How patients and clinicians make meaning of physical suffering in mental health evaluations

Abstract

Clinicians in community mental health settings frequently evaluate individuals suffering from physical health problems. How patients make meaning of such "comorbidity" can affect mental health in ways that may be influenced by cultural expectations and by the responses of clinicians, with implications for delivering culturally sensitive care. A sample of 30 adult mental health intakes exemplifying physical illness assessment was identified from a larger study of patient-provider communication. The recordings of patient-provider interactions were coded using an information checklist containing 21 physical illness items. Intakes were analyzed for themes of meaning making by patients and responses by clinicians. Post-diagnostic interviews with these patients and clinicians were analyzed in similar fashion. Clinicians facilitated disclosures of physical suffering to varying degrees and formulated them in the context of the culture of mental health services. Patients discussed their perceptions of what was at stake in their experience of physical illness: existential loss, embodiment, and limits on the capacity to work and on their sense of agency. The experiences of physical illness, mental health difficulties, and social stressors were described as mutually reinforcing. In mental health intakes, patients attributed meaning to the negative effects of physical health problems in relation to mental health functioning and social stressors. Decreased capacity to work was a particularly salient concern. The complexity of these patient-provider interactions may best be captured by a sociosomatic formulation that addresses the meaning of physical and mental illness in relation to social stressors.

Depression explanatory models of primary care patients and doctors: Relationship with self-stigma, communication effectiveness, and recovery

“…It contradicts an earlier study by Carson, Katz, and Alegría (2016) on physical co-morbidity in mental health patients, which reported that patients perceived limitations on their sense of agency due to their experience of physical illness. It is possible that psychiatric co-morbidity has a different impact on a patient's sense of agency but further research is needed to confirm this and to understand the reasons behind it.…”

Doctor–patient communication about existential, spiritual and religious needs in chronic pain: A systematic review

“…We found one article with quantitative design (see Table 1) (Dezutter et al, 2016), one employing a mixed methods design (Zander et al, 2015) and two using a qualitative approach (Bullington, Nordemar, Nordemar, & Sjostrom-Flanagan, 2003; Carson, Katz, & Alegría, 2016).…”

“…We found one article with quantitative design (see Table 1) (Dezutter et al, 2016), one employing a mixed methods design (Zander et al, 2015) and two using a qualitative approach (Bullington, Nordemar, Nordemar, & Sjostrom-Flanagan, 2003;Carson, Katz, & Alegría, 2016). The quantitative study was from Belgium (Dezutter et al, 2016), analysing patients' experiences of the doctor-patient communication and their satisfaction with the attention given to the impact of pain on their meaning in life by the treatment teams or medical doctors.…”

“…One-third of the clinicians in the American study were physicians. Besides suffering from chronic pain, characteristics of the patients were a comorbid diagnosis with a mental illness (Carson et al, 2016). The American study covered both patients' and clinicians' viewpoints about treatment, and the methods were video recordings of the consultations and interviews with both patients and clinicians.…”

“…The qualitative articles. When the American clinicians approached these issues, it was sometimes done secondarily, sometimes with a focus on empathy and strength-building as a reaction to the patients' expressions of existential needs (Carson et al, 2016). The little group of clinicians from a Swedish specialized pain clinic with an interest in mind-body challenges focused on meeting their patients as persons and provided space for meaning when giving the diagnosis (Bullington et al, 2003).…”