What is diagnostic agreement and why does it matter?

Interrater agreement is the degree of consensus among independent observers who rate, code, or assess the same phenomenon.

In psychiatry, where direct paraclinical tests are scarce, the reliance on clinical observations and patient-reported symptoms necessitates a high degree of interrater agreement for accurate diagnoses. Despite this, recent findings indicate a concerning trend of low reliability in psychiatric diagnoses, with significant variations over time. The tendency for diagnoses to change, particularly when patients are transferred between psychiatric teams, highlights the ongoing struggle for diagnostic consistency.

Mistakes in diagnoses often lead to ineffective and inappropriate treatment. From the patients’ perspective, frequently changing diagnoses may undermine their trust in mental health services, expose them to the stigma of having multiple mental disorders, and cause them to lose hope of ever getting better. This is detrimental to their empowerment and recovery.

Importantly, a substantial part of psychiatric research is based on diagnoses, implying that diagnostic error may substantially impede real progress in the pathophysiology, etiology, and treatment of psychiatric disorders. There has been a relative lack of attention to the issue, resulting in substantial gaps in what is known about diagnostic errors in psychiatry and the magnitude of the problem.

How are we investigating this?

Our research endeavors to examine the current state of diagnostic agreement across Europe and South America. Moreover, it aims to shed light on the diagnostic reasoning processes employed by clinicians. We do this by asking doctors to assess vignette psychiatric cases – either in written form (international) or in video (Denmark).

The doctors will provide their responses through an online link, ensuring their anonymity is maintained throughout the duration of the study.