Mental health overdiagnosis: main causes and consequences

Mental health overdiagnosis is the tendency to diagnose one or more clinical categories of psychiatry in a generalized and disproportionate manner. This is a practice recently questioned within the Specialist Guild due to recent increase in different psychiatric diagnoses.

However, this is a trend that is present not only in the field of mental health, but in other specialties due to certain elements that characterize contemporary medical practice.

More precisely, overdiagnosis of mental health can have different impacts at the individual, economic and social levels, Problems that we will see developed below

    Mental health overdiagnosis

    The overdiagnosis of mental health has been examined in particular in mood disorders in adults, attention deficit hyperactivity disorder (ADHD) in children, and autism spectrum disorder in the same stage of development. Previous, after their numbers increased alarmingly and disproportionately over the past decade, particularly in the United States, Canada and some European countries (Penyes, JJ. and Domínguez, J., 2012).

    According to Pascual-Castroviejo (2008), in a few years, the prevalence of ADHD has increased from 4% – 6% to 20%, according to various epidemiological studies. As for Attention Deficit Disorder, it is the most diagnosed in girls; while Attention Deficit Hyperactivity Disorder is most commonly diagnosed in children.

    In turn, depression is more diagnosed in women than in men. In this case, Leon-Sanromà, Fernández, Gau and Gomà (2015) question the tendency to overdiagnosis in specialist journals. For example, a study carried out in the south of Catalonia and published in the journal Atenció Primària, warned against a 46.7% prevalence of depression in the general population (53% in women and 40% in men ), which means that almost half of the total population of this region was in depression.

    On the other hand, according to the same authors, other studies carried out among the consulting population show a prevalence of only 14.7% for major depression, and 4.6% for dysthymia, for a total of 19.3%. This figure remains alarming; however, this takes us away from the fact that almost half of the population lives with this diagnosis.

    Following different authors, we will see below some of the practices that lead to overdiagnosis and what are its main risks in physiological, psychological, social and economic terms.

      Why is an overdiagnosis generated?

      Overdiagnosis is a consequence of methodological problems present in the study and / or definition of mental disorders, in their detection and in research on their prevalence. In other words, the study and promotion of diseases are often mediated by their defining processes, as well as by strategic use of detection tools and statistics (García Dauder and Pérez Saldaño, 2017; Leon-Sanromà, et al. 2015).

      More specifically in the field of mental health, the validity of the category “disorder”, its non-specificity and its differentiation from the term “disease”, as well as the criteria that define what is “healthy”, And what is not. The same happened when examining the diagnosis of mental disorders.

      For example, some cases of depression have been confirmed after using inaccurate techniques such as applying a test to which the quality of the definitive diagnosis is wrongly attributed (the tests are tools of detection and differentiation, not they are in diagnostic techniques themselves) (Leon-Sanromà, et al. 2015).

      On the other hand, when assessing the proportion of individuals suffering from depression, inaccurate techniques were also used, such as telephone surveys or structured interviews which easily overestimate their prevalence (Ezquiaga, García, Díaz de Neira and García, 2011). Combined with this, the scientific literature tends to pay more attention to underdiagnosis than overdiagnosis.

      In accordance with the above, the methodological problem linked to the definition of mental disorders becomes visible in the ease with which they become generalized. One example is the tendency to consider all fallen moods to be pathological, when this is not always the case (Leon-Sanromà, et al. 2015). This state can be an adaptive and normal response to a painful event, and not necessarily a disproportionate and pathological response.

      In the same sense, another of the methodological problems associated with overdiagnosis in mental health is related to the tendency to exaggerate, or minimize the differences between groups according to different variables such as sex, gender, social class, among others. Often this tendency is implicit in the designs, assumptions, collection and analysis of data in research, Generate a set of biases on the development and prevalence of different diseases (García Dauder and Pérez Sedeño, 2017).

      5 ways to find out what this practice is going through

      There are different factors that can alert you that a disease is overdiagnosed. In addition, these factors make visible certain processes that contribute to this trend. To explain this, we will follow the work of Glasziou and Richards (2013); Leon-Sanromà et al. (2015); and Martínez, Galán, Sánchez and González de Déu (2014).

      1. There are more intervention techniques, but they do not reduce disease

      One can be warned of the possible overdiagnosis of a disease when a significant contradiction between the intervention and the prevalence of the diseases becomes present: there is an increase in the number of techniques of intervention against the disease (for example a production of drugs and higher rates of medicalization). However, this increase it does not result in a decrease in the prevalence of the disorder.

      2. Increase diagnostic threshold

      Conversely, there may not be significant and constant innovation in intervention techniques; however, the diagnostic threshold does not decrease, or even increase. In other words, changes in diagnostic criteria lead to an increase in the number of people affected. It is a common case in mental disordersBut it can also be seen in other medical classifications such as osteoporosis, obesity or high blood pressure.

      Likewise, the prejudices run through by mental health stigma, present in both health workers and the non-specialist population, can contribute to a widespread diagnosis (Tara, Bethany & Nosek, 2008).

      3. Even risk factors are considered a disease

      Another indicator is when risk factors or substances that indicate biological processes or states (biomarkers) are presented as diseases. In this context, the definitions of diseases are changed due to unclear distinctions between them; which generates little evidence on the benefits of these modifications compared to the negative effects they can cause. The latter is in part a consequence of poor diagnostic accuracy surrounding certain discomforts.

      In turn, and as we have already said, this inaccuracy is a consequence of the methodology used in the study and the definition thereof. In other words, it has to do with how it is determined what is and what is not a disease, what elements are used for its explanation and which elements are excluded.

      4. Clinical variability is not taken into account

      The diagnostic spectrum of mental disorders is not only very broad, but its definition and criteria are mainly based on agreements between specialists, Beyond objective evidence.

      Likewise, the severity of his symptoms is determined by intensity, number of symptoms and degree of functional impairment. However, this severity is often widespread or is considered the only aspect of diagnoses, which increases not only the number of people diagnosed, but also the number of people with serious diagnoses.

      5. The role of specialists

      According to Martínez, Galán, Sánchez and González de Déu (2014), what contributes to overdiagnosis is the part of medical practice whose interest is purely scientific and it follows the inertia of the search for diagnoses under the rigidity of the organicist model.

      In the same sense, the position of the professional during consultations plays a relevant role (ibidem). Indeed, a health profile occupied by emotional constraint does not produce the same effect as the health profile when it involves the re-production of demand. In the first case, it does not promote pseudourgency and is therefore not transmitted to the user. In the second trivialization of medical practice can easily be generated.

      Finally, faced with the growing participation of the pharmaceutical industry in mental health, the conflicts of interest of certain professionals, health and research centers and public administrations have increased considerably, sometimes favoring or supporting medicalization by overdiagnosis.

      Several of its consequences

      The overdiagnosis of mental health is a phenomenon that manifests itself in the short and long term, as it has consequences not only at the individual level but also at the economic and social level. In their analysis of the overdiagnosis of depression, Adam-Manes and Ayuso-Mateos (2010) establish three main impacts:

      1. Medical impact

      It refers to the increased risk of iatrogenicity, such as excessive medical attention and over-medicalization can lead to chronicity of the discomfort. Likewise, the overdiagnosis of some disorders may go hand in hand with the underdiagnosis of others, and their resulting inattention.

      2. Psychological and social impact

      It results in a greater stigmatization, with a possible decrease in the autonomy of the users, and a lack of responsibility for the social factors involved in the discomfort. It also refers to the generalization of psychopathology as a more immediate answer to questions of everyday life, Even outside the specialized field.

      3. Economic impact

      This happens in two ways: the first is the high cost of mental health care, especially in primary care services but also in specialized services, which implies expenditure on infrastructure and human resources and pharmacological treatments. And the second impact is the gradual decline in the productivity of those diagnosed.

      conclusion

      Taking these elements and consequences into account does not mean denying the discomfort and suffering, nor does it mean that we must stop investing efforts in timely and respectful detection and response. It means that you must stay vigilant facing the possible negative effects of extrapolating biomedical practices towards understanding and bringing together all aspects of human life.

      In addition, he warns us against the need to constantly review the criteria and methodology that define and intervene in mental health.

      Bibliographical references:

      • Adam-Manes, J. and Ayuso-Mateos, JL (2010). Overdiagnosis and overtreatment of major depressive disorder in primary care: a growing phenomenon. Primary care, 42 (1): 47-49.
      • Ezquiaga, I., García, A., Díaz de la Neira, M. and García, MJ (2011). “Depression.” Diagnostic and therapeutic imprecision. Important consequences in clinical practice. Journal of the Spanish Association of Neuropsychiatry, 31 (111): 457-475.
      • Garcia Dauder. (S). and Pérez Sedeño, I. (2017). Scientific lies about women. Cataract: Madrid.
      • García Penyes, JJ and Domínguez Carral, J. (2012). Is Attention Deficit Hyperactivity Disorder (ADHD) overdiagnosed? Evidence in Pediatrics, 8 (3): 1-5.
      • Glasziou, P. and Moynihan, R. (2013). Mass medicine; little care, British Medical Journal, 7915: 7
      • Leon-Sanromà, M., Fernández, MJ, Gau, A. and Gomà, J. (2015). Half the population has been diagnosed with depression? Primary Care, 47 (4): 257-258.
      • Martínez, C., Riaño, R., Sánchez, M. and González de Déu, J. (2014). Quaternary prevention. Containment as an ethical imperative. Spanish Association of Pediatrics, 81 (6): 396.e1-396.e8.
      • Pascual-Castroviejo, I. (2008). Attention deficit hyperactivity disorder. Spanish Association of Pediatrics. Accessed September 18, 2018.Available at https://www.aeped.es/sites/default/files/documentos/20-tdah.pdf.
      • Valdecasas, J. (2018). Mental health at a crossroads: in search of a new psychiatry for an increasingly sick world. Platform No thanks. Accessed September 18, 2018.Available at http://www.nogracias.eu/2018/01/07/la-salud-mental-la-encrucijada-buscando-una-nueva-psiquiatria-mundo-vez-mas-enfermo – Jose-Valdecasas /.

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