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Diagnosis of a mental condition

The International Classification of D iseases, 10th Revision (ICD-10), defines a mental condition as "the existence of a clinically recognizable set of symptoms or behaviour associated in most cases with distress and with interference with personal functions."³⁸

To identify mental diagnoses, we used the same ICD-9 and ICD-10 codes currently used by the Canadian Institute for Health Information (see Table 1 below for definitions and Appendix Table A for codes²³). This approach reflects the way mental conditions are viewed today.

Table 1 Mental disorder groupings and specific conditions

Table A Mental disorders, conditions, and ICD-9 and ICD-10-CA codes

The diagnostic data from the provinces was extracted using the classification system in which the data were collected in the first place: either the ICD-9 (ICD-9 and ICD-9-CM) or 10th revision (ICD-10-CA) was used as appropriate.^31,32,33,34 Each hospitalization gives a "most responsible diagnosis"—the condition that was most responsible for the hospitalization. Diagnoses of mental conditions other than the most responsible were considered to be comorbid mental conditions. A maximum of 25 diagnostic codes were examined.

Hospitalization

A hospitalization is represented by one hospital record. A record is generated any time a patient leaves because of death, discharge, sign-out against medical advice or transfer. The number of hospitalizations is the most commonly used measure of the utilization of hospital services: it has been used to determine the burden of a disease. Hospitalizations, rather than admissions, are used because hospital abstracts for inpatient care are based on information gathered at the time of discharge. Hospitalizations do not include any outpatient visits. In the literature, some articles refer to hospitalizations as separations, stays or visits.

Length of stay

Length of stay (LOS) is the number of hospital days used within a hospitalization and is a proxy measure of the use of hospital services. LOS is defined as the number of days between the date of admission to hospital and date of discharge. If the patient was admitted and discharged the same day, the LOS set to 0.5.