Review Article|Articles in Press

Intersection of Mental Health and Dysphonia: A Scoping Review



      Previous research has indicated that voice disorders frequently co-occur with mental health disorders, which may influence voice treatment seeking behavior and effectiveness. Our goal is to characterize the existing literature on the relationship between voice disorders and mental health and to investigate nuances related to mental health and voice disorder diagnosis.

      Data Sources

      Ovid MEDLINE, ProQuest PsycINFO, and Web of Science.

      Review Methods

      Using the PRISMA protocol, a scoping review was performed. Databases searched included: Ovid MEDLINE, ProQuest PsycINFO, and Web of Science. Our inclusion criteria were all adults seen in an outpatient setting for voice and mental health disorders, excluding those with a prior history of head and neck surgery, cancers, radiation, or developmental anomalies, and certain mental health disorders. Results were screened by two independent screeners for inclusion. Data were then extracted and analyzed to present key findings and characteristics.


      A total of 156 articles, with publication dates ranging from 1938 to 2021, were included in the analysis, with females and teachers being the most described population groups. The most frequently studied laryngeal disorders were dysphonia (n = 107, 68.6%), globus (n = 33, 21.2%), and dysphonia with globus (n = 16, 10.2%). The two most common mental health disorders found in the included studies were anxiety disorders (n = 123, 78.8%) and mood disorders (n = 111, 71.2%). The Voice Handicap Index was the most used tool to gather data on voice disorders (n = 36, 23.1%), while the Hospital Anxiety and Depression Scale was the most used tool to gather data on mental health disorders (n = 20, 12.8%). The populations studied within the included articles were predominately female and worked in educational occupations. Race and ethnicity was only reported for 10.2% of included articles (n = 16) and the most commonly studied race was White/Caucasian (n = 13, 8.3%).


      Our scoping review of the current literature on mental health and voice disorders reveals an intersection between the conditions. The current literature represents change over time in terms of terminology that recognizes the patient's individualized experience of mental health and laryngeal conditions. However, there is still a great deal of homogeneity in the studied patient populations in terms of race and gender, with patterns and gaps that require further investigation.

      Key Words

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        • Greene JS
        Psychiatric therapy for dysphonia - aphonia; psychophonasthenia; falsetto.
        Arch Otolaryngol. 1938; 28: 213-221
      1. Peters MDJ, Godfrey C, McInerney P, et al. Chapter 11: Scoping Reviews. In: Aromataris E, Munn Z, eds. JBI Manual for Evidence Synthesis. JBI; 2020.

        • Peters MDJ
        • Marnie C
        • Tricco AC
        • et al.
        Updated methodological guidance for the conduct of scoping reviews.
        JBI Evid Synth. 2021; 18: 2119-2126
        • Tricco AC
        • Lillie E
        • Zarin W
        • et al.
        PRISMA extension for scoping reviews (PRISMA-ScR): checklist and explanation.
        Ann Intern Med. 2018; 169: 467-473
      2. Ravi S, Lopez V, Carter KV, et al. Intersection of dysphonia and mental health: a scoping review protocol.

        • McGowan J
        • Sampson M
        • Salzwedel DM
        • et al.
        PRESS peer review of electronic search strategies: 2015 guideline statement.
        J Clin Epidemiol. 2016; 75: 40-46
        • Ouzzani M
        • Hammady H
        • Fedorowicz Z
        • et al.
        Rayyan-a web and mobile app for systematic reviews.
        Syst Rev. 2016; 5: 210
        • Harris PA
        • Taylor R
        • Minor BL
        • et al.
        The REDCap consortium: building an international community of software platform partners.
        J Biomed Inform. 2019; 95103208
        • Harris PA
        • Taylor R
        • Thielke R
        • et al.
        Research electronic data capture (REDCap)–a metadata-driven methodology and workflow process for providing translational research informatics support.
        J Biomed Inform. 2009; 42: 377-381
        • Jacobson BH
        • Johnson A
        • Grywalski C
        • et al.
        The Voice Handicap Index (VHI): development and validation.
        Am J Speech Lang Pathol. 1997; 6: 66-70
        • Rosen CA
        • Lee AS
        • Osborne J
        • et al.
        Development and validation of the Voice Handicap Index-10.
        Laryngoscope. 2004; 114: 1549-1556
        • Zigmond AS
        • Snaith RP
        The hospital anxiety and depression scale.
        Acta Psychiatr Scand. 1983; 67: 361-370
        • Beck AT
        • Ward CH
        • Mendelson M
        • et al.
        An inventory for measuring depression.
        Arch Gen Psychiatry. 1961; 4: 561-571
        • Spitzer RL
        • Kroenke K
        • Williams JB
        • et al.
        A brief measure for assessing generalized anxiety disorder: the GAD-7.
        Arch Intern Med. 2006; 166: 1092-1097
        • Kroenke K
        • Spitzer RL
        • Williams JB
        The PHQ-9: validity of a brief depression severity measure.
        J Gen Intern Med. 2001; 16: 606-613
        • Spielberger CD
        • Gorsuch RL
        • Lushene R
        • et al.
        Manual for the State-Trait Anxiety Inventory.
        Consulting Psychologists Press, Palo Alto, CA1983
        • Ware Jr, JE
        • Sherbourne CD
        The MOS 36-item short-form health survey (SF-36). I. conceptual framework and item selection.
        Med Care. 1992; 30: 473-483
      3. U.S. Bureau of Labor Statistics. Standard Occupational Classification. Washington

        • House AO
        • Andrews HB.
        Life events and difficulties preceding the onset of functional dysphonia.
        J Psychosom Res. 1988; 32: 311-319
        • Lehtinen V
        • Puhakka H
        A psychosomatic approach to the globus hystericus syndrome.
        Acta Psychiatr Scand. 1976; 53: 21-28
        • Puhakka H
        • Lehtinen V
        • Aalto T
        Globus hystericus-a psychosomatic disease?.
        J Laryngol Otol. 1976; 90: 1021-1026
        • Willinger U
        • Volkl-Kernstock S
        • Aschauer HN
        Marked depression and anxiety in patients with functional dysphonia.
        Psychiatry Res. 2005; 134: 85-91
        • Willinger U
        • Aschauer HN
        Personality, anxiety and functional dysphonia.
        Pers Individ Dif. 2005; 39: 1441-1449
        • Butcher P
        • Elias A
        • Cavalli L
        Understanding and Treating Psychogenic Voice Disorder: A CBT Framework.
        John Wiley & Sons Ltd, New York, NY2007
        • Seifert E
        • Kollbrunner J
        An update in thinking about nonorganic voice disorders.
        Arch Otolaryngol Head Neck Surg. 2006; 132: 1128-1132
        • Van Mersbergen MR
        Functional Dysphonia During Mental Imagery: Exploring the Sources of Anxiety.
        University of Minnesota, Minneapolis, MN2005
        • Baker J
        The role of psychogenic and psychosocial factors in the development of functional voice disorders.
        Int J Speech Lang Pathol. 2008; 10: 210-230
        • Krischke S
        • Weigelt S
        • Hoppe U
        • et al.
        Quality of life in dysphonic patients.
        J Voice. 2005; 19: 132-137
        • Zraick RI
        • Risner BY
        • Smith-Olinde L
        • et al.
        Patient versus partner perception of voice handicap.
        J Voice. 2007; 21: 485-494
        • Bishop LC
        • Riley WT
        The psychiatric management of the globus syndrome.
        Gen Hosp Psychiatry. 1988; 10: 214-219
        • Cannito MP
        Emotional considerations in spasmodic dysphonia: psychometric quantification.
        J Commun Disord. 1991; 24: 313-329
        • Deary IJ
        • Wilson JA
        Problems in treating globus pharyngis.
        Clin Otolaryngol. 1994; 19: 55-60
        • Gunther V
        • Mayr-Graft A
        • Miller C
        • et al.
        A comparative study of psychological aspects of recurring and non-recurring functional aphonias.
        Eur Arch Otorhinolaryngol. 1996; 253: 240-244
        • Hartman DE
        • Daily WW
        • Morin KN
        A case of superior laryngeal nerve paresis and psychogenic dysphonia.
        J Speech Hear Disord. 1989; 54: 526-529
        • Kinzl J
        • Biebl W
        • Rauchegger H
        Functional aphonia: psychosomatic aspects of diagnosis and therapy.
        Folia Phoniatr (Basel). 1988; 40: 131-137
        • Moser G
        • Vacariu-Granser GV
        • Schneider C
        • et al.
        High incidence of esophageal motor disorders in consecutive patients with globus sensation.
        Gastroenterology. 1991; 101: 1512-1521
        • Falanga C
        • Costa G
        • Volpe U
        • et al.
        Psychological distress in a sample of adult Italian patients affected by vocal nodules and muscle-tension dysphonia: preliminary results.
        J Voice. 2023; 37: 300.e21-300.e29
        • Hu A
        • Isetti D
        • Hillel AD
        • et al.
        Disease-specific self-efficacy in spasmodic dysphonia patients.
        Otolaryngol Head Neck Surg. 2013; 148: 450-455
        • Kosztyla-Hojna B
        • Moskal D
        • Lobaczuk-Sitnik A
        • et al.
        Psychogenic voice disorders.
        Otolaryngol Pol. 2018; 72: 26-34
        • Misono S
        • Haut C
        • Meredith L
        • et al.
        Dysphonia, perceived control, and psychosocial distress: a qualitative study.
        J Voice. 2019; 33: 682-690
        • Tezcaner ZC
        • Gokmen MF
        • Yildirim S
        • et al.
        Clinical features of psychogenic voice disorder and the efficiency of voice therapy and psychological evaluation.
        J Voice. 2019; 33: 250-254
        • White LJ
        • Hapner ER
        • Klein AM
        • et al.
        Coprevalence of anxiety and depression with spasmodic dysphonia: a case-control study.
        J Voice. 2012; 26: 667.e1-667.e6
        • Cybulska EM
        Globus hystericus or depressivus?.
        Hosp Med. 1998; 59: 640-641
        • Finkenbine R
        • Miele VJ
        Globus hystericus: a brief review.
        Gen Hosp Psychiatry. 2004; 26: 78-82
        • Branski RC
        • Cukier-Blaj S
        • Pusic A
        • et al.
        Measuring quality of life in dysphonic patients: a systematic review of content development in patient-reported outcomes measures.
        J Voice. 2010; 24: 193-198
        • Deary V
        • Miller T
        Reconsidering the role of psychosocial factors in functional dysphonia.
        Curr Opin Otolaryngol Head Neck Surg. 2011; 19: 150-154
        • Lauriello M
        • Cozza K
        • Rossi A
        • et al.
        Psychological profile of dysfunctional dysphonia.
        Acta Otorhinolaryngol Ital. 2003; 23: 467-473
        • Misono S
        • Peterson CB
        • Meredith L
        • et al.
        Psychosocial distress in patients presenting with voice concerns.
        J Voice. 2014; 28: 753-761
        • Zraick RI
        • Risner BY
        Assessment of quality of life in persons with voice disorders.
        Curr Opin Otolaryngol Head Neck Surg. 2008; 16: 188-193
        • Jordan VA
        • Cohen S
        • Lunos S
        • et al.
        Mental health and dysphonia: which comes first, and does that change care utilization?.
        Laryngoscope. 2020; 130: 1243-1248