Are Patient Linguistic Tones Associated with Mental Health and Perceived Clinician Empathy?

Abstract

Musculoskeletal specialists have the expertise to distinguish between (1) symptoms that correspond well with observed pathophysiology and (2) disproportionate or incongruent symptoms that may suggest mental and social health opportunities. There is evidence that patient verbal and nonverbal communication can help with this discernment. This study carried this line of research one step further by addressing whether patient linguistic tones, as assessed with use of Linguistic Inquiry and Word Count (LIWC), are associated with symptoms of depression and health anxiety. We also sought associations between both patient and clinician linguistic tones and patient-perceived clinician empathy. A secondary analysis of transcripts of video and audio recordings of 109 adult patients seeking musculoskeletal specialty care was performed. Patients also completed questionnaires quantifying symptoms of depression (PROMIS [Patient-Reported Outcomes Measurement Information System] Depression computerized adaptive test), self-efficacy when in pain (Pain Self-Efficacy Questionnaire, 2-question version), symptoms of health anxiety (5-item Short Health Anxiety Inventory [SHAI-5]), and perceived clinician empathy (Jefferson Scale of Patient Perceptions of Physician Empathy [JSPPPE]). LIWC was used to detect the relative strength of various emotional tones, cognitive processes, and core drives and needs. Bivariate and multivariable regression analyses sought factors associated with symptoms of depression, symptoms of health anxiety, and patient perception of clinician empathy. With greater levels of depression, patients express less emotion overall as detected with use of computational linguistic analysis. After accounting for demographic variables, there were no specific linguistic tones associated with health anxiety and symptoms of depression. Stronger negative linguistic tones were associated with lower pain self-efficacy. Greater perceived clinician empathy was associated with more words spoken by the clinician and the patient, greater patient use of adjectives, lower prevalence of patient tones of "analytic," lower clinician tones of "social," and greater tones of "cause." Musculoskeletal specialists cannot depend on people experiencing symptoms of psychological distress to verbally express their feelings. Specialists may be more likely to identify important symptoms of psychological distress if they anticipate lower emotional expressiveness and are attentive to specific words, concepts, and mannerisms known to be associated with distress.