10-year Trends in Diagnostic Stability and Distribution among Psychiatric Inpatients in a General Hospital in China

doi:10.21203/rs.3.rs-1979033/v1

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10-year Trends in Diagnostic Stability and Distribution among Psychiatric Inpatients in a General Hospital in China

https://doi.org/10.21203/rs.3.rs-1979033/v1

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Purpose： To evaluate the diagnostic stability between admission and discharge of psychiatric inpatients in a general hospital, as well as to assess the distribution of diseases in the sample over the past decade.

Methods: A total of 20,359 psychiatric inpatients were included in this retrospective study from June 2011 to December 2020. The short-term diagnostic consistency was evaluated by comparing their first admission and discharge diagnoses. Readmission patients' first and last discharge diagnoses were also compared to analyze the relatively long-term diagnostic stability. Demographic and clinical characteristics were analyzed to identify predictors of diagnostic discrepancy during hospitalization.

Results: From 2011-2020, for all psychiatric inpatients, the average length of stay decreased from 22 days to 17 days. The hospitalization rate decreased from 42.4% to 20.7% for schizophrenia and grew from 13.8% to 25.5% for depression. Diagnoses were retained by 92.6% of patients at their first discharge diagnosis, ranging from 100% for disorders of psychological development to 16.3% for unspecified mental disorders. Most diagnostic conversions were to bipolar disorder and schizophrenia. However, among rehospitalizations, the diagnostic stability notably dropped to 71.3%. For rehospitalizations, mood disorders and schizophrenia spectrum disorders were relatively stable diagnoses categories, with 72.7%-76.7% of patients receiving the same diagnosis, although results of specified diagnoses within these categories ranged from 5.9% to 91%. Length of hospitalization and age were associated with the diagnosis alterations.

Conclusion: Even though the diagnosis of mental disorders was stable in short hospitalizations, maintaining longitudinal and long-term consistency of diagnosis still requires more effort.

First-admission

Diagnostic stability

Diagnostic conversion

Mental disorder distribution

Diagnosis stability is critical in disease research and clinical practice. Currently, due to the lack of objective and effective biomarkers [1], the final diagnosis of mental disorders can only be made by integrating multiple sources of information from the perspective of symptomatology under the nosology guidance of mainstream diagnostic criteria or manuals, like ICD or DSM system. In this situation, the accuracy of diagnosis highly depends on the effectiveness of the diagnostic criteria and the clinical level of physicians.

Maintaining high stability in clinical diagnosis is a challenge. In the fact, most psychiatric symptoms are not specific to one particular disorder and one symptom may exist in a variety of diseases given the complexity of the mental disorder[2], which may increase the degree of clinical diagnosis uncertainty. When comorbid with other diseases, such as substance use [3] [4] and organic disease[5], the stability of diagnosis will be affected. Length of duration also means a lot to it. The notion of differentiation in functional psychosis was proposed in previous studies [6, 7], which revealed that clinical manifestations may become clearer as time passed.

Consistent diagnosis, as a cornerstone, promotes the progress of the diseases research field. Accurate disease classification contributes to revealing the genetic and pathophysiological mechanisms of the disease [6, 7], and diagnosis misclassification affected the genetic pattern of psychiatric research [8]. Meanwhile, the discovery of biological dysfunction plays positive feedback on diagnostic stability, which would improve early diagnosis and provide personalized of effective treatment.[9]. For patients, inconsistent diagnosis can give rise to delays in treatment, unnecessary tests, increased care costs, poor prognosis, and negative hospital impacts[10, 11].

The admission diagnosis is a hypothesis, based on the patient's problems and the physician's experience, which will be tested by the clinician during hospitalization. Usually, complete information collected (like psychological, relevant physical examinations, neurological, psychopharmacological evaluations, observations and responses in the milieu, and more clinical interviews with the patient and his parents) after admission will often help the clinician to confirm their hypothesis [12]. Therefore, during hospitalization, additional evidence gathered about the patient's mental symptoms, physical condition, and other social factors can change the diagnosis. However, to our knowledge, few studies have focused on diagnostic stability during short-term hospitalization, even though the accurate and stable diagnosis was essential to patients' prognosis and disease research field.

Hence, considering the implications of diagnostic inconsistencies to clinical practice and the development of disciplinary research, we conducted a retrospective study of psychiatric inpatients based on the ICD-10 code from 2011 to 2020. The purpose of this study was to evaluate: 1) the diagnostic distribution of first-admissions in the past decade; 2) the diagnostic consistency between first admission and discharge, the readmission diagnostic stability; and 3) potential predictors of discrepant diagnosis.

Data source

This study was executed at the Second Xiangya Hospital of Central South University, China. Established in 1958, the Second Xiangya hospital was one of the largest general hospitals in China, which has the top psychiatry department in China, and there are more than 4,000 psychiatric inpatients and a large number of difficult cases from all over the country per year nowadays. In addition, as a large comprehensive grade-A hospital, it can provide authoritative and standard diagnoses and treatments.

Design and sample selection

All patient data were collected from non-emergency admission between June 2011 and December 2020, which recorded patient admission and discharge dates, diagnoses, and procedures. Each patient had an exclusive admission number that did not change by the number of hospitalization. We excluded patients without diagnostic information, and further excluded patients who were hospitalized for less than two days, because psychiatrists may not have enough time and adequate evidence to make reliable diagnoses. In the end, a total of 20,359 patients were included in our study. Of 20,359 patients, 3,762 (18.5%) were hospitalized more than once, with an average interval of 1.7 years between their first and last admission.

All admission and discharge diagnoses were finished by two psychiatrists using the International Classification of Diseases Version 10 (ICD-10)[13]. It was generally considered that discharge diagnosis is more definitive and reliable than admission diagnosis, so only discharge diagnosis will be used to observe the distribution of mental disorders in this study.

Diagnosis discrepancy assessment

After analyzing the demographic characteristics of patients, the distribution and discrepancy of diagnosis were measured. The consistency of short-term diagnosis was assessed by analyzing the first admission and discharge diagnoses of 20,359 patients. In addition, rehospitalizations were selected as a subgroup, and their first and last discharge diagnoses were compared to determine the relatively long-term diagnostic stability.

In the present study, the consistency of diagnoses was compared according to the first two-digit of the mental illness ICD-10 code (Fxx.). Due to fewer samples and the scattered distribution of some diagnoses categories, these diseases were grouped into a broad category, e.g. F8x (Disorder of psychological development). For the case of more than one admission diagnosis, only the principal diagnoses of admission and discharge were compared to study the consistency. The principal diagnosis was often defined as a "lifetime" diagnosis. For example, if a patient was admitted with a diagnosis of bipolar affective disorder (BD) and nonorganic insomnia, but discharged with the diagnosis of BD, we would compare the main diagnoses “BD” and still consider the diagnoses to be consistent. For readmission patients, their discharge diagnosis was compared using the same criteria mentioned above. Besides, the frequencies of discrepant diagnoses were tabulated.

Statistical analysis

Data management and analysis were performed in SPSS 25.0 (2017). The results of continuous and categorical variables were presented as mean ± standard deviations and percentages, respectively. T-test was used for two normal independent samples and the rank-sum test was used for non-normal samples to compare age, length of hospitalization (LOS), etc. between the diagnostic consistency and inconsistency groups. Chi-square test for categorical variables. After that, a binary logistics regression analysis prediction model was used to identify predictors of diagnostic discrepancy. The age, sex, marital status, occupation, LOS, and comorbidities of physical diseases were used as predictors of the model. All p values were bilateral, < 0.05 was considered statistically significant.

Characteristics of the sample

The demographic characteristics of the sample were presented in Table 1. The mean age was 25.1 (SD 9.2) years old and 55.5% were female at their first admission. The mean LOS was 18.9 (SD 10.9) days. The most prevailing comorbidities in this study were cardiovascular system and glucose metabolism diseases, of which hypertension was the most common.

Table 1

Demographic characteristics of 20,359 patients
Variable	N (%) / Mean (SD)
Gender
Male	9058 (44.5)
Female	11301 (55.4)
Hospital length of stay (days)	19 (10.9)
Age (years)	25.1 (9.2)
Marital status
Single	10565 (51.9)
Married	8441 (41.5)
Divorced	744 (3.7)
Window	269 (1.3)
Other	340 (1.7)
Current working status
Student	4013 (19.7)
Homemaker	56 (0.3)
Unemployed	9184 (45.1)
Retired	1037 (5.1)
Employed	5758 (0.3)
Other workers	1060 (5.2)
Missing data	310 (1.5)
Comorbid disease	4384 (21.5)
Thyroid dysfunction	361 (8.2)
Hyperthyroidism	178 (4.1)
Respiratory system	217 (4.9)
Cerebrovascular and nervous system	408 (9.3)
Cardiovascular system and glucose metabolism	1728 (39.4)
Hypertension	1356 (78.5)
Coronary heart disease (CHD)	289 (16.7)
Diabetes	653 (37.8)
Hyperlipidemia	448 (25.9)

Diagnostic distribution and hospitalization rate changes

Among 20,359 subjects, 36.3% of the patients had schizophrenia (SCZ) spectrum diagnosis, including 85.9% for SCZ, 7.5% for acute and brief psychotic disorder (ATPD), 3.8% for unspecified nonorganic psychosis, 1.6% for persistent delusion disorder, and 1.3% for schizoaffective disorder (SAD). 19.7% of the patients were diagnosed with BD, 19.2% with depression, 15.8% with neurotic-stress-related and somatoform disorders (NSRD), as well as other mental disorder percentages were shown in Fig. 1.

According to Fig. 2a, despite the rising number of schizophrenia admissions since 2011 (except in 2020, the ward was closed due to the coronavirus outbreak), the percentage of annual psychiatric inpatients with SCZ constantly dropped from 42.4–19.1% from 2011 to 2020. In contrast, hospitalization rates for depression grew from 13.8–25.5%, BD increased slowly from 16–21.6%, and NSRD raised from 13–17.8% (Fig. 2b).

In Fig. 3a, the average hospital age of patients changed slightly from 2011 to 2020, but hospitalization rates significantly changed for different age groups (Fig. 3b). Hospitalization rates among adolescents increased from 16.4% in 2011 to 36.4% in 2019, while hospitalization proportions among 18–29 year-olds decreased from 57.2–36.6%, and hospitalization proportions among 30–60 year-olds showed a small increase. Meanwhile, the average LOS decreased from 22 days in 2011 to 17 days in 2020.

Diagnosis stability

In short term, of 20,359 admissions, 92.6% of patients were diagnosed consistently between first admission and discharge. Table 2 gives a brief overview. Disorders of psychological development (such as child autism, and Asperger's syndrome), substance use, and NSRD had the highest consistency, at 100%, 97%, and 96.5% respectively. “Unspecified mental disorders” (F99) diagnosis was unstable during admission, with the lowest consistency of 16.3%. Most diagnoses are ambiguous until a disease was identified. The consistency of the three most prevailing psychosis was 94.4% for SCZ, 96.4% for BD, and 94.1% for depression.

Table 2

Percentage of diagnostic consistency for first admission patients(N = 20,359) and rehospitalizations (N = 3762)
ICD-10 code		Diagnostic consistency in first hospitalized patients			Diagnostic consistency in repeat hospitalized patients
	N^a	Consistency	Inconsistency	N^b	Consistency	Inconsistency
		N (%)	N (%)		N (%)	N (%)
Organic, including symptomatic, mental disorders (F00-F09)	298	274 (91.9)	24 (8.1)	48	22 (45.8)	26 (54.2)
Mental and behavioral disorders due to psychoactive substance use (F10-F19)	234	228 (97.4)	6 (2.6)	31	21 (67.7)	10 (32.3)
Schizophrenia, schizotypal and delusional disorder (F20-F29)	7542	6911 (91.6)	631 (8.4)	1323	1015 (76.7)	308 (23.3)
Schizophrenia F20	6409	6053 (94.4)	356 (5.6)	1129	980 (86.8)	149 (13.2)
Persistent delusional disorders F22	107	102 (95.3)	5 (4.7)	19	11 (57.9)	8 (42.1)
Acute and brief psychotic disorder F23	658	486 (73.9)	172 (26.1)	118	7 (5.9)	111 (94.1)
Schizoaffective disorders F25	80	69 (86.3)	11 (13.8)	28	9 (32.1)	19 (67.9)
Unspecified nonorganic psychosis F29	288	201 (69.8)	87 (30.2)	29	8 (27.6)	21 (72.4)
Mood (affective) disorders (F30-F39)	7792	7404 (95)	388 (5)	1794	1302 (72.6)	492 (27.4)
Bipolar disorder F31	3642	3510 (96.4)	132 (3.6)	898	817 (91)	81 (9)
Depression F32	3970	3736 (94.1)	234 (5.9)	837	468 (55.9)	369 (44.1)
Recurrent depressive disorder F33	149	130 (87.2)	19 (12.8)	31	13 (41.9)	18 (58.1)
Another mood (affective) disorder F3X	31	28 (90.3)	3 (9.7)	28	4 (14.3)	24 (85.7)
Neurotic, stress-related, and somatoform disorders (F40-F48)	3188	3075 (96.5)	113 (3.5)	405	265 (65.4)	140 (34.6)
Behavioral syndromes associated with physiological disturbances and physical factors (F50-F59)	472	450 (95.3)	22 (4.7)	39	20 (51.3)	19 (48.7)
Disorders of adult personality and behavior (F60-F69)	58	55 (94.8)	3 (5.2)	8	2 (25)	6 (75)
Mental retardation (F70-F79)	103	96 (93.2)	7 (6.8)	10	6 (60)	4 (40)
Disorders of psychological development (F80-F89)	36	36 (100)	0	6	4 (66.7)	2 (33.3)
Behavioral and emotional disorders with onset usually occur in childhood and adolescence (F90-F98)	329	290 (88.1)	39 (11.9)	77	27 (32.5)	52 (67.5)
Unspecified mental disorder F99	307	50 (16.3)	257 (83.7)	21	2 (9.5)	19 (90.5)
Total	20359	18869 (92.6)	1490 (7.4)	3762	2864 (71.3)	1078 (28.7)
^a The admission diagnosis of first-admission patients. The consistency rate is the percentage of discharge diagnoses that are consistent with admission diagnoses ^b Discharge diagnoses of rehospitalizations

In long term, among 3,762 readmission patients, 71.3% of patients received the same diagnosis at their first and last discharge diagnosis. The diagnostic consistency ranged from 91% for BD to 0.9% for unspecified mental disorders. The diagnosis consistency of SCZ and depression was 86.8% and 55.9%, respectively. However, except for mood disorder and SCZ spectrum categories had the highest consistency at 76.7% and 72.6% respectively, the diagnoses of all other categories were below 70%.

The diagnostic consistency of all psychiatric categories in rehospitalizations was significantly lower than the consistency of diagnosis in first-admission inpatients.

Diagnostic shifts

The relatively short-term and long-term discrepancies between initial and final diagnoses across multiple diagnosis categories were detailed. (Supplementary data Table 1 and Table 2, respectively).

Of 20,359 subjects of first-time hospitalizations in the short-term, 1,490 (7.4%) patients presented substantial diagnostic conversion. Among all inconsistent diagnoses, the main admission diagnoses were SCZ at 23.9%, unspecified mental disorders at 17.2%, and depression at 15.7% (Supplementary data Table 1).

Diagnoses shifted to BD were most frequent, accounting for 33.9% of patients having diagnostic switches. The proportion of the patients whose diagnoses were converted to BD was 33.1% (168) from depression, 29.5% (150) from SCZ, and 9.3% (47) from unspecified mental disorders.

Besides, frequently diagnostic conversion to SCZ was mainly from ATPD at 33.6% and BD at 21.2%. Notably, there were forty of 257 patients diagnosed with unspecified mental disorders shifting into SCZ. Conversely, no patients were initially diagnosed with SCZ shifting into unspecified mental disorder. The majority of patients admitted with unspecified psychosis diagnosis mainly turned to SCZ spectrum (34.6%), mood disorder (30%), and organic disorder (19%), followed by NSRD (8.2%).

In the subgroup, 28.7% (1,078) of the 3,762 rehospitalizations occurred diagnosis conversion. In patients with discrepant diagnoses, the most common initial diagnosis was depression at 34.2%, followed by SCZ at 13.8% (Supplementary data Table 2).

Similar to the characteristic of diagnostic discrepancy of first admission patients, diagnoses shifted to BD were most frequently (40.2%), followed by SCZ (21.6%). Diagnostic conversion to BD was mainly from depression (46.4%) and SCZ (12.1%). The diagnostic inconsistency of ATPD was 94.1% and 60.3% of ATPD eventually shifted to SCZ. ATPD was the most common disease revised to SCZ. Among twenty-eight rehospitalizations diagnosed with SAD, seven (24%) shifted to SCZ and nine (32%) shifted to BD. Most unspecified psychosis eventually turned to SCZ and BD. These patients whose baseline diagnosis was NSRD mainly converted to mood disorders (66.4%).

In terms of the year, the diagnostic consistency ranged from 92.1–94.9% in 2011–2019 and 88.5% in 2020 (Supplementary data Fig. 1).

Factors influencing diagnostic consistency

To determine predictors in a diagnostic shift during short-hospitalization, first-admission patients were divided into two groups according to whether the diagnosis was consistent. By comparing the LOS, age, gender, marital status, occupation, and co-morbidity of physical diseases between the two groups, significant differences were found in the LOS (Z=-12.3, p < 0.001) and mean age (Z = 7.45, p < 0.001). LOS increased with inconsistent diagnoses (mean 21.1 days as compared to mean 18.9 days without discrepant diagnoses). The mean age of the discrepant group was 22.1(SD 8.3) years old compared with 25.3(SD 9.2) years old of the consistent group. Then, stepwise logistic regression analysis was used to analyze the predictor of diagnoses discrepancy. The LOS and age were independent predictors of a diagnosis of shifts (Supplementary data Table 3).

In addition, rehospitalization patients were also grouped and compared according to the above method, only hospitalization time was significantly increased in the diagnostic inconsistent group (Z = 3.89, p < 0.001).

This retrospective study covered 20,359 inpatients (3,762 of which were rehospitalizations) from 2011 to 2020 and investigated the distribution and diagnostic consistency of mental disorders. The results found that three major mental disorders remain the leading cause of hospitalization. During short-term hospitalization, most mental disorder diagnoses were highly stable, however, the diagnostic consistency among rehospitalization patients was strikingly decreased. ATPD and unspecified psychosis had the lowest consistency both in the short-term and long-term. Meanwhile, LOS and age were major predictors of inconsistent diagnosis.

Our results showed that the case of psychiatric inpatients increased since 2011. However, despite the number of SCZ patients increasing[14], hospitalization rates for SCZ had noticeably decreased each year in our finding. Conversely, hospitalization rates for BD and depression were both on the rise. In line with previous studies, admission rates for SCZ decreased while mood disorders increased in Taiwan from 1998 to 2007 [15]. Twenge. et al also reported that the proportion of inpatients with mood disorders has been increasing [16, 17]. Notably, decade development of community-based mental health services has contributed to substantial improvements in the early recognition of mental illness, the immediate treatment rates of patients, the continuity of treatment, and personalized rehabilitation[18]. Thus, patients with stable serious mental disorders will receive effective intervention and treatment in community hospitals, which may account for the decreased hospitalization rates for SCZ in general hospitals.

When patients were divided into age groups, we found the proportion of adolescents hospitalized significantly increased every year. Recent surveys reported that the proportion of mood disorders relative to all psychiatric was increased among children and adolescents [19–21], which might be one possible reason for the young age of this sample. Besides, most adult mental disorders began in adolescence [22, 23], and with improving mental health awareness in general, mental illness was identified and treated at an early stage.

Moreover, consistent with previous reports [24, 25], a notable finding was the mean LOS decreased by 5 days during the last decade. On the one hand, it was reported that the hospitalization time for mood disorders was shorter than that of SCZ [26, 27]. With the increase in the effectiveness of antipsychotics and related psychological or physical interventions[28], hospital treatment times were shorted given the rapid recovery of patients. On the other hand, previous studies have reported the impact of healthcare reform on the LOS [6, 29, 30]. It is worth mentioning that, to promote the realization of the international UHC (Universal health coverage) goals, which means all individuals and communities have access to the health services they need without suffering financial hardship, China has launched a series of healthcare reforms since 2009. In 2018, more than 95% of the population was covered by health insurance [31]. Yanling Zhou. et al found that insurance plans with lower co-payments were predictors of longer hospital stays [32]. Chen Gao. et al reported that the payment reform reduced the LOS by 17.7% but did not affect the quality of care [33]. Therefore, changes in these measures may have a substantial impact on reducing the LOS. Despite this, some studies reported that shorter hospital stays were associated with the number of rehospitalizations [34, 35], whereas discordant views reported that shorter hospital stays did not affect patient quality of care and were not directly associated with readmission [24, 36–38].

In our results, the 10-year overall cumulative rate of conversion to another mental illness among first admissions in this general hospital was 7.3%, which confirmed a high degree of diagnostic consistency during short-term hospitalization. However, for patients who were hospitalized at least twice, 28.7% had diagnostic switched in their last discharge diagnosis. This time-mediated instability may be more reflective of the natural transformation of the mental disease.

Consistent with the results of previous studies, diagnostic discrepancies were highly in unspecified psychosis [39–41] and ATPD [42–44]. A significant proportion of patients with unspecified psychosis shifted to the SCZ spectrum and mood disorder classifications. ATPD was the most common disorder converted to SCZ, followed by bipolar disorder among the first and repeated hospitalizations. These findings provided new evidence for the idea of a differentiated process in functional psychosis, that clarity and stability of clinical images would get increased with the decreasing of comorbidity and atypical symptoms over time and consequently contribute to a more definitive diagnosis [45]. Therefore, it is more meaningful to expand the longitudinal sample and find potential predictors of the transition from other functional psychosis to the SCZ spectrum or affective psychosis[46].

Our findings showed cross-conversion between SCZ, SAD, and mood disorder. The diagnostic stability of depression and SAD among the readmissions were 55.9% and 32.1% respectively, still, which were above 85% among the first admission. 24% of readmissions with depression developed BD in our study that in line with previous studies reported unipolar depression frequently developed into BD [47] [48, 49]. Previous reports have illustrated these disorders were difficult to identify when there was a significant overlap of symptoms [50, 51]. In clinical practice, both prominent psychotic symptoms and affective symptoms may occur in a person at the same time, which may confuse clinicians hardly to find a clear boundary to making a pure SCZ or mood disorder. Since lack of a clear boundary between SCZ and mood disorders, Jacob Kasanin proposed a hybrid concept, SAD [52]. However, 32% of readmissions with SAD converted to BD and 24% to SCZ in this study. Thus, emphasis should be placed on the classification and revisioning of criteria among mood disorders, SAD, and SCZ.

Nevertheless, we found the rate of misdiagnosis fluctuated less than 2.5% (except compared with 2020) despite vast scientific and technological advances in medicine over the last decade. That inconsistency may be related to the natural evolution of certain disorders or inherent weaknesses in diagnostic classification.

Patients with inconsistent diagnoses were younger and had longer hospital stays than those with stable diagnoses. Our results showed no significant difference in other demographic characteristics between these two groups. Since children and adolescents were at the peak of the onset of mental disorders and the risk of conversion to other disorders [22, 23, 53]. Especially patients and families have a potential influence on doctors' diagnoses. Clinicians may make a mild admission diagnosis than real symptoms, which affects the stability of diagnosis. This reminds psychiatrists to pay more attention and be more cautiously on young patients when making diagnoses. Longer hospital stays and younger age were associated with increased odds of diagnosis alteration, this result validates the findings of previous studies [54], suggesting that inconsistent diagnosis increases inpatient care costs and may result in delays in treatments or interventions. Therefore, systematically identifying misdiagnosis and reducing diagnosis delay is conducive to the rehabilitation of patients.

Uncommon mental disorders should also get our focus. In the past period, most studies had focused on changes in a single disease category such as SCZ[7, 8], BD[9–11], and personality disorder [12, 13], but our study included uncommon diagnostic classifications. For example, NSRD was ever shifted to BD. These inconsistencies may be related to comorbidity, which increased diagnostic complexity. Thus, clinicians' comprehensive observations and evaluations of symptoms were still important means to determine the correct trend of the disease.

In summary, our results proved that ICD-10 has high diagnostic stability in hospitalized patients, but it still shows some inherent limitations when the diagnosis needs to be made in a long-term follow-up. Further training in clinical assessment and proper revisioning of diagnostic criteria could be beneficial.

Also, our study has certain limitations. Firstly, the study only compared inpatient changes in a single environment, further research needs to be expanded to other settings. Secondly, affected by the quality of documents, there may be some deviation in diagnosis in different periods. However, this research center has a strict medical record management system, and two or more doctors make diagnoses simultaneously, so the samples in this retrospective study are of high quality and representativeness. Finally, it is necessary to compare more characteristics of patients between the diagnoses consistent group and discrepant group to find out the related factors that may affect the accuracy of diagnosis.

ACKNOWLEDGMENTS

This study was supported by the National Natural Science Foundation of China (Grant No. 82072096).

COMPLIANCE WITH ETHICAL STANDARDS

Ethical approval

The ethics committee of the Second Xiangya Hospital, Central South University approved this study.

Conflict of interest

The authors have no relevant financial or non-financial interests to disclose.

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No competing interests reported.

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10-year Trends in Diagnostic Stability and Distribution among Psychiatric Inpatients in a General Hospital in China

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Abstract

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Introduction

Methods

Data source

Design and sample selection

Diagnosis discrepancy assessment

Statistical analysis

Results

Characteristics of the sample

Diagnostic distribution and hospitalization rate changes

Diagnosis stability

Diagnostic shifts

Factors influencing diagnostic consistency

Discussions

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References

Additional Declarations

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