The DOI matches its Crossref record; 24 of the 25 references it cites were found in a registry or an index.
Diagnostic Overshadowing and Other Challenges Involved in the Diagnostic Process of Patients with Mental Illness Who Present in Emergency Departments with Physical Symptoms – A Qualitative Study
Open accessAbstract
We conducted a qualitative study in the Emergency Departments (EDs) of four hospitals in order to investigate the perceived scope and causes of 'diagnostic overshadowing'--the misattribution of physical symptoms to mental illness--and other challenges involved in the diagnostic process of people with mental illness who present in EDs with physical symptoms. Eighteen doctors and twenty-one nurses working in EDs and psychiatric liaisons teams in four general hospitals in the UK were interviewed. Interviewees were asked about cases in which mental illness interfered with diagnosis of physical problems and about other aspects of the diagnostic process. Interviews were transcribed and analysed thematically. Interviewees reported various scenarios in which mental illness or factors related to it led to misdiagnosis or delayed treatment with various degrees of seriousness. Direct factors which may lead to misattribution in this regard are complex presentations or aspects related to poor communication or challenging behaviour of the patient. Background factors are the crowded nature of the ED environment, time pressures and targets and stigmatising attitudes held by a minority of staff. The existence of psychiatric liaison team covering the ED twenty-four hours a day, seven days a week, can help reduce the risk of misdiagnosis of people with mental illness who present with physical symptoms. However, procedures used by emergency and psychiatric liaison staff require fuller operationalization to reduce disagreement over where responsibilities lie.
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“adherence to assessments that involve invasive examinations or procedures, such as blood draws and injections, or unfamiliar treatment settings, can be impaired by various mental conditions [69].”
From Toward Safer Diagnoses: A SEIPS-Based Narrative Review of Diagnostic Errors (2026) · cites this paper as [69]
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In the citing paper
“This stressful setting can impact both patients and ED staff, disturbing communication needed to assess patients’ conditions [69].”
From Toward Safer Diagnoses: A SEIPS-Based Narrative Review of Diagnostic Errors (2026) · cites this paper as [69]
In the citing paper
“Clinicians showing stigma toward clients often leads to lower-quality care and misdiagnoses [124].”
From Expressing stigma and inappropriate responses prevents LLMs from safely replacing mental health providers. (2025) · cites this paper as [124]
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Cites
Qualitative research practice: a guide for social science students and researchers
Ruhl, K. (2003) · Choice Reviews Online · doi:10.5860/choice.41-1319 · Cited by 10,514
Excess mortality of mental disorder
Harris, C., & Barraclough, B. (1998) · British Journal of Psychiatry · doi:10.1192/bjp.173.1.11 · Cited by 1,881 · cited 1×
“People with mental illness suffer higher rates of physical illness and are more likely to die prematurely as a result of physical illness than members of the general population [1–4].”
BackgroundExcess early mortality in schizophrenia.
Laursen, T. M., Nordentoft, M., & Mortensen, P. B. (2014) · Annual Review of Clinical Psychology · doi:10.1146/annurev-clinpsy-032813-153657 · Cited by 913 · cited 1×
“More specifically, these explanations include side effects of medication, failure to seek early treatment or to seek it at all, difficulties in managing medication and complying with treatment more generally, unhealthy life-style and poor economic conditions affecting access to healthcare services [2], [6], [9].”
BackgroundStigma: ignorance, prejudice or discrimination?
Thornicroft, G., Rose, D., Kassam, A., & Sartorius, N. (2007) · British Journal of Psychiatry · doi:10.1192/bjp.bp.106.025791 · Cited by 826 · cited 1×
“health of people with mental illness and the rest of the population [13–14].”
BackgroundSelf-citationPhysical illness and schizophrenia: a review of the literature
Leucht, S., Burkard, T., Henderson, J., Maj, M., & Sartorius, N. (2007) · Acta Psychiatrica Scandinavica · doi:10.1111/j.1600-0447.2007.01095.x · Cited by 633 · cited 2×
“More specifically, these explanations include side effects of medication, failure to seek early treatment or to seek it at all, difficulties in managing medication and complying with treatment more generally, unhealthy life-style and poor economic conditions affecting access to healthcare services [2], [6], [9].”
BackgroundMental Disorders and Use of Cardiovascular Procedures After Myocardial Infarction
Druss, B. G. (2000) · JAMA · doi:10.1001/jama.283.4.506 · Cited by 541 · cited 1×
“Such possible contributions can be indicated from service users’ complaints [15] and from evidence of disparities in treatment – for example, in hospitalisation and pathology tests for diabetes [5], [16–17], coronary re-vascularisation procedures and in basic health assessments such as blood pressure monitoring [18–19…”
Background‘Diagnostic overshadowing’: worse physical health care for people with mental illness
Jones, S., Howard, L., & Thornicroft, G. (2008) · Acta Psychiatrica Scandinavica · doi:10.1111/j.1600-0447.2008.01211.x · Cited by 475 · cited 3×
“This finding is consistent with the prediction of researchers that ‘diagnostic overshadowing’ is unlikely to be simply the result of bias or of discriminatory attitudes and that a range of other factors related to the communication between doctor and patient may also be relevant [14].”
BackgroundResultInfluentialSelf-citationLaursen, T. M., Munk-Olsen, T., Nordentoft, M., & Mortensen, P. B. (2007) · The Journal of Clinical Psychiatry · doi:10.4088/jcp.v68n0612 · Cited by 380
Disparities in Diabetes Care: Impact of Mental Illness
Frayne, S. M., Halanych, J. H., Miller, D. R., Wang, F., Lin, H., Pogach, L., Sharkansky, E. J., Keane, T. M., Skinner, K. M., Rosen, C. S., et al. (2005) · Archives of Internal Medicine · doi:10.1001/archinte.165.22.2631 · Cited by 336 · cited 1×
“Such possible contributions can be indicated from service users’ complaints [15] and from evidence of disparities in treatment – for example, in hospitalisation and pathology tests for diabetes [5], [16–17], coronary re-vascularisation procedures and in basic health assessments such as blood pressure monitoring [18–19…”
BackgroundAli, A., Scior, K., Ratti, V., Strydom, A., King, M., & Hassiotis, A. (2013) · PLoS ONE · doi:10.1371/journal.pone.0070855 · Cited by 334
Cited by
Sorted by citations
Moore, J., Grabb, D., Agnew, W., Klyman, K., Chancellor, S., Ong, D. C., & Haber, N. (2025) · Proceedings of the 2025 ACM Conference on Fairness, Accountability, and Transparency · doi:10.1145/3715275.3732039 · Cited by 204
“Clinicians showing stigma toward clients often leads to lower-quality care and misdiagnoses [124].”
Adams, D., & Young, K. (2021) · Review Journal of Autism and Developmental Disorders · doi:10.1007/s40489-020-00226-7 · Cited by 179
Solmi, M., Fiedorowicz, J. G., Poddighe, L., Delogu, M., Miola, A., Høye, A., Heiberg, I. H., Stubbs, B., Smith, L., Larsson, H., et al. (2021) · American Journal of Psychiatry · doi:10.1176/appi.ajp.2021.21010031 · Cited by 153
Hallyburton, A. (2022) · International Journal of Mental Health Nursing · doi:10.1111/inm.13034 · Cited by 159
“Of note, psychiatry researcher Thornicroft contributed to several included publications (Jones et al. 2008; Shefer et al. 2014, 2015; van Nieuwenhuizen et al. 2013) as well as the editorial.”
BackgroundInfluentialO’Connor, R. C., Worthman, C. M., Abanga, M. A., Athanassopoulou, N., Boyce, N., Chan, L. F., Christensen, H. M., Das‐Munshi, J., Downs, J. L., Koenen, K. C., et al. (2023) · The Lancet Psychiatry · doi:10.1016/s2215-0366(23)00058-5 · Cited by 139
“…misattribute physical health presentations to an existing mental health condition, which delays people with such conditions from receiving health care for their somatic conditions, 66 and people with existing physical health conditions also experience misattribution of mental health presentations.”
Background
Metadata
- Authors
- Shefer, G., Henderson, C., Howard, L. M., Murray, J., & Thornicroft, G.
- Affiliations
- King's College London (GB)
- Corresponding author
- Shefer, Guy
- Venue
- PLoS ONE
- Publisher
- Public Library of Science (PLoS)
- Published
- 2014-11-04
- Volume
- 9
- Issue
- 11
- Pages
- e111682
- ISSN
- 1932-6203 (ISSN-L)
- PMC
- PMC4219761
- OpenAlex
- W1988019453
- Cited by
- 299
- References
- 25
- Citations by year
- 2026: 45 · 2025: 33 · 2024: 29 · 2023: 30 · 2022: 54 · 2021: 22 · 2020: 26 · 2019: 24 · 2018: 12 · 2017: 12 · 2016: 10 · 2015: 2
- FWCI
- 8.26
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- PLoS ONE (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- RePEc: Research Papers in Economics (submittedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Research Portal (King's College London) (submittedVersion)
- Funders
- South London and Maudsley NHS Foundation Trust
- Maudsley Charity
- National Institute for Health and Care Research (RP-PG-0606-1053, NF-SI-0611-10053, NIHR-RP-R3-12-011)
- King's College London
- Topics
- Health Sciences › Medicine › Family Practice › Clinical Reasoning and Diagnostic Skills
- Health Sciences › Medicine › Emergency Medicine › Emergency and Acute Care Studies
- Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
- Keywords
- diagnostic overshadowing, mental illness, somatic symptoms, emergency department, misdiagnosis, delayed diagnosis, employee attitudes, stigma, patient communication, behavioral problems, time pressure, diagnostic process
- MeSH terms
- Attitude of Health Personnel, Mental Disorders, Diagnostic Errors, Emergency Service, Hospital, Female, Humans, Male, Surveys and Questionnaires, Stereotyping
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