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

Abstract

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.

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

“… 2021b ) and its resulting qualitative systematic review (Molloy et al . 2021a ) focused on diagnostic overshadowing in a mental health context. This Disability Rights Commission report bridges usages of the term and states, ‘both people with learning disabilities and people with mental health problems experience ‘diagnostic overshadowing’, that is reports of physical ill health being viewed as part of the mental health problem or learning disability – and so not investigated or treated’ (2006, p. 6).…”

“…This date follows the late 2006 release of a report by the United Kingdom's Disability Rights Commission. This report (Disability Rights Commission 2006) is noted within a Joanna Briggs Institute (JBI) research protocol (Molloy et al 2021b) and its resulting qualitative systematic review (Molloy et al 2021a) focused on diagnostic overshadowing in a mental health context. This Disability Rights Commission report bridges usages of the term and states, 'both people with learning disabilities and people with mental health problems experience 'diagnostic overshadowing', that is reports of physical ill health being viewed as part of the mental health problem or learning disabilityand so not investigated or treated ' (2006, p. 6).…”

“…Supporting the distinctive nature of this review, extensive searching of English language literature yielded no other published concept analysis on the topic. While the phenomenon of diagnostic overshadowing has been the subject of a meta-analysis (White et al 1995) and a qualitative systematic review (Molloy et al 2021a), neither provides the in-depth exploration of term meanings and implications afforded through concept analysis methodology.…”

“…1995 ) and a qualitative systematic review (Molloy et al . 2021a ), neither provides the in‐depth exploration of term meanings and implications afforded through concept analysis methodology.…”

“…workers. The author debated on whether to include both the research protocol published by JBI(Molloy et al 2021b) and the resulting qualitative systematic review(Molloy et al 2021a) or simply the final review alone. However, differing explanations of diagnostic overshadowing appear in the publications and research teams differ also, thereby making inclusion of both publications advisable.…”