Predictors of Trauma-Related Diagnostic Overshadowing Bias

Abstract

Diagnostic overshadowing occurs when healthcare professionals misattribute an individual’s presenting symptoms to other features of an individual’s clinical presentation. Mental health providers may incorrectly diagnose and treat trauma-exposed individuals due to trauma-related diagnostic overshadowing bias. No research has investigated provider factors associated with this bias. Mental health provider background and training characteristics were examined as predictors of trauma-related diagnostic overshadowing in a sample of mental health providers (N = 210). Hierarchical regression modeling was used to evaluate predictors related to trauma-related diagnostic overshadowing in diagnostic and treatment decision-making. Providers with diagnostic responsibilities in their professional role were significantly less likely to demonstrate bias in some diagnostic and treatment decisions. Older mental health providers and providers with more clients experiencing traumatic stress demonstrated greater bias in some diagnostic responses. Providers with doctoral degrees, compared to all other degree types, demonstrated less bias through some diagnostic and treatment responses. Bias in diagnostic decisions strongly predicted bias in treatment decision-making. Findings suggest that factors related to clinical experience may be important in predicting trauma-related diagnostic overshadowing. Future work should extend this research to understand which factors affect trauma-related diagnostic overshadowing in real-world settings.