Doing Diagnosis in Child And Adolescent Mental Healthcare: A Content Analysis of Diagnostic Statements in a Psychiatric Case Register

• In Event: (Re)generating Dialogues between STS and Bioethics

Abstract

The benefits and risks of psychiatric diagnosis, particularly in youth mental health contexts, are currently hotly debated. This paper advances the argument that understanding actual diagnostic practice in mental healthcare is crucial for an informed and relevant debate about prevailing systems of diagnosis. To date, minimal research has explored psychiatric diagnostic practice by studying the diagnostic information present in clinical records. Understanding typical recording practices is important for informing scholarship in the sociology of psychiatry, identifying avenues for service improvement, and developing clinically valid research methods. The current study identifies, quantifies and describes the range of contexts in which diagnostic terms appear in free-text child and adolescent clinical notes. Data collection took place using an electronic case register maintained by a large London-based mental health service. Text segments containing a diagnostic term (N=2,993) were extracted from young people’s clinical notes and subjected to content analysis. Definite confirmations of a diagnosis were responsible for nearly half (49.4%) of mentions of a diagnostic term in clinical notes. An additional 6.4% of cases involved qualified confirmations of a diagnosis. Reference to diagnostic queries or clinical assessment procedures accounted for 16.9%. Diagnoses were definitely or tentatively excluded in 3.1% and 2.2% of cases respectively. In 13.5% of cases, the diagnostic term was introduced in relation to someone other than the young person in question (e.g. describing family history of mental illness). The remaining 8.6% of cases were clinically irrelevant, e.g. when a diagnostic term appeared in a clinic’s letterhead. This paper considers the linguistic patterns that characterised each of these contexts of use and the implications for service, research, and theoretical development.

Author

• Cliodhna O'Connor, University College Dublin