The evaluation and success of our efforts to prevent, detect, and treat mental illness depend on the assessment of psychopathology. Almost all psychiatric assessments consist of asking questions, through questionnaires or interviews, about behaviors and experiences. We either ask the person being assessed or someone who knows them well. Based on the answers, we diagnose, recommend treatment, and monitor outcome. Regardless of who is reporting, overreporting and underreporting are common. People may overreport or underreport on purpose when they are hoping for benefits associated with a diagnosis (eg, educational support, time off work, or access to medication), or fearing the consequences of diagnosis, including stigma or adverse effects of medication. Beliefs about mental illness not being real, concerns about privacy, health insurance cost, and implications for custody of children are also reasons for underreporting.
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Pavlova B, Uher R. Assessment of Psychopathology: Is Asking Questions Good Enough? JAMA Psychiatry. Published online March 11, 2020. doi:10.1001/jamapsychiatry.2020.0108
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