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Severe mental illness diagnosis in English general hospitals 2006-2017: A registry linkage study.
Mansour, Hassan; Mueller, Christoph; Davis, Katrina A S; Burton, Alexandra; Shetty, Hitesh; Hotopf, Matthew; Osborn, David; Stewart, Robert; Sommerlad, Andrew.
Afiliação
  • Mansour H; Division of Psychiatry, University College London, United Kingdom.
  • Mueller C; King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom.
  • Davis KAS; South London and Maudsley NHS Foundation Trust, London, United Kingdom.
  • Burton A; King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom.
  • Shetty H; South London and Maudsley NHS Foundation Trust, London, United Kingdom.
  • Hotopf M; Division of Psychiatry, University College London, United Kingdom.
  • Osborn D; South London and Maudsley NHS Foundation Trust, London, United Kingdom.
  • Stewart R; King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom.
  • Sommerlad A; South London and Maudsley NHS Foundation Trust, London, United Kingdom.
PLoS Med ; 17(9): e1003306, 2020 09.
Article em En | MEDLINE | ID: mdl-32941435
ABSTRACT

BACKGROUND:

The higher mortality rates in people with severe mental illness (SMI) may be partly due to inadequate integration of physical and mental healthcare. Accurate recording of SMI during hospital admissions has the potential to facilitate integrated care including tailoring of treatment to account for comorbidities. We therefore aimed to investigate the sensitivity of SMI recording within general hospitals, changes in diagnostic accuracy over time, and factors associated with accurate recording. METHODS AND

FINDINGS:

We undertook a cohort study of 13,786 adults with SMI diagnosed during 2006-2017, using data from a large secondary mental healthcare database as reference standard, linked to English national records for 45,706 emergency hospital admissions. We examined general hospital record sensitivity across patients' subsequent hospital records, for each subsequent emergency admission, and at different levels of diagnostic precision. We analyzed time trends during the study period and used logistic regression to examine sociodemographic and clinical factors associated with psychiatric recording accuracy, with multiple imputation for missing data. Sensitivity for recording of SMI as any mental health diagnosis was 76.7% (95% CI 76.0-77.4). Category-level sensitivity (e.g., proportion of individuals with schizophrenia spectrum disorders (F20-29) who received any F20-29 diagnosis in hospital records) was 56.4% (95% CI 55.4-57.4) for schizophrenia spectrum disorder and 49.7% (95% CI 48.1-51.3) for bipolar affective disorder. Sensitivity for SMI recording in emergency admissions increased from 47.8% (95% CI 43.1-52.5) in 2006 to 75.4% (95% CI 68.3-81.4) in 2017 (ptrend < 0.001). Minority ethnicity, being married, and having better mental and physical health were associated with less accurate diagnostic recording. The main limitation of our study is the potential for misclassification of diagnosis in the reference-standard mental healthcare data.

CONCLUSIONS:

Our findings suggest that there have been improvements in recording of SMI diagnoses, but concerning under-recording, especially in minority ethnic groups, persists. Training in culturally sensitive diagnosis, expansion of liaison psychiatry input in general hospitals, and improved data sharing between physical and mental health services may be required to reduce inequalities in diagnostic practice.
Assuntos

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Hospitalização / Transtornos Mentais Tipo de estudo: Diagnostic_studies / Observational_studies / Risk_factors_studies Limite: Female / Humans / Male País/Região como assunto: Europa Idioma: En Ano de publicação: 2020 Tipo de documento: Article

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Hospitalização / Transtornos Mentais Tipo de estudo: Diagnostic_studies / Observational_studies / Risk_factors_studies Limite: Female / Humans / Male País/Região como assunto: Europa Idioma: En Ano de publicação: 2020 Tipo de documento: Article