Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Québec, Canada,
Department of Psychiatry, McGill University, Montreal, Québec, Canada,
Psychother Psychosom. 2019;88(4):193-202. doi: 10.1159/000501647. Epub 2019 Jul 24.
Overdiagnosis is thought to be common in some mental disorders, but it has not been defined or examined systematically. Assessing overdiagnosis in mental health requires a consistently applied definition that differentiates overdiagnosis from other problems (e.g., misdiagnosis), as well as methods for quantification.
Our objectives were to (1) describe how the term "overdiagnosis" has been defined explicitly or implicitly in published articles on mental disorders, including usages consistent (overdefinition, overdetection) and inconsistent (misdiagnosis, false-positive test results, overtreatment, overtesting) with accepted definitions of overdiagnosis; and (2) identify examples of attempts to quantify overdiagnosis.
We searchedPubMed through January 5, 2019. Articles on mental disorders, excluding neurocognitive disorders, were eligible if they usedthe term "overdiagnosis" in the title, abstract, or text.
We identified 164 eligible articles with 193 total explicit or implicit uses of the term "overdiagnosis." Of 9 articles with an explicit definition, only one provided a definition that was partially consistent with accepted definitions. Of all uses, 11.4% were consistent, and 76.7% were related to misdiagnosis and thus inconsistent. No attempts to quantify the proportion of patients who were overdiagnosed based on overdetection or overdefinition were identified.
There are few examples of mental health articles that describe overdiagnosis consistent with accepted definitions and no examples of quantifying overdiagnosis based on these definitions. A definition of overdiagnosis based on diagnostic criteria that include people with transient or mild symptoms not amenable to treatment (overdefinition) could be used to quantify the extent of overdiagnosis in mental disorders.
过度诊断被认为在某些精神障碍中较为常见，但尚未得到明确界定或系统研究。评估精神卫生领域的过度诊断需要一个始终如一的定义，该定义能够区分过度诊断与其他问题（例如误诊），同时还需要有量化方法。
我们的目标是：（1）描述在关于精神障碍的已发表文章中，“过度诊断”一词是如何被明确或隐含定义的，包括与过度诊断的公认定义一致（过度定义、过度检测）和不一致（误诊、假阳性检测结果、过度治疗、过度检测）的用法；（2）确定尝试量化过度诊断的实例。
我们于 2019 年 1 月 5 日前在 PubMed 上进行了检索。排除神经认知障碍的精神障碍相关文章，如果在标题、摘要或正文中使用了“过度诊断”一词，则符合入选标准。
我们共确定了 164 篇符合条件的文章，其中有 193 次明确或隐含地使用了“过度诊断”一词。在 9 篇有明确定义的文章中，只有 1 篇的定义部分与公认的定义一致。在所有用法中，有 11.4%是一致的，而 76.7%与误诊相关，因此不一致。未发现任何根据过度检测或过度定义来量化基于过度诊断患者比例的尝试。
符合公认定义的精神健康文章中很少有描述过度诊断的实例，也没有根据这些定义来量化过度诊断的实例。基于包括短暂或轻度症状且无法治疗的人群（过度定义）的诊断标准的过度诊断定义，可以用于量化精神障碍中过度诊断的程度。
