(PS11-A2) Investigating Moderators of Trauma-related Diagnostic Overshadowing Bias

Background. Diagnostic overshadowing refers to when healthcare providers are less likely to extend an accurate diagnosis to qualifying individuals due to the presence of other information, such as comorbid diagnosis or unrelated clinical features. Recent work has indicated that trauma-related diagnostic overshadowing may interfere with the accurate diagnosis and treatment of individuals with a trauma history who present with symptoms unrelated to trauma. There has been no work examining potential moderators of trauma-related diagnostic overshadowing. Establishing relevant moderators for trauma-related diagnostic overshadowing is paramount for understanding and mitigating this bias in practice.

Methods. Mental health professionals (N = 232, M age = 43.7, SD = 16) were randomly assigned to one of eight vignettes. Vignette described two adults presenting with obsessive-compulsive symptoms (Case #1) or substance abuse symptoms (Case #2). One vignette was randomly selected to include a history of trauma exposure, in which exposure type (i.e., sexual trauma, physical trauma) varied across conditions. Trauma exposure was standardized to have occurred after the onset of the presenting symptoms. Following each vignette, participants answered questions about their preferences for diagnosis and treatment selection for clients within the vignettes. Two-way analysis of variance (ANOVA) and linear regression were used to assess whether diagnostic ratings varied as a function of client-focused moderators (i.e., gender) and clinician-focused moderators (i.e., years of experience, confidence in treating trauma, previous trauma training).

Results. The interaction effect between client gender and trauma type in the vignette was marginally significant in the OCD case, but non-significant in the SUD case, indicating that ratings of OCD likelihood varied as a function of the interaction between gender and trauma type (F(2, 229) = 3.01, p = .05). Specifically, in cases with a history of sexual assault, there was greater evidence of bias (less likely to assign an OCD diagnosis) when the client was female compared to when the client was male (F(1, 224) = 5.75, p = .02). In contrast, mean ratings of OCD likelihood in physical and no trauma conditions did not significantly vary by client gender (ps > .28). The interaction effect between clinician confidence level in treating traumatic stress and trauma type in the vignette was significant in the SUD case, but not the OCD case, indicating that ratings of SUD likelihood varied as a function of clinician confidence level in treating traumatic stress and trauma type (F(3, 203) = -2.36, p = .02). In cases involving sexual trauma, clinicians with higher confidence ratings in treating traumatic stress demonstrated greater evidence of bias (less likely to assign an SUD diagnosis) than clinicians with lower confidence. Clinician experience and previous trauma training did not produce significant interactions with trauma type to predict diagnostic ratings in either case.

Discussion. Findings indicated mixed support for relevant moderators in trauma-related diagnostic overshadowing. More work is needed to identify what factors moderate trauma-related diagnostic overshadowing.