Misdiagnosis, detection rate, and associated factors of severe psychiatric disorders in specialized psychiatry centers in Ethiopia

Abstract Background There are limited studies regarding the magnitude of misdiagnosis as well as underdiagnosis in a specialized psychiatric setting. Thus far, to the best of our knowledge, this is the first study that determined the epidemiology of misdiagnosis as well as detection rates of severe psychiatric disorders including schizophrenia, schizoaffective, bipolar, and depressive disorders in a specialized psychiatric setting. Method In this cross-sectional study, a random sample of 309 patients with severe psychiatric disorders were selected by systematic sampling technique. Severe psychiatric disorders were measured by structured clinical interview for DSM-IV (SCID). The potential determinates of misdiagnosis were explored using binary and multivariable logistic regression models, adjusting for the potential confounding factors. Result The current study demonstrated that a remarkable proportion (39.16%) of people with severe psychiatric disorders were misdiagnosed. The commonly misdiagnosed disorder was found to be schizoaffective disorders (75%) followed by major depressive disorder (54.72%), schizophrenia (23.71%), and bipolar disorder (17.78%). Among the patients detected with the interview by SCID criteria, the highest level of the correct diagnosis was recorded in the medical record for schizophrenia (76.29%) followed by bipolar (72.22%), depressive (42.40%), and schizoaffective (25%) disorders with detection rate (sensitivity) of 0.76 (95%CI 0.69-0.84), 0.42 (95%CI 0.32-0.53), 0.72 (95%CI 0.60-0.84), and 0.25 (95%CI 0.09-0.41), respectively for schizophrenia, depressive, bipolar, and schizoaffective disorders. This study revealed that bipolar disorder patients are more likely to be diagnosed as schizophrenia (60%) whereas schizophrenia was most likely diagnosed as bipolar disorder (56.25%) and depressive disorders as schizophrenia (54.72%). Having a diagnosis of schizoaffective and depressive disorders as well as suicidal ideation were found to be significant predictors of misdiagnosis. Conclusion The current study revealed that four out of ten patients with severe psychiatric disorders are misdiagnosed in a specialized psychiatric setting in Ethiopia. The highest rate of misdiagnosis was observed for schizoaffective disorder (3 out of 4), followed by major depressive disorder (1 out of 2), schizophrenia (1 out of 4), and bipolar disorders (1 in 5). The detection rates were highest for schizophrenia, followed by bipolar, depressive, and schizoaffective disorders. Having a diagnosis of schizoaffective and depressive disorders as well as suicidal ideation were found to be significant predictors of misdiagnosis.