Overdiagnosis in psychiatry: its effect on children and ethnic minority groups
James Kakanyera
Over the past 20 years, health service providers and mental health organizations have noticed a significant rise in the prevalence of mental health in children and young people. In a survey conducted in 2004 by the Office for National Statistics (Green et al., 2005) , it was shown that 1 in 10 young people ages 5 – 16 were clinically diagnosed with a type of mental health disorder (emotional, hyperactive or behavioural) out of a sample size of 7977 families. The same organization undertook a second survey in 2017 (Mental Health of Children and Young People in England, 2017), and it was shown that now 1 in 8 (12.8%) of 5 – 19 year olds have been clinically diagnosedwith amental health disorder; an increase of 2.8% overall in 13 years. However, epidemiological studies have shown that the trends in the prevalence of mental health disorders have seen mixed effects, which tells us that the rise in these diagnoses is likely due to overdiagnosis. This occurs when often during early screening for a disorder, when a patient is mistakenly dia gnosed with a disorder. The effects of what this does to a patient’s life are often detrimental, and particularly when a patient is diagnosed at a young age. This essay will explore how overdiagnosis occurs and what effect this has on the doctor-patient relationship as well as in children and ethnic minorities. Overdiagnosis is defined as ‘the diagnosis of a medical condition that would never have caused symptoms or problems’ (National Centre for Biotechnology Information, 2017). This is different from a m isdiagnosis; in that an overdiagnosis is a ‘correct’ diagnosis that shows all the symptoms of an illness, but none of these symptoms are directly linked to a particular illness. For example, one might have several of the symptoms which show for ADHD; poor concentration skills, impulsiveness, disorganization or trouble multitasking, but these may just be persistent behaviours of an individual, and not necessarily a diagnosable condition. Overdiagnosis often arises as a result of screening tests; these tests are conducted before symptoms show to try and prevent and reduce the effects of a condition. These cases are also quite common in cancer screenings, for breast cancer and prostate cancer screenings small tumours may be found which turn out to be non-progressive or slow growing (which would have no effect on the patient) but are diagnosed as malignant. This is often discovered after the patient has died, when the cause of death is related to other causes, not the tumour. This has applications in mental health, as health professionals find it much more difficult to diagnose, as symptoms are mostly behavioural or obscured. Thus, it is much harder as they must distinguish between actual symptoms and simple personality traits or behaviours of a patient. This will often lead to an overdiagnosis or a misdiagnosis. A study was conducted which looks at the relationship of Black, Asian and Minority Ethnic (BAME) groups and mental health professionals, specifically in their overdiagnosis. (Suite et al., 2007) The article examines the history of racism in mental health, even touching on the invented disorder of ‘drapetomania’ by Samuel A. Cartwright. It describes the ‘uncontrollable urge [of African slaves] to escape slavery, destroy property on the plantation, be disobedient, talk back, fight with their masters
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