The Diagnostic Consistency Of The Depressive Disorder In 1739 Inpatients

Objective: To investigate the diagnostic consistency and related factors of depressive disorder inpatients in some one psychiatric hospital.Methods: Patients who were diagnosed as depressive episode（F32）or recurrent depressive disorder（F33）in accordance of the International Statistical Classification of Diseases and Related Health Problems 10 th Revision（ICD-10）,and discharged in 2012,were selected as the samples.A customized questionnaire was used to collect the general demographic data,disease characteristics and each inpatient diagnosis.Define the discharge diagnosis in 2012 as the index diagnosis,the first psychiatric medical consultation diagnosis as the retrospective starting point,and the last consultation time as the follow-up end point.Then find out the consistency of the diagnoses.Results: A total of 1739 patients were included in this investigation,with a follow-up period of 9 years and a mean follow-up time of 56.6months.85.6% of patients were diagnosed with a depressive disorder at the first psychiatric medical consultation（i.e.,the retrospective diagnostic concordance rate for depressive disorders was 85.6%）,14.4% were diagnosed with other psychiatric disorders.7.2% were diagnosed with neurotic,stress-related,and somatoform disorders,and 5.1% were diagnosed with schizophrenia spectrum disorders.At the follow-up period,with an effective follow-up of 1332 cases,83.0% of patients were still diagnosed with depressive disorders（i.e.,the follow-up diagnostic concordance rate for depressive disorders was 83.0%）,and 17.0% changed their diagnosis to other psychiatric disorders.13.8% changed their diagnosis to bipolar disorders and 2.0% to schizophrenia spectrum disorders.78.4% of the diagnostic conversions occurred in the first five years of follow-up,and 31.3% in the first year of follow-up.75.4% of patients had a stable diagnosis throughout.The distribution of gender,age,marriage,education,number of recurrent episodes and hospitalizations,family history,presence or absence of psychotic symptoms,and suicidal behaviors were significantly different between the groups（P<0.05）.Possible risk factors of diagnostic conversion to severe mental disorders were male,early onset age,presence of psychotic symptoms,more times of repeated hospitalizations（OR = 0.967,0.571,4.439,1.603,P<0.05）.Conclusion: The ICD-10 diagnosis of depressive disorders has fair follow-up consistency and retrospective consistency in clinical application in this research hospital,but inconsistent diagnoses still exist in clinical practice.Diagnostic conversion usually occurs at the first five years during the follow-up period.Severe impairment of social function,positive family history,recurrent episodes,repeated hospitalizations,presence of psychotic symptoms,suicidal behaviors may indicate the probable of diagnostic conversion from depressive disorders to severe mental disorders.There might be more similarity between bipolar disorders and schizophrenia spectrum disorders.