Recognizing psychologically masked illnesses: the need for collaborative relationships in mental health care

Both research and clinical experience support the view that unrecognized medical illnesses in mental health, as well as in primary care, treatment settings can directly cause or exacerbate a patient's presenting psychological symptoms. No study has compared medical and nonmedical health care professionals on their respective abilities to identify common medical illnesses that frequently masquerade as psychological disorders.

In this study, 24 psychiatrists, 20 primary care physicians, 31 psychologists, and 17 social workers, recruited between November 2005 and April 2007, were asked to complete a questionnaire designed to measure the respondents' knowledge of masked medical illness. The questionnaire consisted of 10 different clinical vignettes in which a patient is seeking treatment for psychological problems that are due to a hidden medical illness. Statistical (analysis of covariance) comparisons of questionnaire scores were conducted between the medically trained and nonmedically trained participants.

After adjusting for clinical experience, medical mental health care professionals demonstrated significantly greater knowledge of medical illnesses that commonly masquerade as psychological disorders (F = 177.02, df = 1,82, p = .000, partial eta(2) = .68) than did nonmedical providers. In addition, correlational results showed a strong relationship (r = .82, N = 92, p < .001) between the presence of medical training and knowledge of masked medical illness in mental health care.

Study findings suggest that non-medical mental health care providers may be at increased risk of not recognizing masked medical illnesses in their patients. On the basis of these findings, proposed collaborative and educational approaches to minimize this risk and improve patient care are described.