnoses for some clients. Fewer diagnostic errors occurred when the youth's clinical picture was more clear (e.g., high or low symptom severity, lower comorbidity), when the youth was older, when the family was higher functioning, and when the parent had more depression. However, youth and family characteristics explained very little of the variability in diagnostic errors.
RESULTS support the need to investigate strategies to improve clinician diagnostic accuracy.
诊断在治疗计划制定和监测中起着重要作用，但大量研究表明，临床医生做出的诊断与结构化诊断访谈得出的诊断之间一致性较低。然而，大多数先前的一致性研究并未采用基于金标准方法的研究诊断，且研究人员需要确定诊断具有挑战性的患者的特征。本研究考察了通过基于研究的LEAD（纵向、专家和全数据）标准得出的青少年诊断与临床医生诊断之间的一致性。
参与者为391个寻求为6至18岁青少年提供门诊社区心理健康服务的家庭（女性占39.1%，非裔美国人占88.2%）。青少年及其父母完成了研究访谈，并从临床记录中提取了临床诊断。LEAD诊断综合了学龄儿童情感障碍和精神分裂症量表（目前和终生版，KSADS-PL）的结果以及青少年的发育、家庭和精神病史。
LEAD诊断与病历诊断之间的一致性较低，大多数诊断类别不超过“较差”的一致性（κ值 = 0.10 - 0.46，中位数 = 0.37）。分歧主要是由漏诊导致的，不过临床医生也确实为一些患者额外做出了诊断。当青少年的临床表现更清晰时（例如，症状严重程度高或低、共病情况较少）、青少年年龄较大时、家庭功能较高时以及父母抑郁程度较高时，诊断错误较少。然而，青少年和家庭特征对诊断错误变异性的解释非常少。
研究结果支持有必要研究提高临床医生诊断准确性的策略。
