Diagnostic Overshadowing of the Psychiatric Population in the Emergency Department: Physiological Factors Identified for an Early Warning System

Geiss, Michelle; Chamberlain, Jill; Weaver, Tamsyn; McCormick, Carrie; Raufer, Ashley; Scoggins, Lorna; Petersen, Lindsey; Davis, Shannon D. N.; Edmonson, Deborah

doi:10.1177/1078390317728775

Cited by 17 publications

(20 citation statements)

References 18 publications

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“…In 2006, it was formally recognised as contributing to the physical health inequalities experienced by people with mental health problems following an inquiry by the Disability Rights Commission (2006). Since this investigation, a growing number of studies exploring diagnostic overshadowing have been undertaken, mostly in emergency departments (ED) using both quantitative (Geiss et al, 2018) and qualitative methods (Shefer et al, 2014;Van Nieuwenhuizen et al, 2013).…”

Section: Introductionmentioning

confidence: 99%

Seeing the complete picture: A systematic review of mental health consumer and health professional experiences of diagnostic overshadowing

Molloy

Brand

Munro

et al. 2021

Journal of Clinical Nursing

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Aim To systematically identify, explore and synthesise qualitative data related to mental health consumer and health professional experiences of diagnostic overshadowing. Background Mental health consumers experience significantly high rates of physical illness, poorer health outcomes and are more likely to die prematurely of physical illnesses than the general population. Diagnostic overshadowing is a complex and life‐threatening phenomenon that occurs when physical symptoms reported by mental health consumers are misattributed to mental disorders by health professionals. This typically occurs in general healthcare settings. Methods Drawing on JBI methodology for systematic reviews, four scholarly databases and grey literature was searched, followed by eligibility screening and quality assessment using JBI QARI frameworks, resulting in six studies for inclusion. Findings were synthesised using meta‐aggregation. The PRISMA checklist was adhered to throughout this process. Findings Five synthesised findings emerged. Three from the health professional experience: working in ill‐suited healthcare systems, missing the complete diagnostic picture, and misunderstanding the lived experience of mental illness. Two from the mental health consumer experience: not knowing if the cause is physical or mental, and surviving and ill‐suited health care system. Conclusions Diagnostic overshadowing is a multidimensional experience of interconnecting factors including systematic healthcare system issues, health professionals limited mental health knowledge and skills, stigmatic attitudes and mental health consumers miscommunicating their physical healthcare needs. Further research is needed to make diagnostic overshadowing visible and mitigate against this phenomenon that deprives mental health consumers of equitable access to quality healthcare. Relevance to clinical practice Those who govern healthcare systems have an obligation to recognise and address the unique needs of mental health consumers who seek help for physical illnesses to ensure they receive quality and safe care. Forming collaborative partnerships with mental health consumers in the development of knowledge translation initiatives targeting healthcare policy, practice and education are urgently required.

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Section: Introductionmentioning

confidence: 99%

Seeing the complete picture: A systematic review of mental health consumer and health professional experiences of diagnostic overshadowing

Molloy

Brand

Munro

et al. 2021

Journal of Clinical Nursing

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“…Unifying themes (Table 1 ) presented in the literature sample include stigmatization and underestimation of individuals with mental illness as well as delays they experience in receiving appropriate care (Cromar‐Hayes & Seaton 2020 ; Geiss et al . 2018 ; Happell et al . 2016 ; Ho et al .…”

Section: Resultsmentioning

confidence: 99%

“…presented in the literature sample include stigmatization and underestimation of individuals with mental illness as well as delays they experience in receiving appropriate care(Cromar- Hayes & Seaton 2020;Geiss et al 2018;Happell et al 2016;Ho et al 2021;Nash 2013;Stoklosa et al 2017). Providers' fear of violence from patients with mental illness presents another recurring theme(Fontesse et al 2021;Hext et al 2018;Perrone McIntosh 2021;van Nieuwenhuizen et al 2013 van Nieuwenhuizen et al ).…”

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confidence: 99%

Diagnostic overshadowing: An evolutionary concept analysis on the misattribution of physical symptoms to pre‐existing psychological illnesses

Hallyburton

2022

Int J Mental Health Nurs

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This evolutionary concept analysis explores the meaning of diagnostic overshadowing within the context of physical health care for individuals with mental illness. Diagnostic overshadowing, the misattribution of symptoms of one illness to an already diagnosed comorbidity, leads to compromised patient care and likely contributes to increased mortality experienced by individuals with mental illness. A systematic literature search led to identification of a sample of 25 publications on the topic. Following Rodgers' Evolutionary Concept Analysis methodology, this literature sample yielded unifying definitions, shared themes, factors contributing to the action of diagnostic overshadowing, outcomes caused by this type of misdiagnosis, and possible interventions available to nurses and other healthcare providers. Understanding of the concept diagnostic overshadowing may help prevent its occurrence and its adverse results.

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“…Alguns fatores que se associam a este fenómeno incluem a colheita inadequada de história clínica, preconceito e receio do clínico em relação às pessoas com doença mental, articulação deficiente com os profissionais de saúde mental e apresentações clínicas complexas. 47 Um estudo qualitativo realizado na população sueca sobre as principais barreiras aos cuidados médicos prestados a pessoas com DMG, concluiu, de forma global, que existem diferenças marcadas entre a organização dos serviços de saúde e as necessidades destes doentes. Em particular, as principais dificuldades encontradas foram o "auto -estigma" (a perceção dos próprios doentes de estigmatização por parte dos profissionais de saúde) e a necessidade de contato com vários profissionais e diferentes estruturas de saúde, especialmente nos doentes com declínio cognitivo e/ou sintomas psicóticos.…”

Section: F Disparidades No Acesso Aos Cuidados De Saúdeunclassified

Doença Somática nas Pessoas com Doença Mental Grave

Martins

Rodrigues

Queiroz

et al. 2022

RPPSM

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Desde o início do século XX que vários autores foram constatando que as pessoas com doença mental grave (DMG) apresentam maiores taxas de doenças médicas crónicas e de mortalidade em relação à população geral. Com este trabalho, pretendeu‐se realizar uma revisão narrativa relativa às particularidades da doença somática e mortalidade nas pessoas com DMG, disparidades no acesso aos cuidados de saúde e intervenções a realizar nesta população. A literatura é consensual no reconhecimento de que pessoas com DMG têm maiores taxas de doenças médicascrónicas e uma mortalidade prematura, o que faz com que tenham uma esperança média de vida 10 a 30 anos inferior à população geral. O suicídio não explica estas diferenças. As pessoas com DMG são especialmente afetadas por doenças cardiovasculares, metabólicas e neoplásicas. Estas doenças, embora também muito comuns na população geral, têm um impacto significativamente maior em indivíduos com doença mental. Se parte desta discrepância pode ser atribuívela limitações funcionais diretamente causadas pela DMG, é reconhecido que a discriminação e o estigma tambémtêm um papel importante. Pessoas com DMG têm pior acesso aos cuidados de saúde, levando a taxas elevadas de subdiagnóstico e subtratamento.Na literatura são escassos os estudos dirigidos a intervenções ou programas que possam colmatar a desigualdadede cuidados de saúde nesta população. As particularidades da expressão de doença somática em pessoas com DMG carecem de estratégias adaptadas de prevenção de nível primário, secundário e terciário, que devem ser priorizadas na investigação clínica e integradas nos programas de saúde nacionais.

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Diagnostic Overshadowing of the Psychiatric Population in the Emergency Department: Physiological Factors Identified for an Early Warning System

Cited by 17 publications

References 18 publications

Seeing the complete picture: A systematic review of mental health consumer and health professional experiences of diagnostic overshadowing

Seeing the complete picture: A systematic review of mental health consumer and health professional experiences of diagnostic overshadowing

Diagnostic overshadowing: An evolutionary concept analysis on the misattribution of physical symptoms to pre‐existing psychological illnesses

Doença Somática nas Pessoas com Doença Mental Grave

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