Patients Diagnosed with Mental Health Distress, Then Vocal Issues Are Less Likely to Have Seen an Otolaryngologist

To what extent does mental health (MH) distress precede or follow voice disorder diagnoses?

Bottom Line: Most patients with voice and MH diagnoses received the MH diagnosis first; those patients were less likely to have ever seen an otolaryngologist.

Background: Patients with voice disorders frequently have significant psychosocial distress or MH. It has been proposed that psychosocial distress may lead to voice disorders, and alternatively that voice disorders may precipitate distress, but a causal relationship remains to be determined.

Study design: Data review of 11,419 patients with both voice and MH diagnoses from January 2005 through July 2017 in a large health system data repository. 

Setting: University of Minnesota Clinical Data Repository, Minneapolis.

Synopsis: Of the 11,419 individuals, 63% had an MH diagnosis first. There were more Medicaid users in the MH first group. Frequency of voice and MH diagnoses were compared, and voice first patients had higher rates of benign neoplasm of the larynx, laryngeal cancer, vocal fold paresis/paralysis, and laryngeal stenosis. MH first patients had an overall higher number of MH diagnoses in every category, including depression, anxiety, somatoform, and stress-related diagnoses. Sociodemographic factors associated with MH first diagnoses included age, female gender, and private and Medicaid insurance. MH first patients were more likely to see a PCP and have radiology tests for their voice concern, and less likely to ever see an ENT or to have a voice evaluation with speech and language pathology. In examining whether sequence of MH and voice diagnoses affected time from PCP to ENT, 5.6% saw a PCP and then an ENT. There was no difference between groups in the amount of time from a PCP visit to an ENT visit or in medication use. Limitations included the retrospective nature of databases, which cannot assess direct causality and have the potential for human error and data misclassification. 

Citation: Jordan VA, Cohen S, Lunos S, Horvath KJ, Sieger G, Misono S. Mental health and dysphonia: Which comes first, and does that change care utilization? Laryngoscope. 2020;130:1243-1248.