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Open Access 01-08-2020 | Hyperkinetic Disorder | Original Contribution

Diagnostic trajectories in child and adolescent mental health services: exploring the prevalence and patterns of diagnostic adjustments in an electronic mental health case register

Authors: Cliodhna O’Connor, Johnny Downs, Hitesh Shetty, Fiona McNicholas

Published in: European Child & Adolescent Psychiatry | Issue 8/2020

Abstract

Community-based epidemiological studies show transitions between psychiatric disorders are common during child development. However, little research has explored the prevalence or patterns of the diagnostic adjustments that occur in child and adolescent mental health services (CAMHS). Understanding diagnostic trajectories is necessary to inform theory development in developmental psychopathology and clinical judgements regarding risk and prognosis. In this study, data from CAMHS clinical records were extracted from a British mental health case register (N = 12,543). Analysis calculated the proportion of children whose clinical records showed a longitudinal diagnostic adjustment (i.e. addition of a subsequent diagnosis of a different diagnostic class, at > 30 days’ distance from their first diagnosis). Regression analyses investigated typical diagnostic sequences and their relationships with socio-demographic variables, service use and standardised measures of mental health. Analysis found that 19.3% of CAMHS attendees had undergone a longitudinal diagnostic adjustment. Ethnicity, diagnostic class and symptom profiles significantly influenced the likelihood of a diagnostic adjustment. Affective and anxiety/stress-related disorders longitudinally predicted each other, as did hyperkinetic and conduct disorders, and hyperkinetic and pervasive developmental disorders. Results suggest that approximately one in five young service users have their original psychiatric diagnosis revised or supplemented during their time in CAMHS. By revealing the most common diagnostic sequences, this study enables policy makers to anticipate future service needs and clinicians to make informed projections about their patients’ likely trajectories. Further research is required to understand how young people experience diagnostic adjustments and their psychological and pragmatic implications.

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This criterion ensured access to relatively complete clinical records, as it excluded (for instance) young people who spent time in a SLaM specialist inpatient unit but who accessed community services elsewhere.

Entering a primary diagnosis is mandatory before any secondary diagnoses can be added. Clinicians can override previous diagnostic entries; however, the overwritten data remain accessible to researchers on the CRIS database.

In cases where the Primary Diagnosis field was populated by diagnoses outside the above list (e.g., diagnoses related to substance dependence or intellectual disability), the earliest mention of any of the included diagnostic classes in the Secondary Diagnosis fields represented Index Diagnosis 1. If neither the Primary nor Secondary Diagnosis contained reference to any of the ten diagnostic classes, that case was not extracted for analysis. Cases with no entries in the structured diagnostic fields were similarly excluded.

Note that for the regressions with each Index 2 diagnostic class as an outcome variable, cases where that diagnostic class was recorded as the Index 1 diagnosis were excluded (because the data extraction strategy precluded these cases from registering that same diagnostic class at Index 2, so including them would have biased the analysis).

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Title: Diagnostic trajectories in child and adolescent mental health services: exploring the prevalence and patterns of diagnostic adjustments in an electronic mental health case register
Authors: Cliodhna O’Connor
Johnny Downs
Hitesh Shetty
Fiona McNicholas
Publication date: 01-08-2020
Publisher: Springer Berlin Heidelberg
Keywords: Hyperkinetic Disorder
Autism Spectrum Disorder
Anxiety
Published in: European Child & Adolescent Psychiatry / Issue 8/2020
Print ISSN: 1018-8827
Electronic ISSN: 1435-165X
DOI: https://doi.org/10.1007/s00787-019-01428-z

At a glance: The STEP trials

Springer Medicine

Diagnostic trajectories in child and adolescent mental health services: exploring the prevalence and patterns of diagnostic adjustments in an electronic mental health case register

Abstract

At a glance: The STEP trials

Springer Medicine

Abstract

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