{"product_id":"mind-and-body-one-patient-how-mental-health-conditions-lead-to-missed-late-and-wrong-physical-diagnoses","title":"Mind and Body, One Patient: How Mental Health Conditions Lead to Missed, Late, and Wrong Physical Diagnoses","description":"\u003cp\u003ePeople who live with mental health conditions are at real risk of receiving slower, missed, or incorrect diagnoses for physical illnesses like cancer, which helps explain why they die 15–20 years younger than the general population. This systematic review of 79 studies found widespread \"diagnostic inequalities\" — preventable and unfair differences in how and when physical health problems are detected. Of the 37 studies with the most reliable comparison groups, 29 showed that having a mental health condition was linked to a statistically significant increased risk of delayed diagnosis of a physical health problem. Crucially, the research shows the burden should not fall solely on patients: health services and clinicians must also change how they work.\u003c\/p\u003e\n\n\u003ch1\u003eMind and Body, One Patient: How Mental Health Conditions Lead to Missed, Late, and Wrong Physical Diagnoses\u003c\/h1\u003e\n\n\u003ch2\u003eTable of Contents\u003c\/h2\u003e\n\u003cul\u003e\n\u003cli\u003e\u003ca href=\"#ddn-key-points\"\u003eKey Points\u003c\/a\u003e\u003c\/li\u003e\n\n  \u003cli\u003e\u003ca href=\"#why-it-matters\"\u003eWhy This Research Matters\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#what-the-study-investigated\"\u003eWhat the Study Set Out to Investigate\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#how-the-review-was-conducted\"\u003eHow the Researchers Found and Analysed the Evidence\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#key-findings\"\u003eKey Findings: Diagnostic Inequalities Are Widespread\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#cancer-studies\"\u003eWhat the Numbers Show: Cancer Diagnosis Delays, Study by Study\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#clinical-implications\"\u003eWhat This Means for Patients and Health Services\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#limitations\"\u003eWhat This Research Could Not Prove\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#recommendations\"\u003eRecommendations: What Needs to Happen Next\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#ddn-faq\"\u003eFrequently Asked Questions\u003c\/a\u003e\u003c\/li\u003e\n\u003cli\u003e\u003ca href=\"#source\"\u003eSource Information\u003c\/a\u003e\u003c\/li\u003e\n\u003c\/ul\u003e\n\n\u003c!-- ddn:keypoints:start --\u003e\n\u003ch2 id=\"ddn-key-points\"\u003eKey Points\u003c\/h2\u003e\n\u003cul\u003e\n\u003cli\u003eA review of 79 studies found that people with mental health conditions are at increased risk of delayed, missed, or incorrect physical illness diagnoses.\u003c\/li\u003e\n\u003cli\u003eOf 37 studies with reliable comparison groups, 29 showed a statistically significant increased risk of delayed physical health diagnosis.\u003c\/li\u003e\n\u003cli\u003eDiagnostic overshadowing, where physical symptoms are wrongly attributed to a mental health condition, is a recognised and dangerous form of diagnostic error.\u003c\/li\u003e\n\u003cli\u003eThe burden should not fall solely on patients; health services and clinicians must also change how they work to reduce these inequalities.\u003c\/li\u003e\n\u003cli\u003eIn one UK study of 2,115 patients with colon cancer signs, the diagnostic interval was 466 days for those with mental health conditions versus 365 days.\u003c\/li\u003e\n\u003c\/ul\u003e\n\u003c!-- ddn:keypoints:end --\u003e\n\n\n\u003ch2 id=\"why-it-matters\"\u003eWhy This Research Matters\u003c\/h2\u003e\n\n\u003cp\u003eOver the past twenty years, evidence has grown rapidly that people with mental health conditions die earlier than other people. In 2024, NHS England declared that people living with severe mental illness (SMI) — conditions such as schizophrenia, bipolar disorder, and severe depression — face \"one of the greatest health equality gaps\".\u003c\/p\u003e\n\n\u003cp\u003eGlobally, patients with SMI have a life expectancy 15–20 years shorter than the general population. But shorter life expectancy is not limited to severe illness. It is found across the whole spectrum of mental health conditions.\u003c\/p\u003e\n\n\u003cp\u003eMost excess deaths in people with mental health conditions are caused by preventable physical illness. A 2019 review found that the risk of obesity, diabetes, and cardiovascular disease (heart disease and stroke) in this population is 1.4–2.0 times that of the general population.\u003c\/p\u003e\n\n\u003cp\u003eSeveral factors are known to contribute to these physical health inequalities:\u003c\/p\u003e\n\u003cul\u003e\n  \u003cli\u003eSocial and financial disadvantages\u003c\/li\u003e\n  \u003cli\u003eAssociated poorer lifestyles\u003c\/li\u003e\n  \u003cli\u003eThe impact of psychotropic medication (medication prescribed for mental health conditions) on physical health\u003c\/li\u003e\n  \u003cli\u003eSuboptimal care for physical health problems\u003c\/li\u003e\n\u003c\/ul\u003e\n\n\u003cp\u003eInequalities in the \u003cem\u003ediagnosis\u003c\/em\u003e of physical health problems are also likely to play a role. Yet until this review, the evidence had never been systematically assessed.\u003c\/p\u003e\n\n\u003cp\u003eDiagnostic inequalities are complex. They have multiple contributing factors and can happen at different stages of the diagnostic process. Diagnostic errors are defined as diagnoses that are missed, incorrect, or delayed. One well-known form is \u003cstrong\u003ediagnostic overshadowing\u003c\/strong\u003e, where physical symptoms are wrongly attributed to a mental health condition. For example, chest pain might be dismissed as \"anxiety\" when it is actually a heart problem.\u003c\/p\u003e\n\n\u003cp\u003eImportantly, diagnostic errors are not the only contributor to inequalities. Factors that happen before a patient even reaches a doctor matter too. Researchers use the concept of \u003cstrong\u003e\"total patient delay\"\u003c\/strong\u003e, which includes the time an individual takes to notice symptoms and seek medical care. People with mental health conditions may struggle to seek a diagnosis in a timely way because of the impact of their condition, financial burdens, healthcare models that do not meet their needs, and anticipation of stigma, poor-quality care, or not being taken seriously.\u003c\/p\u003e\n\n\u003cp\u003eBoth types of challenges matter, but they have different causes. While it is broadly accepted that people with mental health conditions are vulnerable to diagnostic inequalities, no overview of the research existed. This systematic review fills that gap.\u003c\/p\u003e\n\n\u003ch2 id=\"what-the-study-investigated\"\u003eWhat the Study Set Out to Investigate\u003c\/h2\u003e\n\n\u003cp\u003eThe primary research question was direct: \u003cstrong\u003eWhat evidence exists that individuals with mental health conditions are at risk of having their physical health problems undiagnosed, misdiagnosed, or diagnosed late?\u003c\/strong\u003e\u003c\/p\u003e\n\n\u003cp\u003eThe researchers also wanted to answer three secondary questions:\u003c\/p\u003e\n\u003cul\u003e\n  \u003cli\u003eWhich physical and mental health conditions have been examined most frequently?\u003c\/li\u003e\n  \u003cli\u003eWhat kinds of diagnostic problems have been assessed?\u003c\/li\u003e\n  \u003cli\u003eAt which point(s) of the diagnostic process do these problems occur?\u003c\/li\u003e\n\u003c\/ul\u003e\n\n\u003cp\u003eThe research aims were deliberately broad. The team wanted to provide a critical assessment of the current state of knowledge in this area of epidemiology (the study of how often diseases occur and why).\u003c\/p\u003e\n\n\u003ch2 id=\"how-the-review-was-conducted\"\u003eHow the Researchers Found and Analysed the Evidence\u003c\/h2\u003e\n\n\u003cp\u003eThe study was conducted and reported following PRISMA guidelines, an internationally recognised standard for reporting systematic reviews. Findings were synthesised narratively — in other words, described in a structured written summary rather than statistically combined. No meta-analysis (a statistical method that pools results from multiple studies) was conducted.\u003c\/p\u003e\n\n\u003cp\u003eA peer researcher — someone with personal lived experience of mental health conditions — contributed to all stages of the review, including interpretation of the findings.\u003c\/p\u003e\n\n\u003cp\u003eBecause this review synthesises previously published content, ethical approval was not required.\u003c\/p\u003e\n\n\u003ch3\u003eHow the search was conducted\u003c\/h3\u003e\n\n\u003cp\u003eFour major research databases were searched:\u003c\/p\u003e\n\u003cul\u003e\n  \u003cli\u003eMEDLINE (Ovid)\u003c\/li\u003e\n  \u003cli\u003eEmbase (Ovid)\u003c\/li\u003e\n  \u003cli\u003ePsycINFO (EbscoHost)\u003c\/li\u003e\n  \u003cli\u003eCINAHL (EbscoHost)\u003c\/li\u003e\n\u003c\/ul\u003e\n\n\u003cp\u003eThe initial search ran on 21 November 2022 and was updated on 18 September 2024. Additional studies were found through manual searches. The search strategy combined keywords and standardised index terms, developed using the PICO framework (a tool for framing health research questions) by the authors, including a medical librarian, in collaboration with experts in diagnostic error.\u003c\/p\u003e\n\n\u003cp\u003eStudies written in English and published between 1 September 2002 and 18 September 2024 were included. Reviews, letters, editorials, comments, books, book chapters, case studies, and dissertations were excluded.\u003c\/p\u003e\n\n\u003cp\u003eTitles and abstracts were screened independently by two reviewers. To be included, a study had to be a primary study (based on original data collection) using an established quantitative (numerical) design, providing information about physical health-related diagnostic inequalities in people with a mental health condition. Any healthcare setting in any country qualified.\u003c\/p\u003e\n\n\u003cp\u003eSome conditions, such as dementia and delirium, sit at the intersection of mental and physical health. The authors classified them as mental health conditions because they involve significant psychological symptoms.\u003c\/p\u003e\n\n\u003cp\u003eStudies were excluded if they were qualitative (non-numerical), if they dealt with diagnostic inequalities in mental health conditions themselves (for example, delayed diagnosis of bipolar disorder), or if they concerned people with intellectual or learning disabilities. Also excluded were studies of inequalities such as under-screening, undertreatment, or excess mortality that did not relate to diagnostic patterns, and studies of how common physical illness is in people with mental health conditions that did not examine diagnostic patterns.\u003c\/p\u003e\n\n\u003ch3\u003eHow the data were analysed\u003c\/h3\u003e\n\n\u003cp\u003eData were extracted by a single author and checked by an independent reviewer for accuracy. The extraction template was first piloted and refined on a sample of 10 studies. Risk of bias (systematic flaws that could skew results) was assessed using the Newcastle–Ottawa scale for non-randomised studies and the RoB 2 tool for randomised studies. These assessments were based solely on data relating to diagnostic inequalities, so they may not reflect the overall quality of each study.\u003c\/p\u003e\n\n\u003cp\u003eBecause the studies varied so much in design, definitions, measurements, conditions examined, and outcomes, no meta-analysis was conducted. Instead, the studies were grouped by the type of diagnostic problem they examined (studies suggestive of diagnostic error versus studies indicative of wider diagnostic inequalities) and, within those broad categories, by the physical and mental health conditions they targeted.\u003c\/p\u003e\n\n\u003ch2 id=\"key-findings\"\u003eKey Findings: Diagnostic Inequalities Are Widespread\u003c\/h2\u003e\n\n\u003cp\u003eThe search identified 18,966 articles from databases and 20 more from cross-referencing and manual searches. After removing duplicates, the abstracts of 13,428 papers were screened, and 13,066 were excluded. The remaining 362 papers were read in full, leading to the exclusion of 283. A total of \u003cstrong\u003e79 studies\u003c\/strong\u003e were eligible for inclusion.\u003c\/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eThirty-seven studies\u003c\/strong\u003e used a robust mental health comparator group (a group of people without mental health conditions, to allow fair comparison). Only these studies make it possible to measure the difference in risk of diagnostic inequality between people with and without mental health conditions. The review's main conclusions therefore focus on these 37 studies. The other 42 studies, which lacked such a comparison group, are summarised separately in the full paper's appendix.\u003c\/p\u003e\n\n\u003cp\u003eThe headline finding is stark: \u003cstrong\u003eof the 37 studies with a robust comparator group, 29 found that having one or more mental health conditions is associated with a statistically significant increased risk of having a physical health problem delayed\u003c\/strong\u003e — as detected by a subsequent definitive test or finding.\u003c\/p\u003e\n\n\u003cp\u003eStudies fell into two broad groups:\u003c\/p\u003e\n\u003cul\u003e\n  \u003cli\u003e\n\u003cstrong\u003eFifteen studies\u003c\/strong\u003e measured things suggestive of \u003cstrong\u003ediagnostic error\u003c\/strong\u003e — missed, incorrect, or delayed diagnoses occurring \u003cem\u003eafter\u003c\/em\u003e the patient presented to a health service. These designs eliminate late or non-presentation by patients as a possible cause.\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eTwenty-three studies\u003c\/strong\u003e examined broader \u003cstrong\u003ediagnostic inequalities\u003c\/strong\u003e, where the design could not distinguish between problems in the development of a diagnosis by health professionals and problems of patients presenting late or not at all.\u003c\/li\u003e\n\u003c\/ul\u003e\n\n\u003cp\u003eIn total, across the full set of 79 studies, 18 focused on diagnostic error (15 with a comparator group and 3 without), and 62 examined diagnostic disparities (23 with a comparator group and 39 without). One study (O'Rourke 2008) reported findings on both diagnostic error and diagnostic disparities, so it is counted in both groups.\u003c\/p\u003e\n\n\u003cp\u003eA striking pattern emerged regarding the role of healthcare systems. Only a minority of studies (n=15) used a research design capable of isolating the specific role of health services and professionals in producing these inequalities. Of those, \u003cstrong\u003e14 found evidence that people with mental health conditions were at greater risk of diagnostic error (missed, wrong, or delayed diagnosis after seeing a clinician) than people without them\u003c\/strong\u003e. The remaining studies measured diagnostic endpoints only, meaning no conclusion could be drawn about the relative impact of patients' versus clinicians' behaviour.\u003c\/p\u003e\n\n\u003ch2 id=\"cancer-studies\"\u003eWhat the Numbers Show: Cancer Diagnosis Delays, Study by Study\u003c\/h2\u003e\n\n\u003cp\u003eThe visible portion of the review's evidence table focuses on cancer — the physical condition most frequently studied in relation to diagnostic delay. Here is what individual studies found. (A note on reading the numbers: a hazard ratio or odds ratio above 1 means higher risk or longer delay; below 1 can also mean longer delay when it measures the \"hazard\" of being diagnosed. Confidence intervals, shown in brackets, give the range the true value most likely falls within.)\u003c\/p\u003e\n\n\u003cul\u003e\n  \u003cli\u003e\n\u003cstrong\u003eColon cancer — Benitez Majano 2022 (UK):\u003c\/strong\u003e This study followed 2,115 patients with \"red flag\" signs of colon cancer, 308 of whom had a mental health condition (92% had mood disorders such as depression or anxiety). Median age was 75 (interquartile range 65–82). After accounting for other variables, the diagnostic interval (time from consultation to diagnosis) for people with mental health conditions was \u003cstrong\u003e466 days (95% CI 413–519) versus 365 days (95% CI 288.6–442.4)\u003c\/strong\u003e at the 75th percentile (p\u0026lt;0.001), and \u003cstrong\u003e224 days (95% CI 159–290) versus 126 days (95% CI 94.5–157.5)\u003c\/strong\u003e at the 50th percentile (p=0.003). Both differences were statistically significant.\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eColorectal cancer — Mounce 2017 (UK):\u003c\/strong\u003e In 4,512 patients with colorectal cancer, anxiety and depression were associated with longer diagnostic intervals from first symptomatic presentation to diagnosis: a \u003cstrong\u003e9-day diagnostic delay (95% CI 3–17), coefficient 0.11 (0.03, 0.20), p=0.007\u003c\/strong\u003e, adjusted for age and gender.\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eColorectal cancer — Van Hout 2011 (Netherlands):\u003c\/strong\u003e Among 197 patients (11 with mental health conditions, 5.6%), anxiety and depression were significantly associated with delay between first consultation with a general practitioner and referral to an endoscopy unit. The odds ratio (OR) was \u003cstrong\u003e3.87 (95% CI 1.13–13.30)\u003c\/strong\u003e in univariate analysis and remained significant in multivariate analysis at \u003cstrong\u003eadjusted OR 3.97 (95% CI 1.14–13.85)\u003c\/strong\u003e. This means people with anxiety or depression had nearly four times the odds of experiencing this delay.\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eColorectal cancer — Walter 2016 (UK):\u003c\/strong\u003e In a cohort of 2,507 (98.1% white, median age 65), people with anxiety or depression were diagnosed \u003cstrong\u003e0.8 times as quickly as those without (HR 0.8; 95% CI 0.71–0.90; p\u0026lt;0.001)\u003c\/strong\u003e. The time from first symptom onset to diagnosis was also longer (HR 0.86; 95% CI 0.77–0.96; p\u0026lt;0.001). In plain terms, anxiety and depression meant a significantly longer overall diagnostic process.\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eBreast cancer — Iglay 2017 (US):\u003c\/strong\u003e This study of 16,636 women aged 68 or older (3,961 with mental health conditions) found that women with comorbid anxiety or depression had an \u003cstrong\u003e11% increased risk of a diagnosis delay of 90 days or more\u003c\/strong\u003e, measured from first Medicare claim for breast symptoms to diagnosis (adjusted relative risk = 1.11; 95% CI 1.00, 1.23). No significant differences were found for other mental health clusters, or for any mental health condition when the threshold was a 60-day delay.\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eOesophageal cancer — O'Rourke 2008 (US):\u003c\/strong\u003e In 160 veterans (52 with mental health conditions), the median time from onset of alarm symptoms to diagnosis of oesophageal cancer was \u003cstrong\u003e90 days (IQR 20–162) for those with psychiatric illness versus 35 days (IQR 0–76) for those without, p=0.001\u003c\/strong\u003e. Multivariate analysis showed psychiatric illness in general (adjusted HR = 0.605; 95% CI 0.424–0.862) and depression specifically (adjusted HR = 0.622; 95% CI 0.425–0.910) predicted delayed diagnosis. Here, a hazard ratio below 1 indicates a lower \"hazard\" of being diagnosed — meaning a longer wait for diagnosis.\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eLung cancer — Iachina 2017 (Denmark):\u003c\/strong\u003e This study compared 508 people with depression to 27,234 without depression (controls) who were later diagnosed with non-small cell lung cancer. In contrast to the other studies, \u003cstrong\u003eno difference was found\u003c\/strong\u003e in the duration of the diagnostic process between the two groups (adjusted HR = 0.99; 95% CI 0.90–1.09).\u003c\/li\u003e\n\u003c\/ul\u003e\n\n\u003cp\u003eThese findings show that the pattern is not universal — Iachina found no delay for lung cancer — but across the body of evidence, the overall trend is consistent. The conditions most strongly associated with the mortality gap, including cardiovascular disease, deserve particular attention, and the authors note that diagnostic inequalities related to cardiovascular problems should be a priority for future research.\u003c\/p\u003e\n\n\u003ch2 id=\"clinical-implications\"\u003eWhat This Means for Patients and Health Services\u003c\/h2\u003e\n\n\u003cp\u003eThe diagnostic inequalities identified in this review have potentially serious clinical consequences. A cancer that is diagnosed months later can be at a more advanced stage, harder to treat, and more likely to be fatal. The same logic applies to heart disease, diabetes, and other serious physical conditions.\u003c\/p\u003e\n\n\u003cp\u003eA key insight for patients is this: the research shows that the problem is not simply about people with mental health conditions delaying their own care. Diagnostic errors — where clinicians miss, misinterpret, or take too long to reach a correct diagnosis even after the patient has sought help — are also common. Diagnostic overshadowing, where physical symptoms are written off as part of a mental health condition, is a recognised and dangerous form of this error.\u003c\/p\u003e\n\n\u003cp\u003eBecause professional and service-related factors make a clear contribution, the onus of behavioural change should \u003cstrong\u003enot\u003c\/strong\u003e rest solely on patients. Health services, clinicians, and healthcare systems share responsibility for closing the gap.\u003c\/p\u003e\n\n\u003cp\u003eFor patients with mental health conditions and their families, this review offers both a warning and a tool. It is reasonable to be alert to the possibility of physical symptoms being overlooked, to prepare for appointments by describing symptoms clearly and specifically, and to ask clinicians directly: \"Could this be a physical problem?\" It is equally reasonable to expect clinicians to ask about physical symptoms in every consultation, including mental health appointments.\u003c\/p\u003e\n\n\u003ch2 id=\"limitations\"\u003eWhat This Research Could Not Prove\u003c\/h2\u003e\n\n\u003cp\u003eThis review has important limitations, which the authors openly acknowledge:\u003c\/p\u003e\n\u003cul\u003e\n  \u003cli\u003e\n\u003cstrong\u003eCause and effect could not be determined.\u003c\/strong\u003e Most studies measured diagnostic \"endpoints\" only — the final outcome of delay or error. Because of their design, they could not show whether inequalities were caused more by patient behaviour, clinician behaviour, or system failures.\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eOnly a minority of studies examined the healthcare system's role.\u003c\/strong\u003e Just 15 of the studies were designed to isolate professional- and service-related factors, meaning the mechanisms behind the inequalities remain poorly understood.\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eNo meta-analysis was performed.\u003c\/strong\u003e The studies were too heterogeneous — they differed in design, definitions, measurements, conditions, and outcomes — to pool statistically. The findings are presented as a narrative synthesis instead.\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eRisk of bias assessments were narrow.\u003c\/strong\u003e These were based only on the data relating to diagnostic inequalities, so they may not reflect the overall quality of each included study.\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eCertain conditions were excluded.\u003c\/strong\u003e The review excluded diagnostic inequalities in mental health conditions themselves, and physical health diagnostic inequalities in people with intellectual or learning disabilities.\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eCertain mental health conditions were under-represented.\u003c\/strong\u003e The authors note that personality disorders and eating disorders received little attention in the included studies.\u003c\/li\u003e\n\u003c\/ul\u003e\n\n\u003ch2 id=\"recommendations\"\u003eRecommendations: What Needs to Happen Next\u003c\/h2\u003e\n\n\u003cp\u003eThe authors call for a new wave of research that pinpoints \u003cstrong\u003ewhich stage of the diagnostic process\u003c\/strong\u003e inequalities occur at. This is essential to understand the mechanisms at work and to design targeted improvement interventions.\u003c\/p\u003e\n\n\u003cp\u003eSpecifically, they recommend that future research should:\u003c\/p\u003e\n\u003col\u003e\n  \u003cli\u003eConsider the stage of the diagnostic process at which inequalities occur.\u003c\/li\u003e\n  \u003cli\u003eFocus on under-represented mental health conditions, particularly personality disorders and eating disorders.\u003c\/li\u003e\n  \u003cli\u003eAddress diagnostic inequalities related to cardiovascular disease, which is the physical condition most strongly associated with the mortality gap.\u003c\/li\u003e\n\u003c\/ol\u003e\n\n\u003cp\u003eFor healthcare providers, the message is that measurement alone is not enough. Systems should be designed to catch physical illness early in people with mental health conditions. Practical steps might include structured physical health checks, decision support tools that counteract diagnostic overshadowing, and care pathways that coordinate mental and physical health care rather than treating them separately.\u003c\/p\u003e\n\n\u003cp\u003eIn the meantime, patients should know that this is a recognised problem receiving serious attention from the medical community. Being aware that the risk exists is itself a form of protection. So is persistence: if a physical symptom is not improving or is being attributed to a mental health condition, patients are entitled to ask for further investigation.\u003c\/p\u003e\n\n\u003c!-- ddn:faq:start --\u003e\n\u003ch2 id=\"ddn-faq\"\u003eFrequently Asked Questions\u003c\/h2\u003e\n\u003ch3\u003eWhat did this review find about physical health diagnoses in people with mental health conditions?\u003c\/h3\u003e\n\u003cp\u003eA review of 79 studies found that people with mental health conditions often face delayed, missed, or incorrect diagnoses for physical illnesses. Of 37 studies with reliable comparison groups, 29 showed a significantly increased risk of delayed diagnosis. This may help explain why this group dies 15–20 years younger than the general population.\u003c\/p\u003e\n\u003ch3\u003eWhat is diagnostic overshadowing?\u003c\/h3\u003e\n\u003cp\u003eDiagnostic overshadowing is when physical symptoms are wrongly attributed to a mental health condition. For example, chest pain might be dismissed as anxiety when it is actually a heart problem. This is a recognised and dangerous form of diagnostic error that can delay correct diagnosis and treatment of serious physical illnesses.\u003c\/p\u003e\n\u003ch3\u003eDoes this mean patients with mental health conditions are to blame for late diagnoses?\u003c\/h3\u003e\n\u003cp\u003eNo. The research shows the burden should not fall solely on patients. While some people may delay seeking care, studies also found diagnostic errors by clinicians after the patient had already sought help. Health services and clinicians must change how they work to close this gap.\u003c\/p\u003e\n\u003ch3\u003eWhat does a hazard ratio below 1 mean in these studies?\u003c\/h3\u003e\n\u003cp\u003eA hazard ratio below 1 can mean a longer wait for diagnosis. For example, in a study of 160 veterans with oesophageal cancer, an adjusted hazard ratio of 0.605 for psychiatric illness indicated a lower chance of being diagnosed promptly, meaning a longer time to diagnosis compared with those without psychiatric illness.\u003c\/p\u003e\n\u003ch3\u003eWhat can patients do if they are worried about a physical symptom?\u003c\/h3\u003e\n\u003cp\u003eIt is reasonable to be alert to physical symptoms being overlooked. Prepare for appointments by describing symptoms clearly and specifically, and ask directly: 'Could this be a physical problem?' If a symptom is not improving or is being attributed to a mental health condition, you are entitled to ask for further investigation.\u003c\/p\u003e\n\u003ch3\u003eWhat are the limitations of this review?\u003c\/h3\u003e\n\u003cp\u003eThe review could not prove cause and effect. Most studies measured final outcomes only, so they could not show whether patient, clinician, or system factors caused the inequalities. Only 15 studies examined the healthcare system's role. No meta-analysis was done because studies were too varied. Personality and eating disorders were under-represented.\u003c\/p\u003e\n\u003ch3\u003eIf I have a mental health condition and my physical symptoms keep getting attributed to it, when should I seek a second opinion?\u003c\/h3\u003e\n\u003cp\u003eWhen a physical symptom is not improving, or is being attributed to a mental health condition, you are entitled to ask for further investigation. Diagnostic overshadowing — where physical symptoms are written off as part of a mental health condition — is a recognised and dangerous form of diagnostic error. Of 37 studies with robust comparison groups, 29 linked mental health conditions to significantly increased risk of delayed physical diagnosis. Prepare by describing symptoms clearly and asking directly: \"Could this be a physical problem?\" Diagnostic Detectives Network provides independent expert second opinions.\u003c\/p\u003e\n\u003c!-- ddn:faq:end --\u003e\n\n\u003ch2 id=\"source\"\u003eSource Information\u003c\/h2\u003e\n\n\u003cp\u003e\u003cstrong\u003eOriginal article title:\u003c\/strong\u003e Diagnostic inequalities relating to physical healthcare among people with mental health conditions: a systematic review.\u003c\/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eAuthors:\u003c\/strong\u003e Liberati E, Kelly S, Price A, Richards N, Gibson J, Olsson A, Watkins S, Smith E, Cole S, Kuhn I, Martin G.\u003c\/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eJournal:\u003c\/strong\u003e eClinicalMedicine, 2025, Volume 80, Article 103026. Published online by Elsevier Ltd.\u003c\/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eDOI:\u003c\/strong\u003e 10.1016\/j.eclinm.2024.103026\u003c\/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eFunding:\u003c\/strong\u003e The study was funded by The Health Foundation's grant to the University of Cambridge for The Healthcare Improvement Studies (THIS) Institute.\u003c\/p\u003e\n\n\u003cp\u003eThe study was registered on PROSPERO (registration number CRD42022375892) and was conducted following PRISMA reporting guidelines.\u003c\/p\u003e\n\n\u003cp\u003e\u003cem\u003eThis patient-friendly article is based on peer-reviewed research. It is intended for educational purposes and does not constitute medical advice. If you are concerned about physical symptoms, please speak with a healthcare professional.\u003c\/em\u003e\u003c\/p\u003e","brand":"DiagnosticDetectives.Com","offers":[{"title":"Default Title","offer_id":47738898219164,"sku":null,"price":0.0,"currency_code":"RUB","in_stock":true}],"url":"https:\/\/diagnosticdetectives.ru\/products\/mind-and-body-one-patient-how-mental-health-conditions-lead-to-missed-late-and-wrong-physical-diagnoses","provider":"DiagnosticDetectives.Com","version":"1.0","type":"link"}