Overdiagnosis in mental health: main causes and consequences

March 29, 2024

Overdiagnosis in mental health is the tendency to diagnose in a generalized and disproportionate way one or several clinical categories of psychiatry. It is a practice recently questioned within the specialist association due to the recent increases in different psychiatric diagnoses .

However, this is a trend that occurs 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 level , issues that we will see developed below

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Overdiagnosis in mental health

The overdiagnosis in mental health has been revised especially in the Mood Disorders of adulthood, in the Attention Deficit and Hyperactivity Disorder (ADHD) in childhood, and in the Autism Spectrum Disorder in the same stage of development . The above, after his figures increased alarmingly and disproportionately 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; whereas Attention Deficit Hyperactivity Disorder is more diagnosed in children.

At the same time, depression is more diagnosed in women than in men . In this case, Leon-Sanromà, Fernández, Gau and Gomà (2015) question the tendency to show overdiagnoses in specialized journals. For example, a study conducted in the southern area of Catalonia and published in the journal Atención Primaria, alerted 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 in depression.

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, which adds up to a total of 19.3%. This figure continues to be alarming; nevertheless, it distances us from considering that almost half of the population lives with this diagnosis.

Following different authors, we will see below some of the practices that lead to overdiagnosis and what are its main risks in physiological, psychological, social and economic terms .

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Why is overdiagnosis generated?

Overdiagnosis is a consequence of methodological problems present in the study and / or definition of mental disorders, in the detection of them, and in the investigation of their prevalence. In other words, the study and promotion of diseases is frequently mediated by their definition processes, as well as by the strategic use of detection tools and statistics (García Dauder and Pérez Saldaño, 2017, Leon-Sanromà, et al., 2015).

Specifically in the field of mental health the validity of the category "disorder", its non-specificity and its differentiation with respect to the term "disease", as well as the criteria that define what "healthy" , and what is not. The same thing happened when discussing how mental disorders are diagnosed.

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

On the other hand, when evaluating the proportion of individuals who have depression, techniques have also been used that are not very precise, such as telephone surveys or structured interviews that easily overestimate their prevalence (Ezquiaga, García, Díaz de Neira and García, 2011). ). In addition to this, the scientific literature usually pays more attention to insufficient diagnoses than to overdiagnosis .

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 that any state of decayed mood is pathological, when it is not always the case (Leon-Sanromà, et al., 2015). This 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 of the methodological problems related to overdiagnosis in mental health has to do with the tendency to exaggerate, or, to minimize the differences between groups according to different variables such as sex, gender, social class, among others. . Frequently this tendency is implicit in the designs, the hypothesis, the collection and the analysis of data in the investigations , generating a set of biases on the development and prevalence of different diseases (García Dauder and Pérez Sedeño, 2017).

5 ways to know what this practice is happening

There are different factors that can alert you 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 work 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 diseases do not decrease

It is possible to warn of the possible overdiagnosis of a disease when there is an important contradiction between the intervention and the prevalence of the diseases: there is an increase in the number of intervention techniques of the disease (for example, greater production of drugs and greater medicalization indexes). However, this increase does not translate into a decrease in the prevalence of the disorder .

2. Increase the diagnostic threshold

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

Likewise, the biases crossed by mental health stigma, present both in health personnel and in the non-specialized population, can contribute to a generalized 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 the diseases are modified under unclear distinctions between them; which generates little evidence on the benefits of such modifications in the face of the negative effects they can cause. The latter is partly a consequence of the poor diagnostic accuracy that surrounds some discomforts .

At the same time, and as we have said, this imprecision is a consequence of the methodology used in the study and the definition of them. That is, it has to do with how it determines what is and what is not a disease, what elements are used for its explanation and what elements are excluded.

4. Clinical variability is not considered

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

Likewise, the severity of their symptoms is determined by the intensity, by the number of symptoms and by the degree of functional impairment. However, this severity is often generalized or considered as the only face of diagnoses, which not only increases the number of people diagnosed 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 purely scientific and continues the inertia of searching for diagnoses under the rigidity of the organicist model .

In the same sense, the position of the professional during the consultations plays an important role (ibidem). This is the case since a health profile occupied by emotional restraint does not generate the same effect as the health profile when it goes through the re-production of demand. In the first case, the pseudourgency is not favored and, therefore, it is not transmitted to the user. In a second can easily generate a trivialization of medical practice .

Finally, in view of the growing participation of the pharmaceutical industry in mental health, conflicts of interest have increased considerably in 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 an individual level but also at an economic and social level. In their analysis of the overdiagnosis of depression, Adán-Manes and Ayuso-Mateos (2010), they establish three main impacts:

1. Medical impact

It refers to the increased risk of iatrogenesis, while Excessive medical attention and overmedicalization can generate a chronification of discomfort . Similarly, the overdiagnosis of certain disorders can go hand in hand with the underdiagnosis of others, and their consequent lack of attention.

2. Psychological and social impact

It translates into a greater stigmatization, with the possible decrease of the autonomy of the user, and a lack of responsibility of the social factors involved in the discomfort. It also refers to the generalization of psychopathology as a more immediate response in the questions of everyday life , even outside the specialized field.

3. Economic impact

It occurs in two senses: the first is the high costs involved in mental health care, especially in primary care services but also in specialized services, which implies an expense 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 diagnosis.

conclusion

Taking into account these elements and consequences does not mean denying the discomforts and suffering, nor does it mean that it is necessary to stop investing efforts in detections and timely and respectful interventions. It means that it is necessary to stay alert in view of the possible negative effects of extrapolating biomedical practices towards understanding and approaching all aspects of human life.

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

Bibliographic references:

Adán-Manes, J. and Ayuso-Mateos, J.L. (2010). Overdiagnosis and overtreatment of major depressive disorder in primary care: a phenomenon on the rise. Primary Care, 42 (1): 47-49.
Ezquiaga, E., Garcia, A., Diaz de la Neira, M. and Garcia, 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). The scientific lies about women. Waterfall: Madrid.
García Peñas, J. J. and Domínguez Carral, J. (2012). Is there an overdiagnosis of attention deficit hyperactivity disorder (ADHD)? Evidence in Pediatrics, 8 (3): 1-5.
Glasziou, P. and 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 diagnosed with depression? Primary Care, 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). Disorders of attention deficit and hyperactivity. Spanish Association of Pediatrics. Retrieved September 18, 2018. Available at //www.aeped.es/sites/default/files/documentos/20-tdah.pdf.
Valdecasas, J. (2018). Mental health at the crossroads: looking for a new psychiatry for an increasingly sick world. Platform No Thanks. Retrieved September 18, 2018. Available at //www.nogracias.eu/2018/01/07/la-salud-mental-la-encrucijada-seeking-a-new-psiquiatria-mundo-vez-mas-enfermo-jose -valdecasas /.