The following is a summary of “Motives and modifying factors for giving or rejecting psychiatric diagnoses in general medicine and psychiatry – a qualitative interview study,” published in the June 2024 issue of Psychiatry by Elst et al.
Debates about over-diagnosis in general practice vs. under-reporting in psychiatry highlight the need for a better understanding of prevalence through analysis of routine healthcare data while acknowledging potential biases.
Researchers conducted a retrospective study investigating the motivations and factors influencing the decision to assign or withhold psychiatric diagnoses in both psychiatric and general medical environments.
They conducted in-depth interviews using a semi-structured format with 26 German physicians practicing general medicine or psychiatry. A content analysis method was used to analyze the interviews.
The result showed 3 key categories influencing physician decisions to diagnose psychiatric disorders. The first category, “objective matters,” included factors like research categorization. The second category, “functional and performance aspects,” encompassed elements such as medication needs, billing considerations associated with specific diagnoses, and access to appropriate care. Finally, the third category, “individual factors,” focused on physician personality traits. The analysis also identified factors discouraging diagnoses, such as potential patient stigma or negative impacts on insurance status. Additionally, participants mentioned alternative explanations for not diagnosing, such as the presence of other clinical conditions.
Investigators concluded that the diagnostic process encompassed complexities beyond mere identification of medical findings, emphasizing the importance of the insight in utilizing secondary data for healthcare system design or study planning.
Source: bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-024-05900-2
