Accuracy of diagnosis at routine psychiatric assessment in patients presenting to an accident and emergency department
Abstract
Objective This study aimed to compare diagnoses obtained from routine psychiatric assessment in accident and emergency (A&E) settings with those from a standardized diagnostic interview.Methods Using Cohen's kappa, the agreement between diagnoses from routine psychiatric assessment and structured interview was calculated. Further statistical analysis was used to investigate differences between some of the main diagnostic subgroups.Results The overall kappa value for all diagnoses was .47. Adjustment disorder, major depressive disorder and alcohol misuse/dependence were commonly identified, both at routine assessment and on structured interview. There was a disparity between the two diagnostic systems in the extent to which major depressive disorder and adjustment disorder were identified. Further analysis between these two groups was inconclusive as to the reasons for this difference.Conclusions There was moderate agreement between clinical and standardized diagnoses. Anxiety disorders were poorly identified at routine assessment. There is difficulty distinguishing between adjustment disorder and depressive episode in the A&E setting.
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At this point there is some information on the proposed changes to adjustment disorder in DSM-5 including its inclusion in a genre of stress-related disorder, which would lead to harmonisation with ICD-11.
“At this point there is some information on the proposed changes to adjustment disorder in DSM-5 including its inclusion in a genre of stress-related disorder, 19 which would lead to harmonisation with ICD-11.”
From Adjustment disorder: Implications for ICD-11 and DSM-5 (2012) · cites this paper as [19]
Section 2.1 (p. 3) describes diagnoses coded using ICD-10 and transcribed to DSM-IV equivalents. Section 4.2.1 (p. 5) discusses the boundary between adjustment disorder and depression, but does not address proposed DSM-5 changes, a stress-related disorder grouping, or harmonisation with ICD-11. Searches for those terms and for proposed classification changes found no supporting passage in our copy. (LLM, conf=0.78)
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- Authors
- Taggart, C., O'Grady, J., Stevenson, M., Hand, E., Mc Clelland, R., & Kelly, C.
- Affiliations
- Belfast City Hospital (GB)
- Royal Victoria Hospital (GB)
- Corresponding author
- Kelly, Chris
- Venue
- General Hospital Psychiatry
- Publisher
- Elsevier BV
- Published
- 2006-07
- Volume
- 28
- Issue
- 4
- Pages
- 330-335
- ISSN
- 0163-8343 (ISSN-L)
- OpenAlex
- W2138326142
- Cited by
- 51
- References
- 14
- Citations by year
- 2026: 1 · 2025: 2 · 2024: 2 · 2023: 1 · 2022: 4 · 2021: 4 · 2020: 3 · 2019: 6 · 2018: 2 · 2017: 1 · 2016: 1 · 2015: 2 · 2014: 4 · 2013: 4 · 2012: 3
- FWCI
- 2.21
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- General Hospital Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Psychiatric care and mental health services
- Health Sciences › Medicine › Emergency Medicine › Emergency and Acute Care Studies
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Keywords
- emergency department, structured diagnostic interview, diagnostic agreement, adjustment disorder, major depressive disorder, alcohol abuse, alcoholism, anxiety disorders
- MeSH terms
- Adjustment Disorders, Adolescent, Adult, Anxiety Disorders, Demography, Major Depressive Disorder, Diagnosis, Differential, Emergency Medical Services, Female, Humans, Interview, Psychological, Male, Middle Aged, Self-Injurious Behavior, Substance-Related Disorders
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