Patient Disclosure and Diagnostic Outcomes among Hispanic Patients: The Mental Health Provider and Patient Interaction

Authors: Nicole Fedoravicius, MPH, Washington University ; Luis H. Zayas, PhD, Washington University

Background:
An increasing number of Hispanics in the U.S. are seeking mental health treatment. The impact of culture and language on diagnostic accuracy and patient disclosure in this group of people is poorly understood. This study examines patient disclosure in the context of the provider and patient interaction, and its impact on diagnostic outcomes.

Methods:
In this qualitative study, three researchers analyzed fourteen videotapes of in-vivo diagnostic intake interviews. Hispanic patients and both Hispanic and non-Hispanic clinicians were recruited from an urban mental health walk-in clinic between July, 2003 and April, 2005. Interviews lasted between seventeen and sixty-seven minutes and were conducted in both English and Spanish. The video-camera captured the patients' image and voice but only the clinicians' voice was recorded. Videotapes and transcripts were coded by researchers using a coding system specifically designed with the clinical psychiatric encounter in mind and inspired by the Roter Interaction Analysis System (RIAS). Our coding system examined each phrase or utterance made by clinicians and patients.

Results:
Patient disclosure was influenced by personal characteristics of the clinician and the clinician's interview style. Clinicians who followed a closed-ended questioning approach used abrupt changes in topics, and introduced psychiatric jargon. Patients used cultural expressions to describe symptoms and distress but often incorporated technical jargon introduced by the clinician or previous clinicians. This linguistic "pollution" often became the data upon which clinicians based their diagnostic outcomes. Hispanic patients with Hispanic interviewers disclosed more information than needed to support the rationale for the visit.

Conclusions:
The combination of cultural and language disparities results in poor diagnostic outcomes for mental health interviews. To improve diagnostic outcomes for Hispanic patients seeking mental health services in the U.S., attention must given to the cultural aspects of diagnostic interviews.