title: How patients and clinicians make meaning of physical suffering in mental health evaluations.
abstract: Clinicians in community mental health settings frequently evaluate individuals suffering from physical health problems. How patients make meaning of such "comorbidity" can affect mental health in ways that may be influenced by cultural expectations and by the responses of clinicians, with implications for delivering culturally sensitive care. A sample of 30 adult mental health intakes exemplifying physical illness assessment was identified from a larger study of patient-provider communication. The recordings of patient-provider interactions were coded using an information checklist containing 21 physical illness items. Intakes were analyzed for themes of meaning making by patients and responses by clinicians. Post-diagnostic interviews with these patients and clinicians were analyzed in similar fashion. Clinicians facilitated disclosures of physical suffering to varying degrees and formulated them in the context of the culture of mental health services. Patients discussed their perceptions of what was at stake in their experience of physical illness: existential loss, embodiment, and limits on the capacity to work and on their sense of agency. The experiences of physical illness, mental health difficulties, and social stressors were described as mutually reinforcing. In mental health intakes, patients attributed meaning to the negative effects of physical health problems in relation to mental health functioning and social stressors. Decreased capacity to work was a particularly salient concern. The complexity of these patient-provider interactions may best be captured by a sociosomatic formulation that addresses the meaning of physical and mental illness in relation to social stressors.
authors.affiliation: Cambridge Health Alliance/Harvard Medical School ncarson@charesearch.org.
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: Carson
authors.affiliation: Harvard Medical School.
authors.forename: Arlene M
authors.initials: AM
authors.lastname: Katz
authors.affiliation: Harvard Medical School.
authors.forename: Margarita
authors.initials: M
authors.lastname: Alegría
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003156:Community Mental Health Services; D015897:Comorbidity; D005260:Female; D006304:Health Status; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D001523:Mental Disorders / Q000150:complications* / Q000523:psychology*; D008875:Middle Aged; D010146:Pain / Q000175:diagnosis*; D011611:Psychosomatic Medicine; D036301:Qualitative Research; D055815:Young Adult
keywords: community mental health services; comorbidity; pain; physical suffering; psychosomatic medicine; work