The validity of child and adolescent depression diagnoses in the Danish psychiatric central research register
The validity of child and adolescent depression diagnoses in the Danish psychiatric central research register
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DOI：
10.1111/acps.13258
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发表时间：
2020-12-25
影响因子：
6.7
通讯作者：
Wesselhoeft, Rikke
中科院分区：
文献类型：
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作者：
Frederiksen, Line Hofmann;Bilenberg, Niels;Wesselhoeft, Rikke
目的 本研究检验了丹麦精神病学中央研究登记册 (DPCRR) 中儿童抑郁症诊断的有效性，并确定了有效性的预测因素。方法 在 DPCRR 中对 1996 年至 2016 年间诊断为抑郁症的 500 名儿童（6-17 岁）进行全国随机抽样。使用在线检查表对精神病医院的记录进行审查和评级。主要结局是医院记录中记录的抑郁症状和功能障碍是否证明根据 ICD-10 或 DSM-5 诊断标准诊断抑郁症是合理的。诊断有效性计算为阳性预测值。二元 Logistic 回归分析用于确定诊断有效性的潜在预测因素，并将这些因素纳入多元 Logistic 回归中。结果 393 名患者 (78.6%) 可获得精神病医院记录。记录中的文件证实了 72.8% 的 ICD-10 抑郁发作诊断是合理的，73.3% 的登记有抑郁症诊断的患者符合 DSM-5 重度抑郁症诊断。我们确定了诊断有效性的三个预测因素：(i) 从 2000 年到 2016 年，有效性几乎呈线性增加（OR 1.14，95% CI 1.07-1.20，p < 0.001），(ii) 抗抑郁药物的使用与诊断有效性的增加相关（OR 2.27，95% CI 1.35-3.82，p = 0.002）和 (iii) 急诊科入院预测诊断有效性较低（OR 0.33，95% CI 0.12-0.93，p = 0.036）。 结论 根据 ICD-10 和 DSM-5 诊断标准，DPCRR 中登记的儿童抑郁症诊断显示出令人满意的有效性。从 2000 年到 2016 年，诊断有效性稳步上升，并且与抗抑郁药物的使用呈正相关。急诊科分配的抑郁症诊断诊断有效性较低。
Objective This study examined the validity of childhood depression diagnoses in the Danish Psychiatric Central Research Register (DPCRR) and identified predictors of validity.Methods A nationwide random sample of 500 children (6-17 years) diagnosed with depression between 1996 and 2016 was identified in the DPCRR. Psychiatric hospital records were reviewed and rated using an online checklist. The primary outcome was whether depressive symptoms and functional impairment documented in hospital records justified a depressive disorder diagnosis based on ICD-10 or DSM-5 diagnostic criteria. Diagnostic validity was calculated as the positive predictive value. Binary logistic regression analysis was used to identify potential predictors of diagnostic validity, and these were included in a multiple logistic regression.Results Psychiatric hospital records were available for 393 patients (78.6%). The documentation in the records justified an ICD-10 depressive episode diagnosis in 72.8%, and DSM-5 major depressive disorder in 73.3% of the patients registered with a depression diagnosis. We identified three predictors of diagnostic validity: (i) The validity increased almost linearly from 2000 to 2016 (OR 1.14, 95% CI 1.07-1.20, p < 0.001), (ii) antidepressant use was associated with increased diagnostic validity (OR 2.27, 95% CI 1.35-3.82, p = 0.002) and (iii) emergency department admission predicted low diagnostic validity (OR 0.33, 95% CI 0.12-0.93, p = 0.036).Conclusion Childhood depression diagnoses registered in the DPCRR show a satisfactory validity according to both ICD-10 and DSM-5 diagnostic criteria. Diagnostic validity increased steadily from 2000 to 2016 and was positively correlated with antidepressant use. Depression diagnoses assigned in emergency departments had low diagnostic validity.