Overdiagnosis in mental health: main causes and consequences

Overdiagnosis is a problem with human, social and economic consequences.

Overdiagnosis in mental health is the tendency to diagnose one or more clinical categories of psychiatry in a generalized and disproportionate manner. It is a practice that has recently been questioned within the specialist profession due to recent increases in various psychiatric diagnoses. increases in the number of 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 some elements that characterize contemporary medical practice.

Specifically, overdiagnosis in mental health can have different impacts at the individual, economic and social levels, issues that we will see developed below.These issues will be further developed below

Overdiagnosis in mental health

Overdiagnosis in mental health has been reviewed especially in Mood Disorders in adulthood, in Attention Deficit Hyperactivity Disorder (ADHD) in childhood, and in Autism Spectrum Disorder in the same stage of development. The above, after their numbers increased alarmingly and disproportionately in the last decade, especially in the United States. in the last decade, especially in the United States, Canada and some European countries (Peñas, JJ. and Domínguez, J., 2012).

According to Pascual-Castroviejo (2008), in a few years the prevalence of adhd increased from 4% - 6% up to 20%, according to different epidemiological studies. When it comes to Attention Deficit Disorder it is more diagnosed in girls; while Attention Deficit Hyperactivity Disorder is more diagnosed in boys.

At the same time, depression is more commonly diagnosed in women than in men.. In this case, Leon-Sanromà, Fernández, Gau and Gomà (2015) question the tendency to show overdiagnosis in specialized journals. For example, a study conducted in southern Catalonia and published in the journal Atención Primaria, warned of a prevalence of 46.7% of depression in the general population (53% in women and 40% in men), which meant that almost half of the total population of this area was depressed.

In contrast, according to the same authors, other studies conducted with 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 continues to be alarming; nevertheless, it takes us away from considering that almost half of the population lives with this diagnosis.

Following different authors, we will now look at some of the practices that lead to overdiagnosis and What are its main risks in physiological, psychological, social and economic terms?.

Why is overdiagnosis generated?

Overdiagnosis is a consequence of methodological problems 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 illnesses is often mediated by their definition processes, as well as by the strategic use of screening tools and statistics (García Dauder and Pérez Saldaire). (García Dauder and Pérez Saldaño, 2017; Leon-Sanromà, et al. 2015).

Specifically in the field of mental health, the validity of the category "disorder" has been widely debated, as well as its unspecificity and its differentiation with respect to the term "disease", as well as the criteria that define what is "healthy" and what is not.and what is not. The same has occurred when discussing how mental disorders are diagnosed.

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

On the other hand, when assessing the proportion of individuals who have depression, techniques that are also inaccurate have been used, such as telephone surveys or structured interviews that easily overestimate its prevalence (Ezquiaga, García, Díaz de Neira, & García, 2011). In addition to this, the scientific literature usually pays more attention to under-diagnosis than to over-diagnosis..

In line with the above, the methodological problem related to the definition of mental disorders becomes visible in the ease with which they are generalized. An example of this is the tendency to consider any depressed mood as pathological, when this is not always the case (Leon-Sanromà, et al. 2015). Such a state may be an adaptive and normal response to a painful event, and not necessarily a disproportionate and pathological response.

In the same sense, another methodological problem related to overdiagnosis in mental health has to do with 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, hypothesis, data collection and analysis in research, generating a set of biases on the development and prevalence of different diseases (García Dauder and Pérez Sedeño, 2017).

5 ways to know that this practice is occurring.

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

1. There are more intervention techniques, but disease is not decreasing.

The possible overdiagnosis of a disease can be alerted when there is a significant contradiction between intervention and disease prevalence: there is an increase in the number of disease intervention techniques (e.g. increased production of drugs and higher rates of medicalization). However, this increase does not translate into a decrease in the prevalence of the disorder..

2. Increases the diagnostic threshold

On the contrary, there may be no significant and constant innovation in intervention techniques; however, the diagnostic threshold does not decrease or even increase. In other words, changes in diagnostic criteria increase the number of people affected. This is a common case in mental disorders, but can also be seen in other classifications.but it can also be seen in other medical classifications such as osteoporosis, obesity or arterial hypertension.

Similarly, mental health stigma biases, present in both health personnel and the non-specialty population, can contribute to the generalization of a diagnosis (Tara, Bethany and 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. Related to this, the definitions of diseases are modified under unclear distinctions between one and the other; which generates little evidence on the benefits of such modifications versus the negative effects they may cause. The latter is partly a consequence of the lack of diagnostic precision that surrounds some diseases..

In turn, and as we have already mentioned, this imprecision is a consequence of the methodology used in the study and its definition. That is, it has to do with how it is determined what is and what is not a disease, what elements are used to explain it and what elements are excluded.

4. Clinical variability is not considered

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

Likewise, the severity of their symptomatology is determined by the intensity, the number of symptoms and the degree of functional impairment. However, this severity is often generalized or considered as the only side of the diagnoses, thus increasing not only the number of people with a diagnosis but also the number of people with severe diagnoses.

5. The role of specialists

According to Martínez, Galán, Sánchez and González de Dios (2014), something that contributes to overdiagnosis is the part of medical practice whose interest is merely scientific and follows the inertia of seeking diagnoses under the rigidity of the organicist model..

In the same sense, the posture of the professional during consultations plays a relevant role (ibidem). This is so because it does not generate the same effect a sanitary profile occupied by emotional containment as the sanitary profile when it goes through the re-production of the demand. In the first case, pseudurging is not favored and therefore, it is not transmitted to the user. In the second it is easy to generate a trivialization of the medical practice..

Finally, with the growing participation of the pharmaceutical industry in mental health, there has been a considerable increase in the conflicts of interest of some professionals, health and research centers and public administrations, which sometimes promote or support medicalization through overdiagnosis.

Several of its consequences

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

1. Medical impact.

This refers to the increased risk of iatrogenesis, insofar as excessive medical care and over-medicalization can lead to a chronification of the malaise.. Similarly, overdiagnosis of certain disorders may go hand in hand with underdiagnosis of others, and their consequent lack of attention.

Psychological and social impact

This translates into greater stigmatization, with the possible reduction of the user's autonomy, and a loss of responsibility for the social factors involved in the disorder. It also refers to the generalization of psychopathology as the most immediate response to the issues of everyday life, even outside the specialized field.even outside the specialized field.

3. Economic impact

It occurs in two ways: the first is the high costs involved in mental health care, especially in primary care services but also in specialized services, which involves in infrastructure as well as in human resources and pharmacological treatments.. And the second impact is the progressive decrease in the productivity of people with the diagnosis.

Conclusion

Taking into consideration these elements and consequences does not imply denying the discomfort and suffering, nor does it mean that it is necessary to stop investing efforts in timely and respectful detection and intervention. It means that it is necessary to remain alert to the possible negative effects of extrapolating biomedical practices towards understanding and approaching all aspects of human life.

Furthermore, it warns us about the need to constantly review the criteria and methodology that defines and intervenes in mental health.

Bibliographical references:

• Adán-Manes, J. and Ayuso-Mateos, J.L. (2010). Overdiagnosis and overtreatment of major depressive disorder in primary care: a growing phenomenon. Atención Primaria, 42(1): 47-49.
• Ezquiaga, E., García, A., Díaz de la Neira, M. and García, M. J. (2011). "Depression. Diagnostic and therapeutic imprecision. Important consequences in clinical practice. Journal of the Spanish Association of Neuropsychiatry, 31(111): 457-475.
• García Dauder. (S). and Pérez Sedeño, E. (2017). Scientific lies about women. Catarata: Madrid.
• García Peñas, J. J. and Domínguez Carral, J. (2012). is there an overdiagnosis of attention deficit hyperactivity disorder (ADHD). Evidencias en Pediatría, 8(3): 1-5.
• Glasziou, P., & Moynihan, R. (2013). Too much medicine; too little care, British Medical Journal, 7915: 7.
• Leon-Sanromà, M., Fernández, M. J., Gau, A. and Gomà, J. (2015). half of the population with a diagnosis of depression? Atención Primaria, 47(4): 257-258.
• Martínez, C., Riaño, R., Sánchez, M. and González de Dios, 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 and hyperactivity disorders. Spanish Association of Pediatrics. Retrieved September 18, 2018. Available at https://www.aeped.es/sites/default/files/documentos/20-tdah.pdf.
• Valdecasas, J. (2018). Mental health at the crossroads: searching for a new psychiatry for an increasingly sick world. No Gracias Platform. Retrieved 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/.