Cross-discipline disparities in perceptions of mental disorders in a long-term care facility

OBJECTIVES: This study compared prevalence rates of mental disorders in a single long-term care facility as perceived by three professional disciplines and compared professionals' perceptions with two standardized measures of psychopathology. DESIGN: Comparison of (1) prospective standardized psychiatric evaluations performed by psychiatrists, (2) chart reviews of mental disorders as documented by primary care physicians, and (3) interviews of nurses. SETTING: The residential health care facility at Monroe Community Hospital in Rochester, New York. PARTICIPANTS: A 20% random sample of adult residents, stratified by ward (n = 80). MEASUREMENTS: Prevalence rates of psychopathology as determined by each data collection method: psychiatric diagnoses as determined by psychiatrists and primary care physicians, the Brief Psychiatric Rating Scale, and the Psychogeriatric Dependency Rating Scale. RESULTS: Prevalence rates of psychopathology ranged from 60 to 91% across discipline-specific data collection methods. Using psychiatrists' diagnoses as the benchmark, primary care physicians and nurses underestimated the prevalence of mental disorders, particularly organic mental disorders. All disciplines agreed on the presence of personality and developmental disorders. The Brief Psychiatric Rating Scale and Psychogeriatric Dependency Rating Scale validated perceptions of psychopathology by psychiatrists and nurses, but not by primary care physicians' chart diagnoses. CONCLUSION: Disparities in perceptions of mental disorders across disciplines pose a threat to patient care and suggest a need for more reliable incorporation of mental health expertise in the long-term care setting.