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Health Disparities in Neurology: Brain Disease and Mental Illness

Some brain diseases are more likely to be overlooked and go undiagnosed because of signs and symptoms that overlap with mental health conditions. 

People living with mental illness often face stigma and additional struggles getting a diagnosis for certain brain diseases. May is Mental Health Awareness Month, and in an effort to bring awareness to this topic, we are taking a closer look at how stigma around mental illness contributes to health disparities in neurology and brain health.

What Are Health Disparities in Brain Health?

Health disparities refer to differences or gaps in health care for certain groups of people. Research has shown that brain disease has a higher impact on people in lower socioeconomic groups and underserved geographic and global populations, as well as many marginalized populations in the U.S., including Black, Latino, Asian, Native American, and LGBTQ+ individuals. (Read about one of our funded researchers’ projects investigating racial disparities in end-of-life care for Parkinson’s disease.)

People who are dealing with mental health issues also face a unique set of challenges that contribute to disparities in diagnosis and care. For example, they may have trouble describing the subtle differences between certain mental health symptoms and symptoms of brain disease. In some cases, healthcare providers may miss some symptoms of brain disease because they overlap with symptoms of a mental health condition (or may wrongly credit new symptoms to an existing mental health diagnosis).

In a given year, approximately 20 percent of Americans over the age of 18 meet the criteria for a diagnosable mental disorder. This includes a range of different diseases, including depression, schizophrenia, attention deficit hyperactivity disorder (ADHD), and obsessive-compulsive disorder (OCD). 

Bias Around Mental Illness Can Make Brain Disease Harder to Diagnose

People with mental illness tend to die earlier and have higher rates of comorbidities than the general population. This is in part due to the fact that for people with a history of mental health issues, some less common physical symptoms of brain disease and other disorders can be mistaken for mental illness. 

Many in the medical community acknowledge that this common bias negatively impacts people with mental health issues and leads to what is called “diagnostic overshadowing.” Diagnostic overshadowing can cause doctors to mistakenly overlook serious medical conditions. For example, they may assume chest pain is due to anxiety and panic attacks or mistakenly view nausea and abdominal pain as the result of mental or emotional disturbances. 

In one unfortunate example of diagnostic overshadowing, doctors in the U.K. told one woman with a mental illness listed as a pre-existing condition that her symptoms—loss of movement on her left side and garbled speech—were not the result of a stroke but instead had psychological causes. While she was later diagnosed with Moyamoya disease, a rare brain disease that causes debilitating “mini-strokes,” she had already experienced lasting damage to her mobility and vision. She believes that her 15-year history with mental illness influenced how her doctors initially viewed her symptoms and came to a diagnosis.

Doctors take great care to arrive at accurate diagnoses, but mental illness often complicates this process because some symptoms of mental health disorders and neurologic diseases overlap. In some cases, a person may have trouble describing their symptoms and communicating the differences between mental health symptoms and physical ones. Mental illness can affect the way a person thinks, feels, and behaves, and symptoms can range from mild to severe—just like many other brain disorders. Additionally, some neurologic conditions, such as Huntington’s disease and dementia, are associated with personality changes like apathy and aggressive behavior or mood disorders like depression and anxiety. 

The lines between brain disease and mental health have become even more blurred in recent years, as researchers continue to uncover biological causes for certain mental illnesses as well as how mental illness may impact the structure and function of a person’s brain.

Stigma in Mental Health Care

Social stigma refers to generalized negative beliefs about a person or group of people because of a specific distinguishing characteristic. The stigma surrounding mental illness can make it more difficult for people with brain disease to get an accurate diagnosis and effective treatment.

Because of the stigma surrounding mental illness, people may feel self-doubt and shame about seeking care for their mental health symptoms as well as other medical issues. They may face a lack of understanding from their own family and friends, and therefore worry they won’t be taken seriously by medical professionals.

Studies show that people who have a mental illness receive poorer quality care for their physical health problems. This may be due to a range of factors, from reluctance to seek care or report certain symptoms to broader prejudices and stereotypes influencing diagnosis and clinical treatment.

How Research Can Reduce Disparities in Neurologic Care

At the American Brain Foundation, we are committed to funding research into health disparities in neurologic care as well as spreading awareness and education about brain disease. Education can reduce the stigma around mental health and encourage people to self-advocate and seek care for their symptoms.

We know that research will lead to better diagnosis and treatments for all brain diseases, including a deeper understanding of the relationship between brain disease and mental illness. Learning more about the connections and overlapping symptoms between brain diseases and mental illness will help fight bias and enable doctors to make more accurate diagnoses. With your support, we can reduce the health disparities in neurology due to mental illness.The American Brain Foundation is committed to finding cures for brain diseases. Donate today to make a difference. With your help, we can all experience life without brain disease.