Association of voice and mental health diagnoses with differences in voice‐related care utilization

Jordan, Victoria A.; Lunos, Scott; Sieger, Gretchen; Horvath, Keith J.; Misono, Stephanie

doi:10.1002/lary.28277

Cited by 7 publications

(11 citation statements)

References 24 publications

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“…We examined psychosocial distress as an outcome variable given the transdiagnostic recognition of distress among patients across multiple otolaryngologic areas. [14][15][16][17][18][19] In addition, although the study included a variety of voice diagnoses and all patients were new to the academic tertiary care voice clinic, there may have been variable degrees of previous knowl-edge about their voice problems and previous treatments that may have affected their responses on the voice-specific scales. Racial and ethnic diversity in the sample was limited, in part reflecting the demographic characteristics of the state, which limits the generalizability of the study's results to other populations.…”

Section: Limitationsmentioning

confidence: 99%

“…Patients with voice disorders frequently have psychosocial distress (eg, symptoms of depression and anxiety) in addition to physical health concerns. [14][15][16][17][18][19] Assessing psychosocial distress is important given its association with vocal impairment. 20 Although a negative association between communicative participation and depression has been observed in patients with head and neck cancers, 21 the association between communicative participation and psychosocial distress has not been formally assessed in patients with voice disorders.…”

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confidence: 99%

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Association Between Communicative Participation and Psychosocial Factors in Patients With Voice Disorders

Nguyen-Feng

Asplund

Frazier

et al. 2021

JAMA Otolaryngol Head Neck Surg

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IMPORTANCECommunicative participation can be conceptualized as taking part in life situations in which people are socially engaged. Communicative participation is an important aspect in the lives of patients with voice disorders, although it has not been formally assessed among a broad sample of patients with voice disorders. The associations between communicative participation and associated concepts (vocal impairment, psychosocial distress, and voice-specific perceived control) are unknown yet important for integrated treatment approaches.OBJECTIVE The primary objective was to examine the associations between communicative participation and vocal impairment, psychosocial distress, and voice-specific perceived control. The secondary objective was to examine whether perceived control moderates the association of distress with communicative participation and vocal impairment, the latter of which would replicate previous research. The hypotheses were that communicative participation would be associated with lower vocal impairment, lower distress, and higher perceived control and that higher perceived control would moderate the association between communicative participation and both vocal impairment and psychosocial distress. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study was conducted from June 2014 to May 2017 among a consecutive sample of adult patients with voice disorders at an academic voice clinic affiliated with the University of Minnesota. Of the 744 patients approached to participate in the survey study, 590 patients agreed. Data analysis was performed from January to June 2020. MAIN OUTCOMES AND MEASURES Communicative participation (measured by the 10-item general short form of the Communicative Participation Item Bank), vocal impairment (measured by the 10-item version of the Voice Handicap Index), psychosocial distress (measured by the 18-item version of the Brief Symptom Inventory), and voice-specific perceived control (measured by the 8-item present control subscale of the Perceived Control Over Stressful Events Scale). RESULTSThe sample comprised 590 patients (mean [SD] age, 51.9 [17.1] years; 390 women [66.1%]) with voice disorders. Communicative participation was associated with lower vocal impairment (r = −0.73; 95% CI, −0.77 to −0.69), lower overall psychosocial distress (r = −0.22; 95% CI, −0.30 to −0.14), and higher voice-specific perceived control (r = 0.30; 95% CI, 0.23-0.37). Moderation analyses indicated that communicative participation was negatively associated with distress at all levels of perceived control and, replicating previous findings, greater vocal impairment was associated with higher psychosocial distress only in patients with lower perceived control. CONCLUSIONS AND RELEVANCEIn this study, communicative participation was associated with, but distinct from, vocal impairment and was also associated with psychosocial distress and voice-specific perceived control. The study's results suggest that communicative participation is an important addition to voice research...

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Section: Limitationsmentioning

confidence: 99%

mentioning

confidence: 99%

Association Between Communicative Participation and Psychosocial Factors in Patients With Voice Disorders

Nguyen-Feng

Asplund

Frazier

et al. 2021

JAMA Otolaryngol Head Neck Surg

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“…In recent work, we observed in a large health system that 47% of patients with voice diagnoses also had MH diagnoses, compared to a baseline rate of 14% in the overall health system data repository. Patients who had both MH and voice diagnoses were less likely to see an otolaryngologist, more likely to undergo imaging, and more likely to have nonspecific voice diagnoses compared to patients who had voice diagnoses but no MH diagnoses . Although we noted a high prevalence of MH diagnoses and differences in voice‐related care utilization associated with MH diagnoses, this study neither examined whether the MH diagnoses preceded or followed the voice diagnoses nor compared these groups.…”

Section: Introductionmentioning

confidence: 84%

“…Patients were identified using voice and MH diagnosis codes from the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD‐9‐CM) and 10th Revision, Clinical Modification (ICD‐10‐CM) as previously described (Supporting Table SI). MH diagnosis categories were depression, anxiety, somatoform disorders, and stress‐related/adjustment disorders. Voice‐related diagnosis categories were acute laryngitis, chronic laryngitis, benign neoplasm of the larynx, laryngeal cancer, nonspecific dysphonia, vocal fold paresis/paralysis, laryngeal stenosis, and laryngeal spasm.…”

Section: Methodsmentioning

confidence: 99%

“…Voice‐related healthcare utilization was measured via number and type of provider (primary care vs. otolaryngology) of voice‐related visits within 1 year following the first voice‐related visit, prescription of six common voice‐related medications within 2 weeks after a voice‐related visit, and voice‐related tests and procedures performed within 1 year after a voice‐related visit. Utilization of radiology and voice evaluations, the two most common voice‐related tests and procedures identified from previous work, were identified using 2017 Current Procedural Terminology codes (Supporting Table SII).…”

Section: Methodsmentioning

confidence: 99%

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Mental Health and Dysphonia: Which Comes First, and Does That Change Care Utilization?

et al. 2020

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Objectives: Voice patients with voice disorders have a high prevalence of distress and mental health (MH) comorbidities, but it is unknown to what extent distress precedes or follows voice disorder diagnoses. Objectives were to compare 1) proportions of voice patients with MH diagnoses who received MH diagnoses first versus voice-related diagnoses first, 2) voicerelated diagnoses and care utilization, and 3) time to specialty evaluation in each group.Methods: Patients with voice and MH diagnoses were identified using International Classification of Diseases, Ninth and Tenth Revisions codes in a large health system data repository from January 2005 through July 2017. Sociodemographics, comorbidities, MH-and voice-related diagnoses, and voice-related care utilization were analyzed using descriptive statistics and multivariable regression modeling.Results: Among the 11,419 patients with both voice and MH diagnoses, 63% (n = 7,251) received MH diagnoses prior to voice diagnoses, compared with 37% with a voice diagnosis first (P < 0.0001). The latter group received more specific voicerelated diagnoses (e.g., laryngeal cancer [odds ratio (OR) 4.27], benign laryngeal neoplasm [OR 1.60]), and were more likely to ever see an otolaryngologist than those receiving MH diagnoses first (P < 0.0001).Conclusion: Most patients with voice and MH diagnoses received a MH diagnosis first. Patients who receive MH diagnoses first appeared to have different voice-related healthcare compared to those who received voice diagnoses first.

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The Puzzle of Medically Unexplained Symptoms—A Holistic View of the Patient With Laryngeal Symptoms

Misono

Dietrich

Piccirillo

2020

JAMA Otolaryngol Head Neck Surg

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Functional laryngeal and airway disorders are characterized by apparently normal anatomy and neurological function accompanied by clinically significant symptoms, which can include dysphonia, dysphagia, globus sensation, and dyspnea.These disorders are often diagnoses of exclusion, since the presenting symptoms can also accompany important anatomic and neurologic abnormalities that must be ruled out. Primary muscle tension dysphonia (MTD), also often called functional dysphonia or hyperfunctional dysphonia, presents with various forms of laryngeal muscular dysregulation during voice and speech production and remains a voice disorder without established pathophysiology. Some signs and symptoms may be observable during the examination (eg, supraglottic hyperfunction, perceived vocal strain), while others may be elusive (eg, vocal fatigue, stress-induced hyperfunction). Functional airway disorders such as paradoxical vocal fold motion disorder (sometimes also called vocal cord dysfunction) are characterized by dysfunctional respiratory/laryngeal coordination. These can lead to dynamic airway narrowing at the glottis and shortness of breath despite a neurologically normal larynx. Functional laryngeal and airway disorders are frequently associated with psychological distress, including depression, anxiety, and somatic concerns. Somatic concerns involving other parts of the body are also common in patients with MTD and are associated with heightened medical costs, which drive up the costs of health care and further burden patients, who may undergo numerous expensive evaluations, tests, and procedures owing to their symptoms.In the intriguing study by Piersiala et al 1 in the current issue of JAMA Otolaryngology-Head & Neck Surgery, a retrospective review of more than 4000 patients was undertaken to determine whether patients with chronic pain syndromes (CPS: fibromyalgia, irritable bowel syndrome, chronic fatigue syndrome) had different patterns of voice and laryngeal disorders than those without CPS. In the 5% of patients noted to have at least 1 CPS, functional voice disorders (as grouped by the authors) were more commonly diagnosed, and laryngeal and airway conditions were less commonly diagnosed, than in those without CPS. Furthermore, regardless of the specific type of CPS, patients had similar patterns of voice and laryngeal problems. These findings are consistent with the observation in a different health care system that patients with mental health diagnoses, including somatization, had a lower likelihood of receiving anatomic laryngeal disorder diagnoses than patients without mental health diagnoses. 2 It is important to emphasize, as acknowledged by the authors, 1 that the term "medically unexplained" must be used with caution. Some major medical disorders in the past were considered medically unexplained, until they were not. Inroads into

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Association of voice and mental health diagnoses with differences in voice‐related care utilization

Cited by 7 publications

References 24 publications

Association Between Communicative Participation and Psychosocial Factors in Patients With Voice Disorders

Association Between Communicative Participation and Psychosocial Factors in Patients With Voice Disorders

Mental Health and Dysphonia: Which Comes First, and Does That Change Care Utilization?

The Puzzle of Medically Unexplained Symptoms—A Holistic View of the Patient With Laryngeal Symptoms

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