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Peer-reviewedCC BY 4.0CNS Spectrums

Frequency and correlates of inaccurate psychiatric diagnoses in 401 adults hospitalized for major depressive disorder: a comparison of clinical versus research interview-based diagnoses

  • Viktor Benjamin Nöhles1,2
  • Till Julius Adam1
  • Felix Bermpohl3
  • Nikola Schoofs3
  • Rouven Bathe-Peters3
  • Nina Hilpert3
  • Forugh Salimi Dafsari4
  • Peter Falkai5,6,7
  • Cornelius Schüle5
  • Elena Wang5
  • Christine Reif-Leonhard8
  • Andreas Reif8,9
17 more authors
  • Susanne Schillo8
  • Rabia Sana Arshad8
  • Patricia Getty8
  • Christian Otte2,10
  • Dominique Piber10
  • Livia Graumann10
  • Sebastian Weyn-Banningh10
  • Mazda Adli11,12
  • René Papenfuß11
  • Andreas Meyer-Lindenberg13,14
  • Stefan Fritze13
  • Michael Bauer15
  • Ute Lewitzka5,15
  • Maik Spreer15
  • Clemens Karl Krug15
  • Kerstin Rubarth16
  • Christoph Ulrich Correll1,2,17,18
18 affiliations
  1. 1Department of Child and Adolescent Psychiatry, Psychosomatic Medicine and Psychotherapy, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Campus Virchow-Klinikum, Berlin, Germany
  2. 2German Center for Mental Health (DZPG), partner site Berlin, Berlin, Germany
  3. 3Department of Psychiatry and Neurosciences, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
  4. 4Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
  5. 5Clinic for Psychiatry and Psychotherapy, Ludwig Maximilian University of Munich, Munich, Germany
  6. 6German Center for Mental Health (DZPG), partner site Munich, Munich, Germany
  7. 7Max Planck Institute for Psychiatry, Munich, Germany
  8. 8Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Medical Center Frankfurt, Frankfurt am Main, Germany
  9. 9Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Frankfurt am Main, Germany
  10. 10Department of Psychiatry and Psychotherapy, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Campus Benjamin Franklin, Berlin, Germany
  11. 11Department of Psychiatry and Neurosciences, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Campus Charité Mitte, Berlin, Germany
  12. 12Center for Psychiatry, Psychotherapy and Psychosomatic Medicine, Fliedner Klinik Berlin, Berlin, Germany
  13. 13Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Mannheim, Germany
  14. 14German Center for Mental Health (DZPG), partner site Mannheim, Mannheim, Germany
  15. 15Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
  16. 16Institute of Biometry and Clinical Epidemiology, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
  17. 17The Zucker Hillside Hospital, Psychiatry Research, Northwell Health, Glen Oaks, NY, USA
  18. 18Department of Psychiatry and Molecular Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
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Abstract

Objective: To evaluate the validity and correlates of inaccurate clinically diagnosed moderate/severe ICD-10 major depressive disorder (MDD) and psychiatric comorbidities in adult inpatients.

Methods: The multicenter Patient Characteristics, Validity of Clinical Diagnoses and Outcomes Associated with Suicidality in Inpatients with Symptoms of Depression (OASIS-D) study enrolled 18- to 75-year-old inpatients with MDD who underwent assessments for clinical, illness, and treatment characteristics, including the Mini-International-Neuropsychiatric-Interview (MINI). False-positive clinically MDD diagnoses were characterized via MINI. Diagnostic agreement between clinical and MINI-based psychiatric comorbidities was assessed with kappa-statistic.

Results: Among 401 patients (median age = 33.0 years; female = 57.1%), 42 (10.5%) were false positive for MDD (i.e., different primary diagnosis). Reasons for misdiagnosing MDD exclusive to false-positive cases included bipolar disorder (45.2%), subsyndromal depression (16.7%), and physical illness-related/substance use disorder (SUD)-related depression (4.8%), whereas missed diagnoses that could also occur in true-positive, MINI-based MDD patients included primary SUDs (23.8%) and primary anxiety disorders (9.5%). Among comorbidities, greatest disagreement between clinical and MINI-based research diagnoses existed for antisocial personality disorder (0% vs. 5.2%, κ =0), followed by anxiety disorders (7.5% vs. 45.1%, κ =0.17), obsessive-compulsive disorder (3.0% vs. 8.7%, κ =0.27), SUDs (11.0% vs. 28.4%, κ =0.29), eating disorders (3.5% vs. 7.2%, κ =0.39), and posttraumatic stress disorder (10.7% vs. 23.7%, κ =0.40).

Conclusions: Bipolar depression and SUDs contributed to two thirds of misdiagnosed MDD. Missed comorbidities included mostly anxiety disorders, SUDs, and PTSD. Accurate diagnostic assessment, including longitudinal history, is essential to reduce misdiagnosis and ensure guideline-based treatment for psychiatric disorders in MDD inpatients.

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Cite

BibTeXRIS
BibTeX
@article{nohles2026frequency,
  title = {{Frequency and correlates of inaccurate psychiatric diagnoses in 401 adults hospitalized for major depressive disorder: a comparison of clinical versus research interview-based diagnoses}},
  author = {Viktor Benjamin Nöhles and Till Julius Adam and Felix Bermpohl and Nikola Schoofs and Rouven Bathe-Peters and Nina Hilpert and Forugh Salimi Dafsari and Peter Falkai and Cornelius Schüle and Elena Wang and Christine Reif-Leonhard and Andreas Reif and Susanne Schillo and Rabia Sana Arshad and Patricia Getty and Christian Otte and Dominique Piber and Livia Graumann and Sebastian Weyn-Banningh and Mazda Adli and René Papenfuß and Andreas Meyer-Lindenberg and Stefan Fritze and Michael Bauer and Ute Lewitzka and Maik Spreer and Clemens Karl Krug and Kerstin Rubarth and Christoph Ulrich Correll},
  journal = {CNS Spectrums},
  year = {2026},
  month = jun,
  doi = {10.1017/s109285292610100x},
  url = {https://doi.org/10.1017/s109285292610100x},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Frequency and correlates of inaccurate psychiatric diagnoses in 401 adults hospitalized for major depressive disorder: a comparison of clinical versus research interview-based diagnoses
AU  - Viktor Benjamin Nöhles
AU  - Till Julius Adam
AU  - Felix Bermpohl
AU  - Nikola Schoofs
AU  - Rouven Bathe-Peters
AU  - Nina Hilpert
AU  - Forugh Salimi Dafsari
AU  - Peter Falkai
AU  - Cornelius Schüle
AU  - Elena Wang
AU  - Christine Reif-Leonhard
AU  - Andreas Reif
AU  - Susanne Schillo
AU  - Rabia Sana Arshad
AU  - Patricia Getty
AU  - Christian Otte
AU  - Dominique Piber
AU  - Livia Graumann
AU  - Sebastian Weyn-Banningh
AU  - Mazda Adli
AU  - René Papenfuß
AU  - Andreas Meyer-Lindenberg
AU  - Stefan Fritze
AU  - Michael Bauer
AU  - Ute Lewitzka
AU  - Maik Spreer
AU  - Clemens Karl Krug
AU  - Kerstin Rubarth
AU  - Christoph Ulrich Correll
PY  - 2026
DA  - 2026/06/09
JO  - CNS Spectrums
DO  - 10.1017/s109285292610100x
UR  - https://doi.org/10.1017/s109285292610100x
AB  - Objective: To evaluate the validity and correlates of inaccurate clinically diagnosed moderate/severe ICD-10 major depressive disorder (MDD) and psychiatric comorbidities in adult inpatients.  Methods: The multicenter Patient Characteristics, Validity of Clinical Diagnoses and Outcomes Associated with Suicidality in Inpatients with Symptoms of Depression (OASIS-D) study enrolled 18- to 75-year-old inpatients with MDD who underwent assessments for clinical, illness, and treatment characteristics, including the Mini-International-Neuropsychiatric-Interview (MINI). False-positive clinically MDD diagnoses were characterized via MINI. Diagnostic agreement between clinical and MINI-based psychiatric comorbidities was assessed with kappa-statistic.  Results: Among 401 patients (median age = 33.0 years; female = 57.1%), 42 (10.5%) were false positive for MDD (i.e., different primary diagnosis). Reasons for misdiagnosing MDD exclusive to false-positive cases included bipolar disorder (45.2%), subsyndromal depression (16.7%), and physical illness-related/substance use disorder (SUD)-related depression (4.8%), whereas missed diagnoses that could also occur in true-positive, MINI-based MDD patients included primary SUDs (23.8%) and primary anxiety disorders (9.5%). Among comorbidities, greatest disagreement between clinical and MINI-based research diagnoses existed for antisocial personality disorder (0% vs. 5.2%, κ =0), followed by anxiety disorders (7.5% vs. 45.1%, κ =0.17), obsessive-compulsive disorder (3.0% vs. 8.7%, κ =0.27), SUDs (11.0% vs. 28.4%, κ =0.29), eating disorders (3.5% vs. 7.2%, κ =0.39), and posttraumatic stress disorder (10.7% vs. 23.7%, κ =0.40).  Conclusions: Bipolar depression and SUDs contributed to two thirds of misdiagnosed MDD. Missed comorbidities included mostly anxiety disorders, SUDs, and PTSD. Accurate diagnostic assessment, including longitudinal history, is essential to reduce misdiagnosis and ensure guideline-based treatment for psychiatric disorders in MDD inpatients.
SN  - 1092-8529
SN  - 2165-6509
ER  -