Understanding the experience of diagnostic overshadowing associated with severe mental illness from the consumer and health professional perspective: a qualitative systematic review protocol
Abstract
OBJECTIVE: The objective of this review is to identify, appraise, and synthesize available qualitative evidence related to diagnostic overshadowing in mental health consumers who present with clinical manifestations of physical illness. INTRODUCTION: A lived experience of mental illness is associated with compromised physical health and decreased life expectancy. Mental health consumers face greater barriers to accessing treatment for physical illnesses and are less likely to receive appropriate physical care than those without mental illness. Physical illnesses may go underdiagnosed and undertreated in mental health consumers because clinicians tend to focus on the mental illness to the exclusion of other health problems, a phenomenon called diagnostic overshadowing. This systematic review will combine the experiences of mental health consumers and health care professionals to gain deeper understanding of diagnostic overshadowing. INCLUSION CRITERIA: This review will consider qualitative studies that include the experiences of diagnostic overshadowing in mental health consumers and/or the health care professionals who treat them. Studies conducted in any health care facility or service offering care for physical illnesses will be considered. METHODS: MEDLINE, CINAHL, PsycINFO, and Scopus will be searched along with sources of gray literature. Studies in English published from 2004 onward will be considered. Retrieval of full-text studies, assessment of methodological quality, and data extraction will be performed independently by two reviewers. Findings will, where possible, be pooled using JBI SUMARI with the meta-aggregation approach. A ConQual Summary of Findings will be presented. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO CRD42020186418.
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Liberati, A., Altman, D. G., Tetzlaff, J., Mulrow, C., Gøtzsche, P. C., Ioannidis, J. P. A., Clarke, M., Devereaux, P. J., Kleijnen, J., & Moher, D. (2009) · PLoS Medicine · doi:10.1371/journal.pmed.1000100 · Cited by 28,164 · see citing works
Stigma: Notes on the Management of Spoiled Identity
(1969) · Postgraduate Medical Journal · doi:10.1136/pgmj.45.527.642 · Cited by 14,251 · see citing works
James, S. L., Abate, D., Abate, K. H., Abay, S. M., Abbafati, C., Abbasi, N., Abbastabar, H., Abd-Allah, F., Abdela, J., Abdelalim, A., et al. (2018) · The Lancet · doi:10.1016/s0140-6736(18)32279-7 · Cited by 13,867 · see citing works
Liberati, A., Altman, D. G., Tetzlaff, J., Mulrow, C., Gøtzsche, P. C., Ioannidis, J. P. A., Clarke, M., Devereaux, P. J., Kleijnen, J., & Moher, D. (2009) · Annals of Internal Medicine · doi:10.7326/0003-4819-151-4-200908180-00136 · Cited by 10,349 · see citing works
Liberati, A., Altman, D. G., Tetzlaff, J., Mulrow, C., Gøtzsche, P. C., Ioannidis, J. P. A., Clarke, M., Devereaux, P. J., Kleijnen, J., & Moher, D. (2009) · Italian Journal of Public Health · doi:10.2427/5768 · Cited by 3,374 · see citing works
Stigma as a fundamental cause of population health inequalities
Hatzenbuehler, M. L., Phelan, J. C., & Link, B. G. (2013) · American Journal of Public Health · doi:10.2105/ajph.2012.301069 · Cited by 2,674 · see citing works
Munn, Z., Aromataris, E., Tufanaru, C., Stern, C., Porritt, K., Farrow, J., Lockwood, C., Stephenson, M., Moola, S., Lizarondo, L., et al. (2019) · International Journal of Evidence-Based Healthcare · doi:10.1097/xeb.0000000000000152 · Cited by 977 · see citing works
Establishing confidence in the output of qualitative research synthesis: the ConQual approach.
Munn, Z., Porritt, K., Lockwood, C., Aromataris, E., & Pearson, A. (2014) · BMC Medical Research Methodology · doi:10.1186/1471-2288-14-108 · Cited by 803 · see citing works
Mental health-related stigma in health care and mental health-care settings
Henderson, C., Noblett, J., Parke, H., Clement, S., Caffrey, A., Gale-Grant, O., Schulze, B., Druss, B., & Thornicroft, G. (2014) · The Lancet Psychiatry · doi:10.1016/s2215-0366(14)00023-6 · Cited by 761 · see citing works
Review: Inequalities in healthcare provision for people with severe mental illness
Lawrence, D., & Kisely, S. (2010) · Journal of Psychopharmacology · doi:10.1177/1359786810382058 · Cited by 649 · see citing works
Emotional disturbance and mental retardation: diagnostic overshadowing.
Reiss, S., Levitan, G. W., & Szyszko, J. (1982) · PubMed · Cited by 572 · see citing works
Intervening within and across levels: A multilevel approach to stigma and public health
Cook, J. E., Purdie-Vaughns, V., Meyer, I. H., & Busch, J. T. A. (2014) · Social Science & Medicine · doi:10.1016/j.socscimed.2013.09.023 · Cited by 438 · see citing works
Chapter 2: Systematic Reviews of Qualitative Evidence
Lockwood, C. S., Porritt, K. A., Munn, Z., Rittenmeyer, L., Salmond, S. W., Bjerrum, M. B., Loveday, H. P., Carrier, J., & Stannard, D. (2019) · JBI eBooks · doi:10.46658/jbirm-17-02 · Cited by 395 · see citing works
Shefer, G., Henderson, C., Howard, L. M., Murray, J., & Thornicroft, G. (2014) · PLoS ONE · doi:10.1371/journal.pone.0111682 · Cited by 299 · see citing works
Chapter 2: Systematic reviews of qualitative evidence
(2020) · JBI eBooks · doi:10.46658/jbimes-20-03 · Cited by 286 · see citing works
Roth, G., Abate, D., Abate, K., et al. (2018) · The Lancet · doi:10.1016/s0140-6736(18)32833-2 · Cited by 228 · see citing works
Emergency department from the mental health client’s perspective
Clarke, D. E., Dusome, D. L., & Hughes, L. (2007) · International Journal of Mental Health Nursing · doi:10.1111/j.1447-0349.2007.00455.x · Cited by 222 · see citing works
Cancer diagnosis in people with severe mental illness: practical and ethical issues
Howard, L. M., Barley, E. A., Davies, E., Rigg, A. S., Lempp, H. K., Rose, D. S., Taylor, D. M., & Thornicroft, G. (2010) · The Lancet Oncology · doi:10.1016/s1470-2045(10)70085-1 · Cited by 182 · see citing works
HIGH-DOSE INTRAVENOUS GAMMABLOBULIN: A CAUTIONARY NOTE
Ljung, R., & Nilsson, I. (1985) · The Lancet · doi:10.1016/s0140-6736(85)91195-x · Cited by 176 · see citing works
van Nieuwenhuizen, A., Henderson, C., Kassam, A., Graham, T., Murray, J., Howard, L. M., & Thornicroft, G. (2012) · Epidemiology and Psychiatric Sciences · doi:10.1017/s2045796012000571 · Cited by 127 · see citing works
Nash, M. (2013) · Mental Health Practice · doi:10.7748/mhp2013.12.17.4.22.e862 · Cited by 105 · see citing works
Sullivan, G., Han, X., Moore, S. M., & Kotrla, K. J. (2006) · Psychiatric Services · doi:10.1176/ps.2006.57.8.1126 · Cited by 91 · see citing works
Human Trafficking, Mental Illness, and Addiction: Avoiding Diagnostic Overshadowing
Stoklosa, H., MacGibbon, M., & Stoklosa, J. (2017) · The AMA Journal of Ethic · doi:10.1001/journalofethics.2017.19.1.ecas3-1701 · Cited by 58 · see citing works
Age of Onset of Mental Disorders: Etiopathogenetic and Treatment Implications
de Girolamo, G., McGorry, P. D., & Sartorius, N. (2018) · Cited by 57 · see citing works
‘That red flag on your file’: misinterpreting physical symptoms as mental illness
Happell, B., Ewart, S. B., Bocking, J., Platania‐Phung, C., & Stanton, R. (2016) · Journal of Clinical Nursing · doi:10.1111/jocn.13355 · Cited by 53 · see citing works
Enhancing Free-Recall Rates of Individuals With Mental Retardation
Carlin, M. T., Soraci, S. A., Dennis, N. A., Chechile, N. A., & Loiselle, R. C. (2001) · American Journal on Mental Retardation · doi:10.1352/0895-8017(2001)106 · Cited by 16 · see citing works
Hayhow, B., Gaillard, F., Velakoulis, D., & Walterfang, M. (2014) · Australian & New Zealand Journal of Psychiatry · doi:10.1177/0004867414551067 · Cited by 13 · see citing works
Neuropsychiatric presentation following acute hypoxic-ischaemic encephalopathy
Hayhow, B., Velakoulis, D., Dewhurst, R., et al. (2014) · Australian & New Zealand Journal of Psychiatry · doi:10.1177/0004867414555418 · Cited by 3 · see citing works
McGorry, P. D., Sartorius, N., & de Girolamo, G. (2018) · Springer eBooks · doi:10.1007/978-3-319-72619-9_14 · Cited by 3 · see citing works
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Ma, R., Romano, E., Ashworth, M., Smith, T. O., Vancampfort, D., Scott, W., Gaughran, F., Stewart, R., & Stubbs, B. (2024) · The Journal of Pain · doi:10.1016/j.jpain.2023.11.004 · Cited by 19 · see citing works
- Authors
- Molloy, R., Munro, I., & Pope, N.
- Affiliations
- Monash University (AU)
- Venue
- JBI Evidence Synthesis
- Published
- 2020-11-07
- Volume
- 19
- Issue
- 6
- Pages
- 1362-1368
- ISSN
- 2689-8381 (ISSN-L)
- OpenAlex
- W3099560059
- Cited by
- 30
- References
- 29
- Citations by year
- 2026: 6 · 2025: 2 · 2024: 4 · 2023: 7 · 2022: 8 · 2021: 3
- FWCI
- 0.72
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- JBI Evidence Synthesis (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
- Social Sciences › Psychology › Clinical Psychology › Psychiatric care and mental health services
- Keywords
- diagnostic overshadowing, severe mental illness, physical illness, mental health service users, healthcare workers, lived experience, underdiagnosis, undertreatment, physical health in mental illness
- MeSH terms
- Systematic Reviews as Topic, Mental Disorders, Health Personnel, Humans, Mental Health, Qualitative Research
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