Clinician awareness and systemic barriers of diagnostic overshadowing in emergency psychiatry: A latent class analysis

Psychiatry Res. 2026 Jan 19;358:116958. doi: 10.1016/j.psychres.2026.116958. Online ahead of print.

ABSTRACT

OBJECTIVE: Diagnostic overshadowing (DO)-the misattribution of new physical symptoms to a pre-existing psychiatric diagnosis-can delay recognition of medical illness and worsen outcomes in emergency care. This study examined clinicians’ awareness of DO, the provider- and system-level factors perceived as driving it, and whether distinct awareness/attribution profiles can be identified among emergency physicians and psychiatrists in Türkiye.

METHODS: We conducted a nationwide cross-sectional online survey of emergency department-facing emergency physicians and psychiatrists between 15 March and 1 May 2025. A 51-item questionnaire on DO-related determinants was developed and psychometrically refined, yielding a concise nine-item indicator set. Latent class analysis of responses to these indicators was used to identify subgroups of clinicians with similar patterns of DO-related awareness and attribution.

RESULTS: Of 215 invitees, 120 completed the survey (56 % response; median age 33 years; 46.7 % female).

PARTICIPANTS: 65% emergency medicine, 35% psychiatry. A three-class solution best fit the data (AIC=2620.17; BIC=2926.80; SS-BIC=2579.03; entropy=0.949; LMR-LRT/BLRT p < 0.001), with the smallest class ≥25%. LCA defined: Low Recognition; System-Tilted Awareness; Multidimensional High Awareness. Age and years in practice differed modestly across classes (p < 0.05), whereas gender, institution, academic title, and DO familiarity did not (p > 0.05).

CONCLUSIONS: These findings show that DO awareness is heterogeneous and not confined to a single specialty. A brief indicator set and profile-based framework may support tailored education and service redesign to reduce diagnostic overshadowing and improve safety and equity in emergency care.

PMID:41579415 | DOI:10.1016/j.psychres.2026.116958