Impact of Patient Language Proficiency and Interpreter Service Use on the Quality of Psychiatric Care: A Systematic Review

Department of Psychiatry, Cambridge Health Alliance, Cambridge, MA 02139, USA.
Psychiatric services (Washington, D.C.) (Impact Factor: 2.41). 08/2010; 61(8):765-73. DOI: 10.1176/
Source: PubMed


This literature review examined the effects of patients' limited English proficiency and use of professional and ad hoc interpreters on the quality of psychiatric care.
PubMed, PsycINFO, and CINAHL (Cumulative Index to Nursing and Allied Health Literature) were systematically searched for English-language publications from inception of each database to April 2009. Reference lists were reviewed, and expert sources were consulted. Among the 321 articles identified, 26 met inclusion criteria: peer-reviewed articles reporting primary data on clinical care for psychiatric disorders among patients with limited proficiency in English or in the provider's language.
Evaluation in a patient's nonprimary language can lead to incomplete or distorted mental status assessment. Although both untrained and trained interpreters may make errors, untrained interpreters' errors may have greater clinical impact, compromising diagnostic accuracy and clinicians' detection of disordered thought or delusional content. Use of professional interpreters may improve disclosure in patient-provider communications, referral to specialty care, and patient satisfaction.
Little systematic research has addressed the impact of language proficiency or interpreter use on the quality of psychiatric care in contemporary U.S. settings. Findings are insufficient to inform evidence-based guidelines for improving quality of care among patients with limited English proficiency. Clinicians should be aware of the ways in which quality of care can be compromised when they evaluate patients in a nonprimary language or use an interpreter. Given U.S. demographic trends, future research should help guide practice and policy by addressing deficits in the evidence base.

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Available from: Margarita Alegria, Oct 10, 2014
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    • "In mental health care, many symptoms are not associated with directly observable behaviors. Self-reports are needed to conduct a thorough mental status examination (Bauer & Alegría, 2010). In their review of the literature, which included 14 studies in psychiatric care, Bauer and Alegría concluded that people with limited language proficiency are more likely to reply with greater disclosure when they are interviewed in their native language. "
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    ABSTRACT: As language may be an important barrier for ethnic minority families to access health care, interpreters can be a valuable aid to reach these families. Little is known, however, about the effects of using interpreters in mental health care. The present study investigated whether the use of interpreters affected treatment outcomes of Multisystemic therapy (MST) in the Netherlands. Ninety-one cases with an interpreter were compared with 91 cases without an interpreter. The two groups were matched regarding age, gender, imposed sanction, and therapist. Each case’s progress, treatment duration, and treatment outcomes were obtained. For 61 of the matched pairs, long-term re-conviction rates were retrieved from official judicial records. Comparing the cases with interpreter and the matched controls revealed no significant differences. Moreover, the treatment outcomes were the same for professional and family interpreters. Although there was a trend toward higher recidivism rates during MST when an interpreter had been used, the long-term judicial data did not reveal any differences between the interpreter group and the matched control group. Thus, it seems that in a highly structured and goal-oriented treatment like MST, both professional and family interpreters can be used to obtain treatment outcomes comparable with those of native speakers.
    Journal of Emotional and Behavioral Disorders 08/2015; DOI:10.1177/1063426615592821 · 1.28 Impact Factor
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    • "Consequently, the use of professional interpreters or culture brokers is preferred. It has been shown that professional translation improves the quality of treatment and patients' satisfaction with treatment [5]. "
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    ABSTRACT: The stress of migration as well as social factors and changes related to the receiving society may lead to the manifestation of psychiatric disorders in vulnerable individuals after migration. The diversity of cultures, ethnicities, races and reasons for migration poses a challenge for those seeking to understand how illness is experienced by immigrants whose backgrounds differ significantly from their clinicians. Cultural competence represents good clinical practice and can be defined as such that a clinician regards each patient in the context of the patient's own culture as well as from the perspective of the clinician's cultural values and prejudices. The EPA Guidance on cultural competence training outlines some of the key issues related to cultural competence and how to deal with these. It points out that cultural competence represents a comprehensive response to the mental health care needs of immigrant patients and requires knowledge, skills and attitudes which can improve the effectiveness of psychiatric treatment. To reach these aims, both individual and organizational competence are needed, as well as teaching competence in terms of educational leadership. The WPA Guidance on Mental Health and Mental Health Care for Migrants and the EPA Guidance on Mental Health Care for Migrants list a series of recommendations for policy makers, service providers and clinicians; these are aimed at improving mental health care for immigrants. The authors of this paper would like to underline these recommendations and, focusing on cultural competency and training, believe that they will be of positive value. Copyright © 2015 Elsevier Masson SAS. All rights reserved.
    European Psychiatry 02/2015; 30(3). DOI:10.1016/j.eurpsy.2015.01.012 · 3.44 Impact Factor
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    • "Despite this originality our results are consistent with past literature, confirming core results on diversity of interpreters' roles, the crucial places of trust and time, need for recognition of interpreters' and the complexity of practitioners' work. While authors do not agree on whether interpreters should translate literally or play more extensive roles in mental health (Bauer & Alegria, 2010), there appears to be consensus on the complexity of interpreters' work when they are asked to play more extensive roles, as in the clinics chosen for this study. Recognition of the fundamental ambiguity of their roles and laying aside (or positively managing) clinicians' need for control might lead to better practice and health outcomes. "
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    ABSTRACT: Few empirical studies have detailed the specificities of working with interpreters in mental healthcare for children. The integration of interpreters in clinical teams in child mental healthcare was explored in two clinics, in Montreal and Paris. Four focus groups were conducted with interpreters and clinicians. Participants described the development of the working alliance between interpreters and clinicians, the delineation of interpreters' roles, and the effects of translation on the people in the interaction. Integrating interpreters in a clinical team is a slow process in which clinicians and interpreters need to reflect upon a common framework. An effective framework favours trust, mutual understanding, and valorization of the contribution of each to the therapeutic task. The interpreter's presence and activities seem to have some therapeutic value. © The Author(s) 2014 Reprints and permissions:
    Transcultural Psychiatry 12/2014; 52(3). DOI:10.1177/1363461514558137 · 0.99 Impact Factor
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