Diagnostic variability for schizophrenia and major depression in a large public mental health care system dataset

Folsom, David P.; Lindamer, Laurie; Montross, Lori P.; Hawthorne, William; Golshan, Shahrokh; Hough, Richard; Shale, John; Jeste, Dilip V.

doi:10.1016/j.psychres.2005.12.002

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Volume 144, Issue 2 , Pages 167-175, 15 November 2006

Diagnostic variability for schizophrenia and major depression in a large public mental health care system dataset

David P. Folsom
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
- Corresponding author. University of California, San Diego VA San Diego Healthcare System, 3350 La Jolla Village Drive, San Diego, CA 92161, USA. Tel.: +1 858 534 4020; fax: +1 858 552 7404.
Laurie Lindamer
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
Lori P. Montross
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
William Hawthorne
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
- Community Research Foundation, San Diego, CA, USA
Shahrokh Golshan
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
Richard Hough
- Department of Psychiatry, University of New Mexico, Albuquerque, NM, USA
John Shale
- San Diego County Adult and Older Adult Mental Health Services, San Diego, CA, USA
Dilip V. Jeste
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA

Received 6 July 2005; received in revised form 10 November 2005; accepted 3 December 2005.

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.

Keywords: Schizophrenia, Major depression, Variability, Public mental health system