School of Psychology, University College Dublin, Dublin, Ireland.
School of Medicine, University College Dublin, Dublin, Ireland.
J Abnorm Child Psychol. 2020 Aug;48(8):979-993. doi: 10.1007/s10802-020-00657-0.
Psychiatric diagnoses are important resources in helping young people and families make sense of emotional or behavioural difficulties. However, the poor reliability of diagnoses in childhood means many young service-users experience their diagnosis being removed, revised or supplemented over time. No previous research has investigated how young service-users experience, understand or respond to alteration of their original diagnosis. The current study adopted a qualitative approach to explore the lived experience of diagnostic shifts in youth mental health contexts. Narrative interviews were conducted with families living in Ireland, who had direct experience of diagnostic shifts. Participants included 21 parents (19 female) and 14 young people (8 female, mean age = 14). Thematic analysis explored the range of interpretations and implications of diagnostic shifts in families' lives, identifying three themes that underpinned participants' narratives. Diverse Trajectories & Experiences outlined the variety of contexts for diagnostic shifts, ways they were communicated to parents and young people, and their clinical consequences. A Process of Readjustment captured processes of emotional and conceptual adaptation that followed a diagnostic shift. Finally, Social Repositioning explored how diagnostic shifts could prompt changes to interpersonal relations, social identity and stigma experiences. The study shows that diagnostic shifts carry significant emotional, social and practical repercussions. While diagnostic shifts may threaten the therapeutic relationship and service-user understanding, they also offer opportunities to enhance young people's self-concept, social relationships and therapeutic engagement. Clinician awareness of the socio-emotional implications of diagnostic shifts is vital to inform sensitive communication and support strategies.
精神科诊断对于帮助年轻人和家庭理解情绪或行为困难非常重要。然而，儿童诊断的可靠性较差意味着许多年轻的服务使用者随着时间的推移会经历其诊断被删除、修改或补充。以前没有研究调查过年轻的服务使用者如何体验、理解或应对其原始诊断的改变。本研究采用定性方法探讨了青年心理健康背景下诊断变化的生活体验。对在爱尔兰有直接诊断变化经验的家庭进行了叙事性访谈。参与者包括 21 名家长（19 名女性）和 14 名年轻人（8 名女性，平均年龄=14 岁）。主题分析探讨了家庭生活中诊断变化的各种解释和影响，确定了三个主题，这些主题构成了参与者叙述的基础。不同的轨迹和体验概述了诊断变化的各种情况，它们向家长和年轻人传达的方式，以及它们的临床后果。调整过程捕捉了诊断变化后的情绪和概念调整过程。最后，社会重新定位探讨了诊断变化如何促使人际关系、社会认同和耻辱感发生变化。该研究表明，诊断变化会带来重大的情感、社会和实际影响。虽然诊断变化可能会威胁到治疗关系和服务使用者的理解，但它们也为增强年轻人的自我概念、社会关系和治疗参与提供了机会。临床医生对诊断变化的社会情感影响的认识对于告知敏感的沟通和支持策略至关重要。
