Supplementary Material for: Defining and Evaluating Overdiagnosis in Mental Health: A Meta-Research Review

<b><i>Background:</i></b> Overdiagnosis is thought to be common in some mental disorders, but it has not been defined or examined systematically. Assessing overdiagnosis in mental health requires a consistently applied definition that differentiates overdiagnosis from other problems (e.g., misdiagnosis), as well as methods for quantification. <b><i>Objectives:</i></b> Our objectives were to (1) describe how the term “overdiagnosis” has been defined explicitly or implicitly in published articles on mental disorders, including usages consistent <i>(overdefinition, overdetection)</i> and inconsistent <i>(misdiagnosis, false-positive test results, overtreatment, overtesting)</i> with accepted definitions of overdiagnosis; and (2) identify examples of attempts to quantify overdiagnosis. <b><i>Method:</i></b> We searched<b><i></i></b>PubMed through January 5, 2019. Articles on mental disorders, excluding neurocognitive disorders, were eligible if they used<b><i></i></b>the term “overdiagnosis” in the title, abstract, or text. <b><i>Results:</i></b> We identified 164 eligible articles with 193 total explicit or implicit uses of the term “overdiagnosis.” Of 9 articles with an explicit definition, only one provided a definition that was partially consistent with accepted definitions. Of all uses, 11.4% were consistent, and 76.7% were related to misdiagnosis and thus inconsistent. No attempts to quantify the proportion of patients who were overdiagnosed based on overdetection or overdefinition were identified. <b><i>Conclusions:</i></b> There are few examples of mental health articles that describe overdiagnosis consistent with accepted definitions and no examples of quantifying overdiagnosis based on these definitions. A definition of overdiagnosis based on diagnostic criteria that include people with transient or mild symptoms not amenable to treatment (overdefinition) could be used to quantify the extent of overdiagnosis in mental disorders.

**背景**：学界普遍认为过度诊断（overdiagnosis）在部分精神障碍中较为常见，但目前尚未对其形成统一定义，亦未开展系统性研究。精神卫生领域的过度诊断评估，需要具备统一适用的定义以区分过度诊断与其他问题（如误诊），同时还需配套量化分析方法。**研究目标**：本研究旨在达成两项目标：其一，梳理精神障碍相关已发表文献中，“过度诊断”一词的显性与隐性定义方式，涵盖与公认过度诊断定义相符的用法（即过度定义、过度检出），以及与之相悖的用法（如误诊、假阳性检测结果、过度治疗、过度检测）；其二，识别尝试量化过度诊断的相关研究案例。**研究方法**：本研究检索了截至2019年1月5日的PubMed数据库。纳入标准为：以精神障碍（排除神经认知障碍）为研究主题，且在标题、摘要或正文中使用了“过度诊断”一词的文献。**研究结果**：本研究共纳入164篇符合标准的文献，其中“过度诊断”一词的显性或隐性使用频次总计达193次。在9篇给出明确定义的文献中，仅1篇的定义与公认的过度诊断定义部分相符。所有使用场景中，11.4%的用法与公认定义相符，76.7%的用法与误诊相关，因此不符合公认定义。未发现有研究基于过度检出或过度定义的视角，量化过度诊断患者的占比。**研究结论**：目前精神卫生领域文献中，符合公认定义的过度诊断相关描述案例极少，且尚无基于此类定义量化过度诊断的研究。若基于纳入无法接受治疗的一过性或轻度症状人群的诊断标准（即过度定义）来界定过度诊断，则可用于量化精神障碍中的过度诊断程度。