Seeing the complete picture: A systematic review of mental health consumer and health professional experiences of diagnostic overshadowing.

Aim: To systematically identify, explore and synthesise qualitative data related to mental health consumer and health professional experiences of diagnostic overshadowing.

Background: Mental health consumers experience significantly high rates of physical illness, poorer health outcomes and are more likely to die prematurely of physical illnesses than the general population. Diagnostic overshadowing is a complex and life-threatening phenomenon that occurs when physical symptoms reported by mental health consumers are misattributed to mental disorders by health professionals. This typically occurs in general healthcare settings.

Methods: Drawing on JBI methodology for systematic reviews, four scholarly databases and grey literature was searched, followed by eligibility screening and quality assessment using JBI QARI frameworks, resulting in six studies for inclusion. Findings were synthesised using meta-aggregation. The PRISMA checklist was adhered to throughout this process.

Findings: Five synthesised findings emerged. Three from the health professional experience: working in ill-suited healthcare systems, missing the complete diagnostic picture, and misunderstanding the lived experience of mental illness. Two from the mental health consumer experience: not knowing if the cause is physical or mental, and surviving and ill-suited health care system.

Conclusions: Diagnostic overshadowing is a multidimensional experience of interconnecting factors including systematic healthcare system issues, health professionals limited mental health knowledge and skills, stigmatic attitudes and mental health consumers miscommunicating their physical healthcare needs. Further research is needed to make diagnostic overshadowing visible and mitigate against this phenomenon that deprives mental health consumers of equitable access to quality healthcare.

Relevance To Clinical Practice: Those who govern healthcare systems have an obligation to recognise and address the unique needs of mental health consumers who seek help for physical illnesses to ensure they receive quality and safe care. Forming collaborative partnerships with mental health consumers in the development of knowledge translation initiatives targeting healthcare policy, practice and education are urgently required.