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Migration, culture and language are factors that influence medical treatment, consequently, prognosis and outcome. In psychiatry they have been linked to low and delayed mental health service use and sub-optimal diagnosis and treatment. However, due to the close relationship between place of origin, culture, and language, it has been difficult to disentangle these factors and their mutual influence.
Added-value of this studyDue to the multilingualism present in Switzerland, low language proficiency in the local language is not found eclusively in migrants. Using appropriate statistical methods, such as propensity score matching, it is possible to reduce the effects of confounding variables.
Implications of all the available evidenceLow language proficiency constitutes a risk for coercive measures throughout hospitalisation; consequently, language-sensitive medical practice is required, alongside the active use of translation services.
1 IntroductionHuman language is a powerful tool for communication and cooperation. The learning and mastery of a language are the products of a complex interplay between the environment and the individual [1]. Language is more than a medium for communication; it shapes and structures cognition, consciousness, experience, identity, society and culture. Language has also a boundary-creating function in the construction and maintenance of distinct identities.Therefore, language proficiency is highly associated with socioeconomic conditions, educational level, and culture [2,3]. Place of origin influences language development; therefore, non-mastery of a local language is almost exclusively observed in newcomers [1,4].
As communication is essential for the doctor-patient relationship, low language proficiency may lead to sub-optimal diagnosis and therapy; moreover, it obstructs access to medical care [5–8]. With globalisation leading to increasing linguistic and cultural diversity, people who do not speak the local language pose a considerable challenge for the health system, particularly in mental health [6]. In psychiatry, language, speech and narrative are the main diagnostic and therapeutic tools. This process is often disrupted in mental health disorders, low language proficiency further disrupts it [9]. In psychiatric services, low language proficiency has been related to misdiagnosis and poorer outcomes. However, in many sample populations, the effects of language could not be separated from other demographic and clinical sample characteristics [10–12].
Low...