{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T14:36:20Z","timestamp":1777991780658,"version":"3.51.4"},"reference-count":23,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2020,2,8]],"date-time":"2020-02-08T00:00:00Z","timestamp":1581120000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100006441","name":"Center for Outcomes Research and Evaluation, Yale School of Medicine","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100006441","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100005193","name":"American Academy of Otolaryngology-Head and Neck Surgery","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100005193","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100006108","name":"National Center for Advancing Translational Sciences","doi-asserted-by":"publisher","award":["UL1TR000114"],"award-info":[{"award-number":["UL1TR000114"]}],"id":[{"id":"10.13039\/100006108","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000055","name":"National Institute on Deafness and Other Communication Disorders","doi-asserted-by":"publisher","award":["K23DC016335"],"award-info":[{"award-number":["K23DC016335"]}],"id":[{"id":"10.13039\/100000055","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["The Laryngoscope"],"published-print":{"date-parts":[[2020,5]]},"abstract":"<jats:sec><jats:title>Objectives<\/jats:title><jats:p>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\u2010related diagnoses first, 2) voice\u2010related diagnoses and care utilization, and 3) time to specialty evaluation in each group.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>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\u2010 and voice\u2010related diagnoses, and voice\u2010related care utilization were analyzed using descriptive statistics and multivariable regression modeling.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>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 (<jats:italic>P<\/jats:italic> &lt;\u20090.0001). The latter group received more specific voice\u2010related 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 (<jats:italic>P<\/jats:italic> &lt;\u20090.0001).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Most patients with voice and MH diagnoses received a MH diagnosis first. Patients who receive MH diagnoses first appeared to have different voice\u2010related healthcare compared to those who received voice diagnoses first.<\/jats:p><\/jats:sec><jats:sec><jats:title>Level of Evidence<\/jats:title><jats:p>NA<\/jats:p><jats:p><jats:italic>Laryngoscope<\/jats:italic>, 130:1243\u20131248, 2020<\/jats:p><\/jats:sec>","DOI":"10.1002\/lary.28203","type":"journal-article","created":{"date-parts":[[2020,2,8]],"date-time":"2020-02-08T14:47:52Z","timestamp":1581173272000},"page":"1243-1248","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["Mental Health and Dysphonia: Which Comes First, and Does That Change Care Utilization?"],"prefix":"10.1002","volume":"130","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3353-4872","authenticated-orcid":false,"given":"Victoria A.","family":"Jordan","sequence":"first","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery University of Minnesota  Minneapolis Minnesota"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7965-604X","authenticated-orcid":false,"given":"Seth","family":"Cohen","sequence":"additional","affiliation":[{"name":"Duke Voice Care Center, Division of Otolaryngology\u2013Head &amp; Neck Surgery Duke University Medical Center  Durham North Carolina U.S.A."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Scott","family":"Lunos","sequence":"additional","affiliation":[{"name":"Clinical and Translational Science Institute, Biostatistical Design and Analysis Center University of Minnesota  Minneapolis Minnesota"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Keith J.","family":"Horvath","sequence":"additional","affiliation":[{"name":"School of Public Health, Division of Epidemiology and Community Health University of Minnesota  Minneapolis Minnesota"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gretchen","family":"Sieger","sequence":"additional","affiliation":[{"name":"Clinical and Translational Science Institute, Best Practices Integrated Informatics Core University of Minnesota  Minneapolis Minnesota"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9000-6323","authenticated-orcid":false,"given":"Stephanie","family":"Misono","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery University of Minnesota  Minneapolis 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