%0 Journal Article
%T Motives and modifying factors for giving or rejecting psychiatric diagnoses in general medicine and psychiatry - a qualitative interview study.
%A Tebartz van Elst H
%A Niehoff C
%A Steinhäuser J
%J BMC Psychiatry
%V 24
%N 1
%D 2024 Jun 20
%M 38902699
%F 4.144
%R 10.1186/s12888-024-05900-2
%X <B>BACKGROUND: </B>There is a discussion among general practitioners and psychiatrists regarding over-diagnosing versus under-reporting of psychiatric diagnoses. A deeper understanding of this topic is relevant for providing reasonable health care and for planning future studies. A crucial factor to understanding this discussion is the difference in the prevalence of a disease in each sector. One way to attain knowledge about such prevalences is the analysis of routine care data of the sector in question. However, diagnosis-related data might be modified by several additional influencing factors.<BR><B>OBJECTIVE: </B>This study aims to explore what kind of motives and modifying factors play a role for or against giving psychiatric diagnoses in psychiatric and general medical settings.<BR><B>METHODS: </B>Twenty-six semi-structured interviews were conducted with German physicians in the fields of general medicine and psychiatry. Interviews were analysed using content analysis.<BR><B>RESULTS: </B>The analysis revealed three major motivational categories for finding a diagnosis: (1) "objective matters" such as "categorisation for research"; (2) "functional and performance-related factors" such as "requirement for medication", "billing aspects" that go with certain diagnoses or "access to adequate care" and (3) "Individual factors" such as the "personality of a physician". Similarly, factors emerged that lead to not making psychiatric diagnoses like "fear of stigmatization among patients" or "detrimental insurance status with psychiatric diagnosis". Additionally participants mentioned other reasons for "not diagnosing a psychiatric diagnosis", such as "coding of other clinical pictures".<BR><B>CONCLUSIONS: </B>The diagnostic process is a complex phenomenon that goes far beyond the identification of medical findings. This insight should be considered when processing and interpreting secondary data for designing health care systems or designing a study.