The Stability of Axis I Diagnoses in Youth Across Multiple Psychiatric Hospitalizations

Abstract

The literature has yet to reach a consensus as to the stability of severe psychiatric diagnoses in youth. Previous studies among youngsters tracked over set follow-up periods have reported diagnostic stability estimates that are similar to or slightly lower than those of adults. Less is known, however, about the stability of youth psychiatric diagnoses across multiple episodes of psychopathology, such as recurrent inpatient hospitalizations. The present study investigated diagnostic stability among inpatient youth with multiple hospitalizations through longitudinal and cross-sequential designs. Results indicate that diagnostic stability, as measured by positive concordance rates and the kappa coefficient, is highest for mood disorders, especially bipolar disorder. Externalizing disorders and schizophrenia displayed moderate to low stability, with oppositional-defiant disorder displaying the lowest stability. Substance use disorders were found to have moderate stability. Overall, across-episode diagnostic stability among hospitalized youngsters appears to be lower than that of adults. This finding appears to be due to lower stability among certain externalizing disorders and substance use disorders, whereas mood disorders display stability rates resembling those of adults. Potential explanations for and implications of these findings are discussed.

Stability of childhood anxiety disorder diagnoses: a follow-up naturalistic study in psychiatric care

“…It is the presence or absence of a particular disorder at two different time points [19]. Three measures of temporal consistency are presented for each category of anxiety disorders [21].…”

“…However, prospective and retrospective consistency rates fail to account for the fact that new cases may develop after initial presentation and other cases may remit [19], which is corrected by the use of the third measure of temporal consistency, the kappa coefficient [7]. The kappa coefficient is the agreement between diagnoses at first and last evaluations and measures the agreement correcting for the effect of chance.…”

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

“…For instance, a study in a Canadian hospital found poor correspondence (average ϰ = 0.23) between the first and last primary diagnoses recorded in children's clinical files: reliability was higher with shorter (0-1 year) intervals between first and last diagnoses (ϰ = 0.34), but extremely poor when the interval stretched to 4 years (ϰ = 0.08) [21]. A US study of diagnostic stability in children who experienced multiple hospitalisations over a 9-year period found similarly poor reliability across diagnostic episodes (ϰ = 0.37), despite patients typically being assigned to the same clinical team across hospitalisations [23]. These studies confirm diagnostic adjustments are common in clinical practice.…”

“…Finally, individual studies define and measure stability in different ways, usually in terms of prospective concordance, retrospective concordance or kappa coefficients. While these measures offer useful information [23], none facilitates easy inference of the proportion of CAMHS attendees who experience modification of their diagnosis during their service engagement. Furthermore, the extant literature on diagnostic stability in child and adolescent mental healthcare does not provide detailed information on typical diagnostic sequences, i.e.…”

What Happened? Exploring the Relation between Traumatic Stress and Provisional Mental Health Diagnoses for Children and Youth

“…The use of "provisional" psychiatric diagnosis in childhood is common practice, as the stability of many psychiatric diagnoses throughout childhood and over time has yet to be established (Pettit, Morgan, & Paukert, 2005). When using the ChYMH, assessors rank diagnoses according to how much each contributed to the current admission (i.e., 1 = most important; 2 = second most important; 3 = third most important; 4 = less important).…”