Diagnostic changes in a specialized psychiatric outpatient clinic for migrants: An observational study

Abstract

Culture significantly influences the understanding, presentation, diagnosis, and treatment of mental disorders, particularly among migrant patients. This observational study examines the frequency and timing of diagnostic changes among migrant patients in a specialized psychiatric outpatient clinic. Furthermore, the study includes a qualitative sub-study to provide insights into the diagnostic process. Out of the 119 migrant patients included in the study, 27.7% changed referral diagnoses during treatment. Diagnostic changes occurred in 15.7% of cases by the end of treatment, 13.4% at midterm, and 9.1% after the initial assessment. No significant associations were found between diagnostic changes and sociodemographic or treatment-related factors. While the qualitative sub-study primarily offered broader insights into the cultural aspects of treatment and the clinical encounter, rather than establishing causal effects on the diagnostic process, it revealed how acculturative stress and cultural identity influenced the presentation of symptoms. The study is conducted in a real-life clinical setting and, thus, reflects the everyday clinical practice of diagnostic changes at a specialized cultural psychiatric clinic. The findings from this study indicate that in addition to a culturally sensitive assessment, time is an important factor for diagnostic changes, which can be essential knowledge for clinical practice when planning diagnostic assessment and treatment. The findings underscore the need for enhancing clinicians’ cultural competencies through targeted training, emphasizing cultural awareness in clinical practice.