Abstract
In order to assess the specifics of practical use of the ICD-10 Diagnostic Guidelines by Russian psychiatrists, official national statistics on the prevalence of a number of mental disorders in Russia in 2019 were compared with the results of meta-analyses of international epidemiological studies of these disorders. In addition, a number of items in the online psychiatrists' survey, relating to the diagnosis of schizophrenia, were analysed; 807 Russian psychiatrists took part in the online survey. Analysis of national statistics showed that domestic clinicians diagnose some mental disorders significantly less often than might be expected, according to data obtained by international epidemiological studies. The number of cases of bipolar affective disorder registered in Russia is 90-150 times less than that for the prevalence of this disorder, according to meta-analyses of epidemiological studies; for depression, the result is 50-70 times; for anxiety disorders, the number is 25-50 times, and for autism, it is 30 times. Instead of the above disorders, diagnoses of organic non-psychotic mental disorders and schizophrenia might have been used unreasonably often. Between 2005 and 2019, diagnosis of childhood autism changed significantly (an increase of more than 100%), while the frequency of diagnosing other mental disorders remained unchanged. The results of the online survey also showed largely perfunctory use of the ICD-10 Diagnostic Guidelines, with a third of respondents reporting never checking the diagnostic schedules, and another third doing so from time to time. In addition, the low estimates given by survey participants regarding practical utility of the ICD-10 Diagnostic Guidelines, along with a large percentage of respondents who do not directly use diagnostic criteria in their work, indicate the need to improve the clinical usefulness of the diagnostic guidelines in the latest revision of the ICD, including convenience of use in practice. The results of analysis of the Russian national mental health service statistic indicate that at least some diagnostic categories are not used by Russian psychiatrists exactly as ICD-10 suggests. The revealed discrepancy between the principles of diagnostics observed by domestic clinicians and international criteria may interfere with the use of evidence-based treatment algorithms, negatively affecting the quality of psychiatric care. In light of the upcoming transition to ICD-11 and in order to unify approaches to the diagnosis of mental disorders in our country, it is necessary to update and improve educational programmes for psychiatrists.
Highlights
Since 1999, by Order of the Ministry of Health of the Russian Federation, Russian health authorities and institutions have moved towards use of the International Statistical Classification of Diseases and Related Health Problems, 10th version (ICD-10), when "preparing statistical reports".1 Since this time, published national statistics on the incidence of mental disorders in Russia have been based on ICD-10 diagnoses
State healthcare provision units registered 465 thousand patients with schizophrenia (F20), or 0.32% of the population. (Section F20–29 in its entirety accounted for 0.40%.) This frequency almost exactly corresponds to the results of a meta-analysis of epidemiological studies of schizophrenia prevalence, conducted between 1965 and 2002.4 Patients with schizophrenia accounted for 12% of all people who turned to Russian state institutions for psychiatric care in 2019
Since ICD-10 does not distinguish between types I and II of bipolar affective disorder (BAD), it can be assumed that Russian data correlate to a greater extent with the prevalence of BAD type I
Summary
Since 1999, by Order of the Ministry of Health of the Russian Federation, Russian health authorities and institutions have moved towards use of the International Statistical Classification of Diseases and Related Health Problems, 10th version (ICD-10), when "preparing statistical reports".1 Since this time, published national statistics on the incidence of mental disorders in Russia have been based on ICD-10 diagnoses. Since 1999, by Order of the Ministry of Health of the Russian Federation, Russian health authorities and institutions have moved towards use of the International Statistical Classification of Diseases and Related Health Problems, 10th version (ICD-10), when "preparing statistical reports".1 Since this time, published national statistics on the incidence of mental disorders in Russia have been based on ICD-10 diagnoses. Many of the ICD-10 provisions, which suggested a revision of the previously dominant nosological approach and a transition to operational criteria, were completely new for Russian psychiatrists and were criticized by many colleagues who were used to working with a substantially abridged Soviet Union version of ICD-9. We: a) compared official national statistics on the prevalence of mental disorders in Russia with the results of meta-analyses of international epidemiological studies on a number of mental disorders; and b) conducted a large-scale online survey of psychiatrists on specific use of ICD-10 in their practice (in relation to the diagnosis of schizophrenia)
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