Youth Trauma Histories are Associated with Under-diagnosis and Under-treatment of Co-occurring Youth Psychiatric Symptoms

ABSTRACT

Objective

We examined whether in the presence of trauma exposure, non-traumatic stress-related symptoms are interpreted by mental health clinicians as less salient than the trauma exposure and are de-emphasized as a treatment target, consistent with a diagnostic overshadowing bias.

Methods

Using an adapted version of a diagnostic overshadowing bias experimental paradigm, mental health clinicians (N = 266, M age = 34.4 years, 82% female) were randomly assigned to receive two of six clinical vignette variations. Vignette 1 described an adolescent with obsessive-compulsive disorder (OCD). Vignette 2 described a pre-adolescent with oppositional defiant disorder (ODD). Vignettes were identical except for whether the youth reported exposure to a potentially traumatic event (PTE; no PTE, sexual PTE, or physical PTE). Clinicians received one vignette with a PTE and one without, counterbalancing order. Clinicians rated the likelihood the youth met criteria for various diagnoses and the appropriateness of various treatments on 7-point scales.

Results

Across both vignettes, clinicians rated the target diagnosis (OCD in Vignette 1, ODD in Vignette 2) as less likely for vignettes with a PTE than for the same vignettes without a PTE. Clinicians also rated evidence-based treatment modalities for target diagnoses as less appropriate in the presence of a PTE than when a PTE was present.

Conclusions

Consistent with possible bias, clinicians may under-recognize and under-treat non-traumatic stress-related mental health symptoms in youth with a co-occurring trauma history. Future work to validate this bias in real-world practice is indicated.

Acknowledgments

The authors gratefully acknowledge Ms. Anisa Hasan-Granier. Data Availability: The data that support the findings of this study are available from the corresponding author, EBH, upon reasonable request.

Disclosure Statement

Dr. Beidas receives royalties from Oxford University Press and has served as a consultant to the Camden Coalition of Healthcare Providers. Dr. Beidas currently serves as a consultant to United Behavioral Health and on the Clinical and Scientific Advisory Committee for Optum Behavioral Health. All other authors have nothing to disclose.

Additional information

Funding

This research was supported by pilot funds awarded to Emily M. Becker‐Haimes from the National Institute of Mental Health to the Penn ALACRITY Center (NIMH P50113840; MPI: Beidas, Buttenheim, Mandell).