Explaining Away Disorder: The Influence of Context on Impressions of Mental Health Symptoms

Abstract

Clinical assessments involve understanding displays of mental disorder symptoms in the contexts in which they display. Contextual information plays a large role in externalizing disorder assessments. Yet we know little about contextual information's impact within internalizing disorder assessments. Panic disorder symptoms develop outside environmental effects, but over time symptoms become conditioned responses to one's environment, making this disorder an interesting test case. In two experiments (N = 269), lay participants read vignettes about children displaying a single symptom of panic disorder embedded in contextual information that either conformed or did not conform to the presence of panic disorder. Contextual information changed interpretations of panic disorder symptoms and reduced judgments of the likelihood of panic disorder. This effect held when participants made judgments about panic disorder only (Experiment 1) and when alongside externalizing disorder symptoms (Experiment 2). These findings have important implications for understanding interpretive judgments about symptoms within diagnostic assessments of mental health.

The dimensionality and latent structure of mental health difficulties and wellbeing in early adolescence

“…Informant reports are also limited in that the informant (e.g. parent, teacher) typically only observes the adolescent in a single context [95]. Use of mixed informants would also likely have acted as a confound since self and informant ratings are often only weakly or moderately correlated, particularly for children and adolescents [96–98].…”

Improving Interpretability of Subjective Assessments About Psychological Phenomena: A Review and Cross-Cultural Meta-Analysis

“…In recent experimental work, trained judges of children’s behavior (i.e., clinicians experienced in the assessment and treatment of child and adolescent mental health) were more likely to rate children described in vignettes as evidencing conduct problems if the environments in which these children lived contained risk factors for conduct problems (e.g., presence of parental mental health concerns) versus environments containing no such risk factors (De Los Reyes & Marsh, 2011). More recent work indicates that effects of contextual information generalize to clinicians’ judgments of other mental health domains (i.e., attention and hyperactivity; panic disorder), as well as laypeople’s judgments (Marsh, Burke, & De Los Reyes, 2016; Marsh & De Los Reyes, 2018; Marsh, De Los Reyes, & Wallerstein, 2014).…”

“…mental health concerns) versus environments containing no such risk factors(De Los Reyes & Marsh, 2011). More recent work indicates that effects of contextual information generalize to clinicians' judgments of other mental health domains (i.e., attention and hyperactivity; panic disorder), as well as laypeople's judgments(Marsh, Burke, & De Los Reyes, 2016;Marsh & De Los Reyes, 2018;Marsh, De Los Reyes, & Wallerstein, 2014).…”

Concluding Commentary: Clinical Decision Making

“…The stimuli used in the first five articles are suitable for empirical research. In four of the five studies, they are vignettes (also called short clinical reports) of real disorders (Flores, Cobos, & Hagmayer, 2018 [this issue]; Marsh & De Los Reyes, 2018 [this issue]; Weine & Kim, 2018 [this issue]) or fictitious diseases (Hayes, 2018 [this issue]). Such stimuli approximate what clinicians will see in practice and allow the researcher to manipulate the relevant variables.…”

“…In mental health studies, no effect of domain experience on clinical performance has been found yet (cf. Marsh & De Los Reyes, 2018 [this issue]; see also Spengler et al, 2009; Suhr, 2015; Tracey, Wampold, Lichtenberg, & Goodyear, 2014). Does that mean that there are no “expert” clinicians?…”