Chinese Psychiatrists’ Views And Classificatons On Diagnostic Systems

【Objective】To study the formal classification of Chinese psychiatrists on mental disorders, to explore their general views and natural taxonomies of diagnostic systems, and to examine their similarities and differences with those of the international mental health professionals. This study aimed to provide meaningful information for ICD revision in China.【Methods】In the process of ICD-10 revision, we investigated the cross-cultural applicability of the international diagnostic classification in China from three aspects as following:1. CCMD-3 and ICD-10 Clinical Descriptions and Diagnostic Guidelines were compared and analysed on a disorder-by-disorder basis.2. Two hundred and ninety members of the Chinese Society of Psychiatry were invited to participate in the internet study regarding their opinions towards diagnostic systems of mental disorders.3. Based on their clinical experience, 517 mental health professionals in 8 countries, including 62 Chinese psychiatrists, sorted 60 cards representing different mental disorders into groups of similar disorders, and formed a hierarchical structure by aggregating and disaggregating these groupings. Distance matrices were created from the sorting data and used in cluster analysis.【Results】1. Analysis of CCMD-3 and ICD-10:(1) Of the 220 mental and behavioral disorders in ICD-10, 200 specific disorders of CCMD-3(90.9%) had similar terms or same diagnostic concepts for different terms.(2) Twenty of the ICD-10 disorders(9.1%) were deleted by CCMD-3, such as schizotypal disorder and borderline disorder.(3) Seven specific disorders were added or retained in CCMD-3, including travelling psychosis, culture-related mental disorders and recurrent mania, etc.2. General views on diagnostic systems:(1) 90.6% Chinese participants regularly used a formal classification systems, mainly ICD-10(48.8%) or CCMD-3(39.3%).(2) Like their global counterparts, Chinese respondents regarded communication among clinicians as the most important purpose of a classification and preferred a simpler system with fewer categories.(3) Chinese psychiatrists were more likely than international participants to prefer a system with strict diagnostic criteria for all disorders(p < 0.001) and to endorse difficulties in the cross-cultural applicability of the classification(p < 0.005).(4) Ratings of ease of use and goodness of fit for specific ICD-10 categories among Chinese participants were fairly high(0.74 for ease of use and 0.73 for goodness of fit), and were higher than those of the international professionals(p < 0.005).3. ICD-11 formative study:(1) Natural taxonomies of mental disorders among Chinese psychiatrists were found to be remarkably similar to those of clinicians from other parts of the world. This consensus classification structure has not only clear similarities to ICD-10, but also distinct differences from it.(2) According to the overall structure, the only difference was the groupings of neurodevelopmental disorders and other childhood disorders. The Chinese clinicians combined these two groups into one, where the international professionals made a distinction between neurodevelopmental and other childhood disorders.(3) Chinese participants tended to perceive tighter or equal cohesions among groups than the international clinicians. However, the correlation between their cohesion values was 0.892(p < 0.001), which shows the consensus structure among these two samples.【Conclusions】1. The majority of CCMD-3 diagnoses have similar terms or concepts to ICD-10 system. The particular additions or deletions of diagnostic categories of CCMD-3 might be reconsidered in contemporary social realities and united with international trend.2. In general, Chinese psychiatrists have similar opinions and attitudes on most issues of the classification to the international clinicians. However, compared to their global counterparts, Chinese psychiatrists were more likely to endorse strict diagnostic criteria and problems with the cultural applicability of the classification system.3. The natural taxonomies of Chinese and international mental health professionals are highly similar across diagnostic systems used and more compatible with the overall proposed structure of ICD-11.4. Basically, Chinese psychiatrists accept the local applicability of the international ICD classification system. Areas of divergent views and the cross-cultural applicability of some specific mental disorders should be studied further in the following ICD-11 field studies.