Mental Illness Diagnoses May Not Cause All Mental Symptoms: A Simulation Study for Major Depressive Episodes, Dysthymic Disorder, and Manic Episodes.

Autor:	Chao YS; Epidemiology and Public Health, University of Montreal Hospital Centre Research Center, Montreal, CAN., Wu CJ; Computer Sciences, Université du Québec à Montréal, Montreal, CAN., Po JY; Epidemiology and Public Health, Natural Resources Institute, University of Greenwich, London, GBR., Huang SY; Anesthesiology, Shuang Ho Hospital, New Taipei, TWN., Wu HC; Internal Medicine, National Taiwan University Hospital, New Taipei, TWN., Hsu HT; Pathology, Changhua Christian Hospital, Changhua, TWN., Cheng YP; Neurological Surgery, Changhua Christian Hospital, Changhua, TWN., Lai YC; Chest Medicine, National Yang Ming Chiao Tung University Hospital, Yilan, TWN., Chen WC; Chest Medicine, Taipei Veterans General Hospital, Taipei, TWN.
Jazyk:	angličtina
Zdroj:	Cureus [Cureus] 2024 Jan 13; Vol. 16 (1), pp. e52234. Date of Electronic Publication: 2024 Jan 13 (Print Publication: 2024).
DOI:	10.7759/cureus.52234
Abstrakt:	Objectives This study aims to understand the statistical significance of the associations between diagnoses and symptoms based on simulations that have been used to understand the interpretability of mental illness diagnoses. Methods The symptoms for the diagnosis of major depressive episodes, dysthymic disorder, and manic episodes were extracted from the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR, American Psychiatric Association, Philadelphia, Pennsylvania). Without real-world symptom data, we simulated populations using various combinations of symptom prevalence and correlations. Assuming symptoms occurred with similar prevalence and correlations, for each combination of symptom prevalence (0.05, 0.1, 0.3, 0.5, and 0.7) and correlation (0, 0.1, 0.4, 0.7, and 0.9), 100 cohorts with 10,000 individuals were randomly created. Diagnoses were made according to the DSM-IV-TR criteria. The associations between the diagnoses and their input symptoms were quantified with odds ratios and correlation coefficients. P-values from 100 cohorts for each combination of symptom prevalence and correlation were summarized. Results Three mental illness diagnoses were not significantly correlated with their own symptoms in all simulations, particularly when symptoms were not correlated, except for the symptom in the major criteria of major depressive episodes or dysthymic disorder. The symptoms for the diagnosis of major depressive episodes and dysthymic disorder were significantly correlated with these two diagnoses in some simulations, assuming 0.1, 0.4, 0.7, or 0.9 symptom correlations, except for one symptom. The overlap in the input symptoms for the diagnosis of major depressive episodes and dysthymic disorder also leads to significant correlations between these two diagnoses, assuming 0.1, 0.4, 0.7, and 0.9 correlations between input symptoms. Manic episodes are not significantly associated with the input symptoms of major depressive episodes and dysthymic disorder. Conclusion There are challenges to establish the causation between psychiatric symptoms and mental illness diagnoses. There is insufficient prevalence and incidence data to show all psychiatric symptoms exist or can be observed in patients. The diagnostic accuracy of symptoms to detect a disease cause is far from perfect. Assuming the symptoms of three mood disorders may present in patients, three diagnoses are not significantly associated with all psychiatric symptoms used to diagnose them. The diagnostic criteria of the three diagnoses have not been designed to guarantee significant associations between symptoms and diagnoses. Because statistical associations are important for making causal inferences, there may be a lack of causation between diagnoses and symptoms. Previous research has identified factors that lead to insignificant associations between diagnoses and symptoms, including biases due to data processing and a lack of epidemiological evidence to support the design of mental illness diagnostic criteria. Competing Interests: YSC is employed by the Canadian Agency for Drugs and Technologies in Health. YSC conducted this study as an independent researcher out of academic curiosity without any material support. The other authors declared no competing interests. No external funding was received for this study. This study is not associated with any patents, products in development or marketed products. (Copyright © 2024, Chao et al.)
Databáze:	MEDLINE
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