title: Diagnostic variability for schizophrenia and major depression in a large public mental health care system dataset.
abstract: 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.
authors.affiliation: Department of Psychiatry, University of California San Diego, San Diego, CA, USA. dfolsom@ucsd.edu
authors.forename: David P
authors.initials: DP
authors.lastname: Folsom
authors.forename: Laurie
authors.initials: L
authors.lastname: Lindamer
authors.forename: Lori P
authors.initials: LP
authors.lastname: Montross
authors.forename: William
authors.initials: W
authors.lastname: Hawthorne
authors.forename: Shahrokh
authors.initials: S
authors.lastname: Golshan
authors.forename: Richard
authors.initials: R
authors.lastname: Hough
authors.forename: John
authors.initials: J
authors.lastname: Shale
authors.forename: Dilip V
authors.initials: DV
authors.lastname: Jeste
mesh_terms: D000328:Adult; D002140:California / Q000453:epidemiology; D002391:Catchment Area, Health; D003710:Demography; D003865:Major Depressive Disorder / Q000175:diagnosis* / Q000453:epidemiology*; D003937:Diagnosis, Differential; D003954:Diagnostic Services / Q000592:standards*; D004637:Emergency Services, Psychiatric / Q000706:statistics & numerical data; D005260:Female; D006778:Hospitals, Psychiatric / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008605:Mental Health Services / Q000592:standards / Q000706:statistics & numerical data*; D015995:Prevalence; D011330:Prisons / Q000706:statistics & numerical data; D011635:Public Health Administration; D012559:Schizophrenia / Q000175:diagnosis* / Q000453:epidemiology*; D012680:Sensitivity and Specificity