General hospital psychiatry · 2026
Diagnostic visibility and context-dependent referral patterns in consultation-liaison psychiatry: A ten-year retrospective study.
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Otani Kyohei, Yamada Kyoko, Terada Minako, Kurushima Shogo, Yamamoto Yuko, Shindo Ryota
Аннотация
OBJECTIVE: We examined whether psychiatric referral patterns in a general hospital without dedicated psychiatric beds are associated with symptom visibility rather than the underlying burden of psychiatric morbidity, and whether this pattern varies by clinical context.
METHODS: A ten-year retrospective descriptive study (FY2016-2025) was conducted at Kakogawa Central City Hospital, a 600-bed public hospital serving as a Regional Dementia Medical Centre. Three inpatient psychiatric intervention routes were analysed: psychiatrist-led first assessments (n = 7991; diagnostic analyses restricted to n = 7522 with individual diagnostic records), Liaison Team consultations (n = 6610), and Dementia Care Team interventions (n = 4810; total 19,411). Diagnoses were categorised using a visibility framework: Visible disorders (delirium [F05]; neurocognitive disorders [F00-03]) versus Less visible disorders (depression [F30-32]; anxiety [F40-48]; adjustment disorder [F43]). Departmental variation was examined using chi-square analysis across ten referring departments.
RESULTS: Liaison Team consultations increased from 299 to 911 and Dementia Care Team interventions from 117 to 846 over ten years. Among 7522 assessments with individual diagnostic records (FY2017-2025), Visible disorders accounted for 67.7% (n = 5091), with delirium alone comprising 57.6% (n = 4336). Less visible disorders represented only 12.9% (n = 971), yielding a Visible-to-Less visible ratio of 5.2:1. This ratio was consistent across all sensitivity analyses (range: 5.2-5.8:1). Marked departmental variation was observed (χ2(18) = 845.0, p < 0.001): the ratio ranged from ∼16:1 in cardiac surgery to 0.1:1 in obstetrics and gynaecology.
CONCLUSIONS: Psychiatric referral patterns are more closely associated with symptom visibility than with the likely underlying burden of psychiatric morbidity, consistent with relative under-referral of affective disorders. This pattern is context-dependent: the inverse pattern in obstetrics suggests that referral behaviour may be shaped by clinical setting rather than disorder prevalence.
METHODS: A ten-year retrospective descriptive study (FY2016-2025) was conducted at Kakogawa Central City Hospital, a 600-bed public hospital serving as a Regional Dementia Medical Centre. Three inpatient psychiatric intervention routes were analysed: psychiatrist-led first assessments (n = 7991; diagnostic analyses restricted to n = 7522 with individual diagnostic records), Liaison Team consultations (n = 6610), and Dementia Care Team interventions (n = 4810; total 19,411). Diagnoses were categorised using a visibility framework: Visible disorders (delirium [F05]; neurocognitive disorders [F00-03]) versus Less visible disorders (depression [F30-32]; anxiety [F40-48]; adjustment disorder [F43]). Departmental variation was examined using chi-square analysis across ten referring departments.
RESULTS: Liaison Team consultations increased from 299 to 911 and Dementia Care Team interventions from 117 to 846 over ten years. Among 7522 assessments with individual diagnostic records (FY2017-2025), Visible disorders accounted for 67.7% (n = 5091), with delirium alone comprising 57.6% (n = 4336). Less visible disorders represented only 12.9% (n = 971), yielding a Visible-to-Less visible ratio of 5.2:1. This ratio was consistent across all sensitivity analyses (range: 5.2-5.8:1). Marked departmental variation was observed (χ2(18) = 845.0, p < 0.001): the ratio ranged from ∼16:1 in cardiac surgery to 0.1:1 in obstetrics and gynaecology.
CONCLUSIONS: Psychiatric referral patterns are more closely associated with symptom visibility than with the likely underlying burden of psychiatric morbidity, consistent with relative under-referral of affective disorders. This pattern is context-dependent: the inverse pattern in obstetrics suggests that referral behaviour may be shaped by clinical setting rather than disorder prevalence.