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医疗环境中作为精神症状表现的躯体症状:一项定性研究。

Physical symptoms as psychiatric manifestations in medical spaces: A qualitative study.

作者信息

Spurrier Georgia F, Shulman Kai, Dibich Sofia, Benoit Laelia, Duckworth Kenneth, Martin Andrés

机构信息

Yale College, New Haven, CT, United States.

Yale School of Medicine, New Haven, CT, United States.

出版信息

Front Psychiatry. 2023 Jan 4;13:1074424. doi: 10.3389/fpsyt.2022.1074424. eCollection 2022.

Abstract

BACKGROUND

Mental health and physical health issues frequently co-occur, but the impact of the psychological wellbeing on the body's physical functioning remains poorly understood within medical spaces. Individuals living with psychiatric diagnoses in particular are at an increased risk for developing chronic health issues and may be especially disadvantaged by healthcare systems which treat the mind and body as separate entities.

METHODS

We used secondary analysis (SA) to analyze 30 semi-structured interviews of individuals living with a serious mental illness or reflecting on a family member living with a serious mental illness. We deliberately sampled participants who reflected on salient experiences with co-occurring physical and mental health symptoms. All participants were associated with the National Alliance on Mental Illness (NAMI), the nation's largest grassroots mental health organization. We coded interviews using qualitative thematic analysis with an interpretative phenomenological framework centered on participants' subjective experiences.

RESULTS

Our analyses uncovered physical health challenges which often occur in individuals living with a psychiatric illness, emphasizing the bidirectionality of mental and physical symptoms. We identified three overarching domains: (i) , in which participants reflected on how their body responded physically to mental states; (ii) , in which they discussed challenging experiences seeking medical treatment for physical symptoms while living with a mental health condition; and (iii) , in which they reflected on challenges in navigating poorly coordinated mental and physical healthcare systems.

DISCUSSION

Participants and their medical providers struggled to incorporate mental wellbeing and its impact on physical health into overall healthcare. Given common experiences with misdiagnoses, difficulties navigating health care, and significantly delayed treatment, medical spaces may be able to improve patient experiences and satisfaction by accounting for psychological influences on health outcomes.

CONCLUSION

Greater integration of physical and mental health care in medical spaces could improve health outcomes and reduce challenges for patients seeking treatment.

摘要

背景

心理健康问题和身体健康问题经常同时出现,但在医学领域,心理健康对身体机能的影响仍未得到充分理解。尤其是患有精神疾病诊断的个体,患慢性健康问题的风险增加,而将身心视为独立实体的医疗系统可能会使他们处于特别不利的地位。

方法

我们采用二次分析(SA)对30名患有严重精神疾病的个体或对患有严重精神疾病的家庭成员进行反思的半结构化访谈进行分析。我们特意选取了那些对身心共病症状的显著经历进行反思的参与者。所有参与者都与美国最大的基层心理健康组织全国精神疾病联盟(NAMI)有关联。我们使用定性主题分析对访谈进行编码,采用以参与者主观体验为中心的解释现象学框架。

结果

我们的分析揭示了精神疾病患者中经常出现的身体健康挑战,强调了精神和身体症状的双向性。我们确定了三个总体领域:(i),参与者在此反思他们的身体对精神状态的生理反应;(ii),他们在此讨论在患有心理健康问题时为身体症状寻求医疗治疗的具有挑战性的经历;(iii),他们在此反思在协调不佳的精神和身体医疗系统中导航的挑战。

讨论

参与者及其医疗提供者难以将心理健康及其对身体健康的影响纳入整体医疗保健。鉴于误诊、就医困难和治疗显著延迟的常见经历,医疗领域或许能够通过考虑心理因素对健康结果的影响来改善患者体验和满意度。

结论

在医疗领域更好地整合身心健康护理可以改善健康结果,并减少寻求治疗的患者所面临的挑战。

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