Mental Health and Dysphonia: Which Comes First, and Does That Change Care Utilization?

Victoria A. Jordan, Seth Cohen, Scott Lunos, Keith J. Horvath, Gretchen Sieger, Stephanie Misono

Research output: Contribution to journalArticlepeer-review


OBJECTIVES: Voice patients with voice disorders have a high prevalence of distress and mental health (MH) comorbidities, but it is unknown to what extent distress precedes or follows voice disorder diagnoses. Objectives were to compare 1) proportions of voice patients with MH diagnoses who received MH diagnoses first versus voice-related diagnoses first, 2) voice-related diagnoses and care utilization, and 3) time to specialty evaluation in each group.

METHODS: Patients with voice and MH diagnoses were identified using International Classification of Diseases, Ninth and Tenth Revisions codes in a large health system data repository from January 2005 through July 2017. Sociodemographics, comorbidities, MH- and voice-related diagnoses, and voice-related care utilization were analyzed using descriptive statistics and multivariable regression modeling.

RESULTS: Among the 11,419 patients with both voice and MH diagnoses, 63% (n = 7,251) received MH diagnoses prior to voice diagnoses, compared with 37% with a voice diagnosis first (P < 0.0001). The latter group received more specific voice-related diagnoses (e.g., laryngeal cancer [odds ratio (OR) 4.27], benign laryngeal neoplasm [OR 1.60]), and were more likely to ever see an otolaryngologist than those receiving MH diagnoses first (P < 0.0001).

CONCLUSION: Most patients with voice and MH diagnoses received a MH diagnosis first. Patients who receive MH diagnoses first appeared to have different voice-related healthcare compared to those who received voice diagnoses first.

LEVEL OF EVIDENCE: NA Laryngoscope, 130:1243-1248, 2020.

Original languageEnglish (US)
Pages (from-to)1243-1248
Number of pages6
Issue number5
StatePublished - May 1 2020

Bibliographical note

Funding Information:
Research reported in this publication was supported by the Health Services Research Grant (to v.a.j. ) from the Centralized Otolaryngology Research Efforts (CORE) of the American Academy of Otolaryngology Head and Neck Surgery Foundation. This research was also supported by the National Center for Advancing Translational Sciences (National Institutes of Health [NIH] award UL1TR000114 to the University of Minnesota Clinical and Translational Science Institute) and the National Institute on Deafness and Other Communication Disorders (K23DC016335 to s.m. ). The content is solely the responsibility of the authors and does not necessarily represent the official views of the American Academy of Otolaryngology Head and Neck Surgery Foundation or the NIH National Center for Advancing Translational Sciences.

Publisher Copyright:
© 2019 The American Laryngological, Rhinological and Otological Society, Inc.


  • Laryngology
  • dysphonia
  • health services
  • mental health
  • voice
  • Mental Disorders/complications
  • Humans
  • Middle Aged
  • Male
  • Dysphonia/complications
  • Adult
  • Female
  • Aged
  • Retrospective Studies
  • Patient Acceptance of Health Care/statistics & numerical data

PubMed: MeSH publication types

  • Research Support, Non-U.S. Gov't
  • Journal Article
  • Research Support, N.I.H., Extramural
  • Comparative Study


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