Diagnostic error in mental health: a review

Abstract

Diagnostic errors are associated with patient harm and suboptimal outcomes. Despite national scientific efforts to advance definition, measurement and interventions for diagnostic error, diagnosis in mental health is not well represented in this ongoing work. We aimed to summarise the current state of research on diagnostic errors in mental health and identify opportunities to align future research with the emerging science of diagnostic safety. We review conceptual considerations for defining and measuring diagnostic error, the application of these concepts to mental health settings, and the methods and subject matter focus of recent studies of diagnostic error in mental health. We found that diagnostic error is well understood to be a problem in mental healthcare. Although few studies used clear definitions or frameworks for understanding diagnostic error in mental health, several studies of missed, wrong, delayed and disparate diagnosis of common mental disorders have identified various avenues for future research and development. Nevertheless, a lack of clear consensus on how to conceptualise, define and measure errors in diagnosis will pose a barrier to advancement. Further research should focus on identifying preventable missed opportunities in the diagnosis of mental disorders, which may uncover generalisable opportunities for improvement.

Keywords: Diagnostic errors; Medical error, measurement/epidemiology; Mental health.

Figure 1. The diagnostic process model from the National Academies of Science, Medicine and Engineering report Improving Diagnosis in Health Care (reprinted with permission) emphasises data gathering and synthesis, as depicted in the circular portion of the diagram. To better describe the context of missed and delayed diagnosis in mental health, we suggest an elaboration of this model (depicted in the upper portion) that describes the steps and potential delays involved in seeking and accessing mental health services (adapted from Andersen et al⁶⁴).