Mental illness can be misdiagnosed amongst the population who are deaf or hearing impaired. It is important to have the effective tools and resources necessary to appropriately diagnose mental health diseases within this population. In this paper, the authors present a review of the literature on this topic and its significance

Fernadez, Francisco

Nwokolo, Vania

English

Scholarworks@UTRGV Univ. of Texas RioGrande Valley

University of Texas Rio Grande Valley ScholarWorks @ UTRGV MEDI 9331 Scholarly Activities Clinical Years School of Medicine Winter 2020 Psychiatric assessment of a Spanish understanding patient who is deaf – A Literature Review Vania Nwokolo The University of Texas Rio Grande Valley, vania.nwokolo01@utrgv.edu Francisco Fernadez The University of Texas Rio Grande Valley Follow this and additional works at: https://scholarworks.utrgv.edu/som9331  Part of the Analytical, Diagnostic and Therapeutic Techniques and Equipment Commons Recommended Citation Nwokolo, Vania and Fernadez, Francisco, "Psychiatric assessment of a Spanish understanding patient who is deaf – A Literature Review" (2020). MEDI 9331 Scholarly Activities Clinical Years. 19. https://scholarworks.utrgv.edu/som9331/19 This Article is brought to you for free and open access by the School of Medicine at ScholarWorks @ UTRGV. It has been accepted for inclusion in MEDI 9331 Scholarly Activities Clinical Years by an authorized administrator of ScholarWorks @ UTRGV. For more information, please contact justin.white@utrgv.edu, william.flores01@utrgv.edu.   Vania Nwokolo Psychiatric assessment of a Spanish understanding patient who is deaf – A Literature Review  Authors: Vania Nwokolo, MS4, & Francisco Fernandez, MD University of Texas Rio Grande Valley School of Medicine  Abstract Mental illness can be misdiagnosed amongst the population who are deaf or hearing impaired. It is important to have the effective tools and resources necessary to appropriately diagnose mental health diseases within this population. In this paper, the authors present a review of the literature on this topic and its significance.  Introduction Mental illness is a health condition that is prevalent in the United States (1). Research has shown that nearly one in five adults in the United States are living with some form of a mental illness (1). To effectively diagnose and manage a mental disorder, communication between clinicians and patients is critical (2). However, in communities where some individuals have limited English-language proficiency, such as the Hispanic community, there seems to be a substantial gap between the need for mental health services and its availability (3). Research has shown that Hispanics with mental illness deal with many obstacles of obtaining adequate healthcare, including language barriers (4). Various solutions have been provided to bridge this gap, such as ad hoc interpreters (family members and local staff), telephone interpretation, professional interpretation, and mobile computer technology at the bedside (5). However, when these resources are not available, there is a huge barrier to adequate translation services (5). Adding a hearing impairment can make mental health assessment and therapeutics more complex (6). Research has shown that approximately 6.8% of the world population considered   Vania Nwokolo themselves deaf or have serious difficulty hearing (7). It has also been shown that about 1 in 7 Hispanic/Latino adults in the United States, suffer from some form of hearing loss (8). People who are deaf also have barriers to access the health care they need, such as limited health literacy and sign language barriers (9). However, there is limited research available concerning the evaluation, diagnosis, and treatment of mental health disorders in deaf individuals (10,11). This literature review is the outcome of a clinical experience with a bilingual Mexican American male patient in a safety net clinic in the Rio Grande Valley.   THIS DISCUSSION IS FOR WHEN HOPE CONSENTS THE PATIENT AND CLEARS THE USE OF PHI FOR THIS REPORT  Discussion Our experience demonstrated the problems of diagnostic assessment and treatment in an underserved indigent rural area. Both the medical and psychiatric diagnostic considerations were concluded based on written communication. In the initial phases of written communication, due to lack of sign language interpreters, staff assumed patient to understand primarily the Spanish language. The initial workup was done with typed up behavioral health intake questions, translated into Spanish. The patient was able to respond in written Spanish his symptoms of depression and trouble sleeping. However, as the written conversation continued, the patient noted the examiners predilection to communicate in English and he alerted all to his ability to also read and comprehend English. Due to this, the interviewers and the patient were able to write and respond to each other with follow up questions in English. The interviewers were able to deduce that the patient had issue with his sleep, including increased daytime sleepiness, spouse alerting the patient that he snores, observed episodes of the patient stopped breathing   Vania Nwokolo during sleep, and abrupt awakenings accompanied by gasping or choking. Based on these finds, the patient was given a potential diagnosis of Obstructive Sleep Apnea.  Obstructive sleep apnea (OSA) is a sleep-related breathing disorder that is caused by periods of narrowing and obstruction of the pharyngeal airway while sleeping (12). OSA is a common, chronic disorder that predominantly affects middle aged men (13). It affects approximately 2-4% of the population (14). Obstructive sleep apnea that is untreated can lead to long term health issues, including cardiovascular disease, metabolic disorders, cognitive impairment, and depression (15).  Not only can OSA lead to Depression, but due to symptom overlap, OSA can be mistaken for Depression, leading to under-diagnoses (16). Overlapping symptoms include daytime sleepiness, fatigue/loss of energy, poor concentration, irritability, psychomotor retardation, and weight gain (16). However, whereas Depression will also present with symptoms of sadness, anhedonia, agitation and guilt, OSA will have accompanying symptoms of snoring, witnessed apneas and snort arousals (16). Due to possible discrepancies with diagnosing of these two disorders, it is imperative that clinicians utilize effective communication to always look for an underlying cause of depression, instead of simply diagnosing the patient with Major Depressive Disorder. For patients where there are barriers to communication, such as non-English understanding patients who are deaf, this may make effective communication strategies to come up with a true diagnosis of OSA a little more complex.  It is crucial that clinicians accurately diagnose patients presenting with symptoms that can be due to various causes. It may seem a harder obstacle diagnosing patients who may primarily speak and understand a language that is different from what the physician is used to, and much more a patient who is deaf. This may be due to a variety of reasons, such as lack of resources or   Vania Nwokolo lack of training and confidence in dealing with this patient population. However, patient’s health comes first, and clinicians must be creative in finding ways to effectively communicate with them in any way possible. When clinicians are unable to find the right resources to effectively communicate with patients who may have communication barriers, it can lead monolingual patients, especially those who are deaf, not being treated, leading to unwanted mental and medical health consequences. Research has shown that people who are hearing impaired are at a greater risk for depression (17). According to a study by Hallam et. al, individuals who are deaf are 4.8 times more likely to have clinically significant depression than the population average (17). This is in accordance with other studies, such as the Emond et. al study which also indicated individuals who are deaf had high levels of self-reported depression, as well as anxiety (18-20). This may be in part due to the challenges individuals who are deaf face when trying to seek out mental health services, such as counseling or psychiatrist, that provide resources to facilitate communication tools that are more comfortable for them.  Studies show that there is a lack of clinicians and facilities that are proficient in American Sign Language and that have access to resources that can serve as interpreters for this population (21). Clinicians may misinterpret behaviors, attitudes and written responses of Spanish understanding patients who are deaf, leading to misdiagnosis and unsuitable management.   Conclusion In the case above, written communication was the resource at hand employed to reach a psychiatric diagnosis in a Spanish understanding patient who is deaf. However, it was later proven that this patient not only read and wrote in Spanish, but in English as well. The   Vania Nwokolo interviewers did not know sign language but could read and write in English and Spanish. If they could not read and write in Spanish and the patient only understood Spanish, this psychiatric assessment would have been even more complicated to obtain.  In many clinical settings, technology has been utilized for interpretive services (5). If a similar patient seeks mental health treatment, it is vital that the clinicians do their duty and use all these resources at hand to come up with an adequate diagnosis to give appropriate treatment. However, in underserved areas, these advances are not always readily available or even accessible. Reliance on written communication is key in these settings.                                Vania Nwokolo References: 1. Mental Illness. National Institute of Mental Health. https://www.nimh.nih.gov/health/statistics/mental-illness.shtml. Accessed June 4, 2020. 2. Kilian S, Swartz L, Chiliza B. Doing their best: strategies used by South African clinicians in working with psychiatric inpatients across a language barrier. Global Health Action. 2015;8(1):28155. doi:10.3402/gha.v8.28155 3. Alegría M, Mulvaney-Day N, Torres M, Polo A, Cao Z, Canino G. Prevalence of Psychiatric Disorders Across Latino Subgroups in the United States. American Journal of Public Health. 2007;97(1):68-75. doi:10.2105/ajph.2006.087205 4. Cabassa LJ, Gomes AP, Meyreles Q, et al. Using the collaborative intervention planning framework to adapt a health-care manager intervention to a new population and provider group to improve the health of people with serious mental illness. Implementation Science. 2014;9(1). doi:10.1186/s13012-014-0178-9 5. Martin ML, Heron S, Moreno-Walton L, Strickland M. Diversity and Inclusion in Quality Patient Care: Your Story/Our Story - A Case-Based Compendium. Cham: Springer International Publishing; 2019. 6. Øhre, B., Volden, M., Falkum, E., & Tetzchner, S. V. (2016). Mental Disorders in Deaf and Hard of Hearing Adult Outpatients: A Comparison of Linguistic Subgroups. Journal of Deaf Studies and Deaf Education, 22(1), 105-117. doi:10.1093/deafed/enw061 7. Blazer, Dan G., and Debara L. Tucci. “Hearing Loss and Psychiatric Disorders: a Review.” Psychological Medicine, vol. 49, no. 6, 2018, pp. 891–897., doi:10.1017/s0033291718003409.  8. Cruickshanks KJ, Dhar S, Dinces E, et al. Hearing Impairment Prevalence and Associated Risk Factors in the Hispanic Community Health Study/Study of Latinos. JAMA Otolaryngology–Head & Neck Surgery. 2015;141(7):641. doi:10.1001/jamaoto.2015.0889 9. Barnett S, Klein JD, Pollard RQ, et al. Community Participatory Research With Deaf Sign Language Users to Identify Health Inequities. American Journal of Public Health. 2011;101(12):2235-2238. doi:10.2105/ajph.2011.300247 10. Fellinger J, Holzinger D, Pollard R. Mental health of deaf people. The Lancet. 2012;379(9820):1037-1044. doi:10.1016/s0140-6736(11)61143-4 11. Landsberger SA, Sajid A, Schmelkin L, Diaz DR, Weiler C. Assessment and Treatment of Deaf Adults with Psychiatric Disorders. Journal of Psychiatric Practice. 2013;19(2):87-97. doi:10.1097/01.pra.0000428555.48588.f9 12. Punjabi NM. The Epidemiology of Adult Obstructive Sleep Apnea. Proceedings of the American Thoracic Society. 2008;5(2):136-143. doi:10.1513/pats.200709-155mg 13. Spicuzza L, Caruso D, Maria GD. Obstructive sleep apnoea syndrome and its management. Therapeutic Advances in Chronic Disease. 2015;6(5):273-285. doi:10.1177/2040622315590318 14. Young T, Palta M, Dempsey J, Skatrud J, Weber S, Badr S. The Occurrence of Sleep-Disordered Breathing among Middle-Aged Adults. New England Journal of Medicine. 1993;328(17):1230-1235. doi:10.1056/nejm199304293281704 15. Tuomilehto H, Seppä J, Uusitupa M. Obesity and obstructive sleep apnea – Clinical significance of weight loss. Sleep Medicine Reviews. 2013;17(5):321-329. doi:10.1016/j.smrv.2012.08.002   Vania Nwokolo 16. Ejaz S, Khawaja I, Bhatia S, Hurwitz , ISKT. Obstructive sleep apnea and depression: a review. Innov Clin Neurosci. 2011;8(8):17-25. 17. Hallam R, Ashton P, Sherbourne K, Gailey L. Acquired profound hearing loss: Mental health and other characteristics of a large sample. International Journal of Audiology. 2006;45(12):715-723. doi:10.1080/14992020600957335 18. Emond A, Ridd M, Sutherland H, Allsop L, Alexander A, Kyle J. The current health of the signing Deaf community in the UK compared with the general population: a cross-sectional study. BMJ Open. 2015;5(1). doi:10.1136/bmjopen-2014-006668 19. Wallace, S., Mactaggart, I., Banks, L. M., Polack, S., & Kuper, H. (2020). Association of anxiety and depression with physical and sensory functional difficulties in adults in five population-based surveys in low and middle-income countries. Plos One, 15(6). doi:10.1371/journal.pone.0231563 20. Shoham, N., Lewis, G., Mcmanus, S., & Cooper, C. (2019). Common mental illness in people with sensory impairment: Results from the 2014 adult psychiatric morbidity survey. BJPsych Open, 5(6). doi:10.1192/bjo.2019.81 21. Ekin S, Turan M, Arısoy A, et al. Is There a Relationship Between Obstructive Sleep Apnea (OSA) and Hearing Loss? Medical Science Monitor. 2016;22:3124-3128. doi:10.12659/msm.897347    

Psychiatric assessment of a Spanish understanding patient who is deaf – A Literature Review

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Psychiatric assessment of a Spanish understanding patient who is deaf – A Literature Review

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