Severe mental illness diagnosis in English general hospitals 2006-2017: A registry linkage study.

<h4>Background</h4>The higher mortality rates in people with severe mental illness (SMI) may be partly due to inadequate integration of physical and mental healthcare. Accurate recording of SMI during hospital admissions has the potential to facilitate integrated care including tailoring...

Full description

Bibliographic Details
Main Authors: Hassan Mansour, Christoph Mueller, Katrina A S Davis, Alexandra Burton, Hitesh Shetty, Matthew Hotopf, David Osborn, Robert Stewart, Andrew Sommerlad
Format: Article
Language:English
Published: Public Library of Science (PLoS) 2020-09-01
Series:PLoS Medicine
Online Access:https://doi.org/10.1371/journal.pmed.1003306
id doaj-54377043fb2e49c69251ea0c4927d0b3
record_format Article
spelling doaj-54377043fb2e49c69251ea0c4927d0b32021-04-21T18:34:37ZengPublic Library of Science (PLoS)PLoS Medicine1549-12771549-16762020-09-01179e100330610.1371/journal.pmed.1003306Severe mental illness diagnosis in English general hospitals 2006-2017: A registry linkage study.Hassan MansourChristoph MuellerKatrina A S DavisAlexandra BurtonHitesh ShettyMatthew HotopfDavid OsbornRobert StewartAndrew Sommerlad<h4>Background</h4>The higher mortality rates in people with severe mental illness (SMI) may be partly due to inadequate integration of physical and mental healthcare. Accurate recording of SMI during hospital admissions has the potential to facilitate integrated care including tailoring of treatment to account for comorbidities. We therefore aimed to investigate the sensitivity of SMI recording within general hospitals, changes in diagnostic accuracy over time, and factors associated with accurate recording.<h4>Methods and findings</h4>We undertook a cohort study of 13,786 adults with SMI diagnosed during 2006-2017, using data from a large secondary mental healthcare database as reference standard, linked to English national records for 45,706 emergency hospital admissions. We examined general hospital record sensitivity across patients' subsequent hospital records, for each subsequent emergency admission, and at different levels of diagnostic precision. We analyzed time trends during the study period and used logistic regression to examine sociodemographic and clinical factors associated with psychiatric recording accuracy, with multiple imputation for missing data. Sensitivity for recording of SMI as any mental health diagnosis was 76.7% (95% CI 76.0-77.4). Category-level sensitivity (e.g., proportion of individuals with schizophrenia spectrum disorders (F20-29) who received any F20-29 diagnosis in hospital records) was 56.4% (95% CI 55.4-57.4) for schizophrenia spectrum disorder and 49.7% (95% CI 48.1-51.3) for bipolar affective disorder. Sensitivity for SMI recording in emergency admissions increased from 47.8% (95% CI 43.1-52.5) in 2006 to 75.4% (95% CI 68.3-81.4) in 2017 (ptrend < 0.001). Minority ethnicity, being married, and having better mental and physical health were associated with less accurate diagnostic recording. The main limitation of our study is the potential for misclassification of diagnosis in the reference-standard mental healthcare data.<h4>Conclusions</h4>Our findings suggest that there have been improvements in recording of SMI diagnoses, but concerning under-recording, especially in minority ethnic groups, persists. Training in culturally sensitive diagnosis, expansion of liaison psychiatry input in general hospitals, and improved data sharing between physical and mental health services may be required to reduce inequalities in diagnostic practice.https://doi.org/10.1371/journal.pmed.1003306
collection DOAJ
language English
format Article
sources DOAJ
author Hassan Mansour
Christoph Mueller
Katrina A S Davis
Alexandra Burton
Hitesh Shetty
Matthew Hotopf
David Osborn
Robert Stewart
Andrew Sommerlad
spellingShingle Hassan Mansour
Christoph Mueller
Katrina A S Davis
Alexandra Burton
Hitesh Shetty
Matthew Hotopf
David Osborn
Robert Stewart
Andrew Sommerlad
Severe mental illness diagnosis in English general hospitals 2006-2017: A registry linkage study.
PLoS Medicine
author_facet Hassan Mansour
Christoph Mueller
Katrina A S Davis
Alexandra Burton
Hitesh Shetty
Matthew Hotopf
David Osborn
Robert Stewart
Andrew Sommerlad
author_sort Hassan Mansour
title Severe mental illness diagnosis in English general hospitals 2006-2017: A registry linkage study.
title_short Severe mental illness diagnosis in English general hospitals 2006-2017: A registry linkage study.
title_full Severe mental illness diagnosis in English general hospitals 2006-2017: A registry linkage study.
title_fullStr Severe mental illness diagnosis in English general hospitals 2006-2017: A registry linkage study.
title_full_unstemmed Severe mental illness diagnosis in English general hospitals 2006-2017: A registry linkage study.
title_sort severe mental illness diagnosis in english general hospitals 2006-2017: a registry linkage study.
publisher Public Library of Science (PLoS)
series PLoS Medicine
issn 1549-1277
1549-1676
publishDate 2020-09-01
description <h4>Background</h4>The higher mortality rates in people with severe mental illness (SMI) may be partly due to inadequate integration of physical and mental healthcare. Accurate recording of SMI during hospital admissions has the potential to facilitate integrated care including tailoring of treatment to account for comorbidities. We therefore aimed to investigate the sensitivity of SMI recording within general hospitals, changes in diagnostic accuracy over time, and factors associated with accurate recording.<h4>Methods and findings</h4>We undertook a cohort study of 13,786 adults with SMI diagnosed during 2006-2017, using data from a large secondary mental healthcare database as reference standard, linked to English national records for 45,706 emergency hospital admissions. We examined general hospital record sensitivity across patients' subsequent hospital records, for each subsequent emergency admission, and at different levels of diagnostic precision. We analyzed time trends during the study period and used logistic regression to examine sociodemographic and clinical factors associated with psychiatric recording accuracy, with multiple imputation for missing data. Sensitivity for recording of SMI as any mental health diagnosis was 76.7% (95% CI 76.0-77.4). Category-level sensitivity (e.g., proportion of individuals with schizophrenia spectrum disorders (F20-29) who received any F20-29 diagnosis in hospital records) was 56.4% (95% CI 55.4-57.4) for schizophrenia spectrum disorder and 49.7% (95% CI 48.1-51.3) for bipolar affective disorder. Sensitivity for SMI recording in emergency admissions increased from 47.8% (95% CI 43.1-52.5) in 2006 to 75.4% (95% CI 68.3-81.4) in 2017 (ptrend < 0.001). Minority ethnicity, being married, and having better mental and physical health were associated with less accurate diagnostic recording. The main limitation of our study is the potential for misclassification of diagnosis in the reference-standard mental healthcare data.<h4>Conclusions</h4>Our findings suggest that there have been improvements in recording of SMI diagnoses, but concerning under-recording, especially in minority ethnic groups, persists. Training in culturally sensitive diagnosis, expansion of liaison psychiatry input in general hospitals, and improved data sharing between physical and mental health services may be required to reduce inequalities in diagnostic practice.
url https://doi.org/10.1371/journal.pmed.1003306
work_keys_str_mv AT hassanmansour severementalillnessdiagnosisinenglishgeneralhospitals20062017aregistrylinkagestudy
AT christophmueller severementalillnessdiagnosisinenglishgeneralhospitals20062017aregistrylinkagestudy
AT katrinaasdavis severementalillnessdiagnosisinenglishgeneralhospitals20062017aregistrylinkagestudy
AT alexandraburton severementalillnessdiagnosisinenglishgeneralhospitals20062017aregistrylinkagestudy
AT hiteshshetty severementalillnessdiagnosisinenglishgeneralhospitals20062017aregistrylinkagestudy
AT matthewhotopf severementalillnessdiagnosisinenglishgeneralhospitals20062017aregistrylinkagestudy
AT davidosborn severementalillnessdiagnosisinenglishgeneralhospitals20062017aregistrylinkagestudy
AT robertstewart severementalillnessdiagnosisinenglishgeneralhospitals20062017aregistrylinkagestudy
AT andrewsommerlad severementalillnessdiagnosisinenglishgeneralhospitals20062017aregistrylinkagestudy
_version_ 1714664681370550272