A Review of 20 Years of Research on Overdiagnosis and Underdiagnosis in the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) Project
Open accessAbstract
The Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) project represents an integration of research methodology into a community-based outpatient practice affiliated with an academic medical centre. The MIDAS project is the largest clinical epidemiological study using semi-structured interviews to assess a wide range of psychiatric disorders in a general clinical outpatient practice. In an early report from the MIDAS project, we found that across diagnostic categories clinicians using unstandardized, unstructured clinical interviews underrecognized diagnostic comorbidity, compared with the results of semi-structured interviews. Moreover, we found that the patients often wanted treatment for symptoms of disorders that were diagnosed as comorbid, rather than principal, conditions. This highlighted the importance, from the patient’s perspective, of conducting thorough diagnostic interviews to diagnose disorders that are not related to the patient’s chief complaint because patients often desire treatment for these additional diagnoses. While several of the initial papers from the MIDAS project identified problems with the detection of comorbid disorders in clinical practice, regarding the diagnosis of bipolar disorder we observed the emergence of an opposite phenomenon—clinician overdiagnosis. The results from the MIDAS project, along with other studies of diagnosis in routine clinical practice, have brought to the forefront the problem with diagnosis in routine clinical practice. An important question is what do these findings suggest about the community standard of care in making psychiatric diagnoses, and whether and how the standard of care should be changed? The implications are discussed.
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The mean age and gender distribution in RADAR-MDD participants is comparable to other MDD samples such as STAR*D and MIDAS.
“The mean age and gender distribution in our participants is comparable to other MDD samples, such as Sequenced Treatment Alternatives to Relieve Depression (STAR*D; [48]) and the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS; [49]).”
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Chandra, B., Kindy, G. O., Gunawan, K. S., Satria, G. P., Edbert, I. S., & Suhartono, D. (2023) · International Conference on Sustainable Information Engineering and Technology (SIET) · doi:10.1145/3626641.3627492 · Cited by 2 · see citing works
Stanton, K. J., Balzen, K. M., Levin-Aspenson, H. F., & DeFluri, C. M. (2022) · doi:10.31219/osf.io/fzuye · Cited by 2 · see citing works
Nicoletta, V., Ruiz, A. B., Bélanger, V., Paccalet, T., Isabelle, M., & Maziade, M. (2025) · PLOS mental health. · doi:10.1371/journal.pmen.0000327 · Cited by 1 · see citing works
Clinically Distinguishing Bipolar Disorder From Other Psychiatric Conditions
Weber, S. R., & Duchemin, A. (2025) · Journal of Psychiatric Practice · doi:10.1097/pra.0000000000000886 · Cited by 2 · see citing works
Psychotropes et personnalité borderline : prescrire, ne pas prescrire, déprescrire ?
Berna, F. S., Musso, M., Weibel, S., & Brunn, M. (2026) · Annales Médico-psychologiques revue psychiatrique · doi:10.1016/j.amp.2026.03.011 · Cited by 1 · see citing works
Prevalence and Treatment Desire for Comorbid Psychiatric Disorders in Outpatient Clinical Practice
Zimmerman, M., Snyder, M. D., & Faqqouseh, M. (2026) · Annals of Clinical Psychiatry · doi:10.1177/10401237261453590 · Cited by 1 · see citing works
Self-citationStanton, K. J., McGonigal, P. T., Kerr, S., Morgan, T. A., & Zimmerman, M. A. (2020) · Journal of Psychopathology and Behavioral Assessment · doi:10.1007/s10862-020-09815-6 · Cited by 1 · see citing works
Self-citationVaughan, E. P., Kemp, E. C., Robertson, E., Walker, T. M., Picou, P., Frick, P. J., & de Back, J. (2023) · Child & Youth Care Forum · doi:10.1007/s10566-023-09738-9 · Cited by 1 · see citing works
Chen, J. J., Mermin, S. A., Duffy, L., Wong, S., Layfield, S., Rodriguez‐Villa, F., Gelda, S. E., Gelwan, E. M., Eisen, J., Ressler, K. J., et al. (2025) · BMC Psychiatry · doi:10.1186/s12888-025-06928-8 · Cited by 1 · see citing works
Zimmerman, M. A., Kerr, S., Balling, C. E., Kiefer, R., & Dalrymple, K. L. (2020) · Annals of Clinical Psychiatry · doi:10.1177/104012372003200103 · Cited by 1 · see citing works
Self-citationBipolar Affective Disorder in Men
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Clinician Perception of the Utility of the Hierarchical Taxonomy of Psychopathology (HiTOP) SystemPreprint
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Müller, S., Schroeders, U., Bachrach, N., Benecke, C., Cuevas, L., Doering, S., Elklit, A., Gutiérrez, F., Hengartner, M. P., Hogue, T. E., et al. (2023) · doi:10.31234/osf.io/f2yvj · Cited by 1 · see citing works
Self-citation(2020) · Australasian Psychiatry · doi:10.1177/1039856220926601c
Zimmerman, M. A., & Becker, L. (2023) · Annals of Clinical Psychiatry · doi:10.12788/acp.0098
Self-citationRepnikov, G. (2023) · Philosophy of Medicine · doi:10.5195/pom.2023.15
Unlocking disease associations during prefrontal cortex development with scRNAseqPreprint
Farley, K. O., Chen, K. G., & Lassmann, T. (2024) · Research Square · doi:10.21203/rs.3.rs-4948061/v1
Reutimann, S., Steiner, J., Hübscher, N., Voderholzer, U., Meule, A., & Augsburger, M. (2025) · JMIR Formative Research · doi:10.2196/50504
Diehl, J. M., Levin-Aspenson, H. F., Boyd, S. I., & Zimmerman, M. (2026) · Research Square · doi:10.21203/rs.3.rs-9487881/v1
Self-citationChapter 8. Reducing Treatment Failure: Steps to Follow
(2024) · American Psychiatric Association Publishing eBooks · doi:10.1176/appi.books.9798894551937.lg08
Is Chronic Emptiness a Transdiagnostic Suicide Risk Factor?
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The Significance of Borderline Personality Disorder in Older Depressed Patients
Schweitzer, J., & Zimmerman, M. A. (2026) · Annals of Clinical Psychiatry · doi:10.1177/10401237261493995
Self-citationSchweitzer, J., & Zimmerman, M. A. (2026) · Journal of Personality Disorders · doi:10.1521/pedi.2026.40.5.444
Self-citationZimmerman, M. A., & Snyder, M. D. (2026) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2026.10.016
Self-citation
- Authors
- Zimmerman, M.
- Affiliations
- Brown University (US)
- Corresponding author
- Zimmerman, Mark
- ORCID
- Zimmerman, Mark
- Venue
- The Canadian Journal of Psychiatry
- Publisher
- SAGE Publications
- Published
- 2016-01-26
- Volume
- 61
- Issue
- 2
- Pages
- 71-79
- ISSN
- 0706-7437 (ISSN-L)
- 1497-0015
- PMC
- PMC4784239
- OpenAlex
- W2309166653
- Cited by
- 83
- References
- 41
- Citations by year
- 2026: 10 · 2025: 6 · 2024: 4 · 2023: 11 · 2022: 14 · 2021: 9 · 2020: 8 · 2019: 6 · 2018: 11 · 2017: 3 · 2016: 1
- FWCI
- 8.53
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- The Canadian Journal of Psychiatry (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Family Practice › Clinical Reasoning and Diagnostic Skills
- Health Sciences › Medicine › Psychiatry and Mental health › Bipolar Disorder and Treatment
- Social Sciences › Arts and Humanities › Philosophy › Mental Health and Psychiatry
- Keywords
- overdiagnosis, underdiagnosis, psychiatric comorbidity, diagnostic interview, semi-structured interviews, bipolar disorder, standard of care, patient preferences, diagnostic accuracy
- MeSH terms
- Medical Overuse, Mental Disorders, Diagnostic Errors, Humans, Interview, Psychological, Psychiatry, Comorbidity
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