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The uncertainty of psychological and psychiatric diagnoses


Mokros, A; Habermeyer, E; Kuchenhoff, H (2018). The uncertainty of psychological and psychiatric diagnoses. Psychological Assessment, 30(4):556-560.

Abstract

Psychiatric and psychological diagnoses are imperfect. Unlike somatic medicine, most psychological and psychiatric phenomena have no gold standard to establish their presence beyond reasonable doubt. Consequently, prevalence estimates are based on the average agreement of imperfect evaluators. Kuchenhoff, Augustin, and Kunz (2012) provided a statistical method for estimating confidence intervals of the prevalence based on the well-known kappa coefficient of interrater agreement. We expand this method and derive confidence intervals for the probability of a diagnosis being true (i.e., the positive predictive value). We illustrate the method and its results with empirical data for a particular type of paraphilia (pedophilia) in sexual offenders. The findings indicate that up to 1 in 3 diagnoses of pedophilia may be wrong. Given the similar rates of prevalence and interrater agreement reported for diagnoses in general psychiatry (such as schizophrenia or affective disorders), the results likely apply to other diagnostic domains as well. (PsycINFO Database Record

Abstract

Psychiatric and psychological diagnoses are imperfect. Unlike somatic medicine, most psychological and psychiatric phenomena have no gold standard to establish their presence beyond reasonable doubt. Consequently, prevalence estimates are based on the average agreement of imperfect evaluators. Kuchenhoff, Augustin, and Kunz (2012) provided a statistical method for estimating confidence intervals of the prevalence based on the well-known kappa coefficient of interrater agreement. We expand this method and derive confidence intervals for the probability of a diagnosis being true (i.e., the positive predictive value). We illustrate the method and its results with empirical data for a particular type of paraphilia (pedophilia) in sexual offenders. The findings indicate that up to 1 in 3 diagnoses of pedophilia may be wrong. Given the similar rates of prevalence and interrater agreement reported for diagnoses in general psychiatry (such as schizophrenia or affective disorders), the results likely apply to other diagnostic domains as well. (PsycINFO Database Record

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Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > Psychiatric University Hospital Zurich > Clinic for Psychiatry, Psychotherapy, and Psychosomatics
Dewey Decimal Classification:610 Medicine & health
Language:English
Date:2018
Deposited On:08 Mar 2019 08:52
Last Modified:25 Sep 2019 00:25
Publisher:American Psychological Association
ISSN:1040-3590
Additional Information:Mokros, Andreas Habermeyer, Elmar Kuchenhoff, Helmut eng 2017/10/20 06:00 Psychol Assess. 2018 Apr;30(4):556-560. doi: 10.1037/pas0000524. Epub 2017 Oct 19.
OA Status:Closed
Publisher DOI:https://doi.org/10.1037/pas0000524
PubMed ID:29048178

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