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The Growing Importance of Mixed-Methods Research in Health

Sharada prasad wasti.

1,2 School of Human and Health Sciences, University of Huddersfield, United Kingdom

Padam Simkhada

3 Centre for Midwifery, Maternal and Perinatal Health, Bournemouth University, Bournemouth, United Kingdom

Edwin R. van Teijlingen

Brijesh sathian.

4 Geriatrics and long term care Department, Rumailah Hospital, Hamad Medical Corporation, Doha, Qatar

Indrajit Banerjee

5 Sir Seewoosagur Ramgoolam Medical College, Belle Rive, Mauritius

All authors have made substantial contributions to all of the following: (1) the conception and design of the study (2) drafting the article or revising it critically for important intellectual content, (3) final approval of the version to be submitted

There is no conflict of interest for any author of this manuscript.

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sector.

This paper illustrates the growing importance of mixed-methods research to many health disciplines ranging from nursing to epidemiology. Mixed-methods approaches requires not only the skills of the individual quantitative and qualitative methods but also a skill set to bring two methods/datasets/findings together in the most appropriate way. Health researchers need to pay careful attention to the ‘best’ approach to designing, implementing, analysing, integrating both quantitative (number) and qualitative (word) information and writing this up in a way offers greater insights and enhances its applicability. This paper highlights the strengths and weaknesses of mixed-methods approaches as well as some of the common mistakes made by researchers applying mixed-methods for the first time.

Quantitative and qualitative research methods each address different types of questions, collect different kinds of data and deliver different kinds of answers. Each set of methods has its own inherent strengths and weaknesses, and each offers a particular approach to address specific types of research questions (and agendas). Health disciplines such as dentistry, nursing, speech and language therapy, and physiotherapy often use either quantitative or qualitative research methods on their own. However, there is a steadily growing literature showing the advantages of mixed-methods research is used in the health care and health service field [ 1-2 ]. Although we have advocated the use of mixed-methods in this journal eight years ago [ 3 ], there is still not enough mixed-methods research training in the health research field, particularly for health care practitioners, such as nurses, physiotherapists, midwives, and doctors, wanting to do research. Mixed-methods research has been popular in the social sciences since the twentieth century [ 4 ], and it has been growing in popularity among healthcare professionals [ 5 ], although it is still underdeveloped in disciplines such nursing and midwifery [ 6 , 7 ].

Underpinning philosophies

To help understand that mixed-methods research is not simply employing two different methods in the same study, one needs to consider their underpinning research philosophies (also called paradigms). First, quantitative research is usually underpinned by positivism. This includes most epidemiological studies; such research is typically based on the assumption that there is one single real world out there that can be measured. For example, quantitative research would address the question “What proportion of the population of India drinks coffee?” Secondly, qualitative research is more likely to be based on interpretivism. This includes research based on interviews and focus groups, research which us is typically based on the assumption that we all experience the world differently. Since we all live in a slightly different world in our heads the task of qualitative research is to analyse the interpretations of the people in the sample. For example, qualitative research would address the question “How do people experience drinking coffee in India?”, and “What does drinking coffee mean to them?”

Mixed-methods research brings together questions from two different philosophies in what is being referred to as the third path [ 8 ], third research paradigm [ 9 , 10 ], the third methodology movement [ 11 , 12 ] and pragmatism [ 5 ]. The two paradigms differ in key underlying assumptions that ultimately lead to choices in research methodology and methods and often give a breadth by answering more complicated research questions [ 4 ]. The roles of mixed-methods are clear in an understanding of the situation (the what), meaning, norms, values (the why or how) within a single research question which combine the strength of two different method and offer multiple ways of looking at the research question [ 13 ]. Epidemiology sits strongly in the quantitative research corner, with a strong emphasis on large data sets and sophisticated statistical analysis. Although the use of mixed methods in health research has been discussed widely researchers raised concerns about the explanation of why and how mixed methods are used in a single research question [ 5 ].

The relevance of mixed-methods in health research

The overall goal of the mixed-methods research design is to provide a better and deeper understanding, by providing a fuller picture that can enhance description and understanding of the phenomena [ 4 ]. Mixed-methods research has become popular because it uses quantitative and qualitative data in one single study which provides stronger inference than using either approach on its own [ 4 ]. In other words, a mixed-methods paper helps to understand the holistic picture from meanings obtained from interviews or observation to the prevalence of traits in a population obtained from surveys, which add depth and breadth to the study. For example, a survey questionnaire will include a limited number of structured questions, adding qualitative methods can capture other unanticipated facets of the topic that may be relevant to the research problem and help in the interpretation of the quantitative data. A good example of a mixed-methods study, it one conducted in Australia to understand the nursing care in public hospitals and also explore what factors influence adherence to nursing care [ 14 ]. Another example is a mixed-methods study that explores the relationship between nursing care practices and patient satisfaction. This study started with a quantitative survey to understand the general nursing services followed by qualitative interviews. A logistic regression analysis was performed to quantify the associations between general nursing practice variables supplemented with a thematic analysis of the interviews [ 15 ]. These research questions could not be answered if the researchers had used either qualitative or quantitative alone. Overall, this fits well with the development of evidence-based practice.

Despite the strengths of mixed-methods research but there is not much of it in nursing and other fields [ 7 ]. A recent review paper shows that the prevalence of mixed-methods studies in nursing was only 1.9% [ 7 ]. Similarly, a systematic review synthesised a total of 20 papers [ 16 ], and 16 papers [ 17 ] on nursing-related research paper among these only one mixed-methods paper was identified. Worse, a further two mixed-methods review recently revealed that out of 48 [ 18 , 19 ] synthesised nursing research papers, not one single mixed-methods paper was identified. This clearly depicts that mixed-methods research is still in its infancy stage in nursing but we can say there is huge scope to implement it to understand research questions on both sides of coin [ 4 ]. Therefore, there is a great need for mixed-methods training to enhance the evidence-based decision making in health and nursing practices.

Strengths and weaknesses of mixed-methods

There are several challenges in identifying expertise of both methods and in working with a multidisciplinary, interdisciplinary, or transdisciplinary team [ 20 ]. It increases costs and resources, takes longer to complete as mixed-methods design often involves multiple stages of data collection and separate data analysis [ 4 , 5 ]. Moreover, conducting mixed-methods research does not necessarily guarantee an improvement in the quality of health research. Therefore, mixed-methods research is only appropriate when there are appropriate research questions [ 4 , 6 ].

Identifying an appropriate mixed-methods journal can also be challenging when writing mixed-methods papers [ 21 ]. Mixed-methods papers need considerably more words than single-methods papers as well as sympathetic editors who understand the underlying philosophy of a mixed-methods approach. Such papers, simply require more words. The mixed-methods researcher must be reporting two separate methods with their own characteristics, different samples, and ways of analysing, therefore needs more words to describe both methods as well as both sets of findings. Researcher needs to find a journal that accepts longer articles to help broaden existing evidence-based practice and promote its applicability in the nursing field [ 22 ].

Common mistakes in applying mixed-methods

Not all applied researchers have insight into the underlying philosophy and/or the skills to apply each set of methods appropriately. Younas and colleagues’ review identified that around one-third (29%) of mixed-methods studies did not provide an explicit label of the study design and 95% of studies did not identify the research paradigm [ 7 ]. Whilst several mixed-methods publications did not provide clear research questions covering both quantitative and qualitative approaches. Another common issue is how to collect data either concurrent or sequential and the priority is given to each approach within the study where equal or dominant which are not clearly stated in writing which is important to mention while writing in the methods section. Similarly, a commonly overlooked aspect is how to integrate both findings in a paper. The responsibility lies with the researcher to ensure that findings are sufficiently plausible and credible [ 4 ]. Therefore, intensive mixed-methods research training is required for nursing and other health practitioners to ensure its appropriate.

The way forward

Despite the recognised strengths and benefits of doing mixed-methods research, there is still only a limited number of nursing and related-health research publications using such this approach. Researchers need training in how to design, conduct, analyse, synthesise and disseminate mixed-methods research. Most importantly, they need to consider appropriate research questions that can be addressed using a mixed methods approach to add to our knowledge in evidence-based practice. In short, we need more training on mixed-methods research for a range of health researchers and health professionals.

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The Journal of Research in Health Sciences (JRHS) serves as the official publication of the School of Public Health at Hamadan University of Medical Sciences and is released on a quarterly basis. Since 2017, JRHS has transitioned to an electronic format.

JRHS is a rigorously peer-reviewed scientific journal with a multidisciplinary focus within the realm of public health. It welcomes contributions from diverse fields including Epidemiology, Biostatistics, Public Health, Occupational Health, Environmental Health, Health Education, and Preventive and Social Medicine.

It is important to note that we do not accept submissions related to clinical trials, animal studies, qualitative studies, health insurance, or hospital management. Additionally, we do not consider research findings from laboratory and chemical studies in the domains of ergonomics, occupational health, and environmental health for publication.

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Effects of the maternal and child health handbook and other home-based records on mothers' non-health outcomes: a systematic review

Affiliations.

• 1 Department of Community and Global Health, The University of Tokyo Graduate School of Medicine Faculty of Medicine, Bunkyo-ku, Tokyo, Japan [email protected].
• 2 Department of Public Health Sciences, University of Connecticut Health Center, Farmington, Connecticut, USA.
• 3 Department of Community and Global Health, The University of Tokyo Graduate School of Medicine Faculty of Medicine, Bunkyo-ku, Tokyo, Japan.
• 4 Faculty of Policy Management, Keio University, Fujisawa-shi, Kanagawa, Japan.
• 5 National Medical Research Center for Obstetrics, Gynecology and Perinatology named after Academician V.I. Kulakov of the Ministry of Health of the Russian Federation, Moscow, Russian Federation.
• 6 Department of Neonatal Pathology, National Medical Research Center for Children's Health, Moscow, Russian Federation.
• PMID: 35728908
• PMCID: PMC9214383
• DOI: 10.1136/bmjopen-2021-058155

Objective: This review aimed to investigate the effects of the maternal and child health (MCH) handbook and other home-based records on mothers' non-health outcomes.

Design: Systematic review.

Data sources: PubMed, Web of Science, CINAHL, Academic Search Complete, PsycArticles, PsycINFO, SocINDEX, CENTRAL, NHS EED, HTA, DARE, Ichuushi and J-STAGE through 26 March 2022.

Eligibility criteria for selecting studies: Original research articles examining home-based records and mothers' non-health outcomes published in English or Japanese across various study designs.

Data extraction and synthesis: Two independent reviewers extracted relevant data and assessed the risk of bias. We assessed the certainty of evidence for each study using the Grading of Recommendations Assessment, Development, and Evaluation approach. Due to the heterogeneity of the included studies, we conducted a narrative synthesis of their findings.

Results: Of the 4199 articles identified, we included 47 articles (20 in Japanese) in the review. Among the different types of home-based records, only the MCH handbook provided essential information about the mother-child relationship, and its use facilitated the mother-child bonding process. Mothers reported generally feeling satisfied with the use of home-based records; although their satisfaction with health services was influenced by healthcare providers' level of commitment to using these records. While home-based records positively affected communication within the household, we observed mixed effects on communication between mothers/caregivers and healthcare providers. Barriers to effective communication included a lack of satisfactory explanations regarding the use of home-based records and personalised guidance from healthcare providers. These records were also inconsistently used across different health facilities and professionals.

Conclusions: The MCH handbook fostered the mother-child bond. Mothers were generally satisfied with the use of home-based records, but their engagement depended on how these records were communicated and used by healthcare providers. Additional measures are necessary to ensure the implementation and effective use of home-based records.

Prospero registration number: CRD42020166545.

Keywords: Community child health; PUBLIC HEALTH; SOCIAL MEDICINE.

© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

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Competing interests: None declared.

PRISMA flow diagram of the…

PRISMA flow diagram of the screening process. MCH, maternal and child health; PRISMA,…

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Conducting Research in the New Abortion Care Policy Landscape

• 1 University of Michigan Ford School of Public Policy, Ann Arbor
• Research Letter A Cautionary Note on Trends in Maternal Death Post- Dobbs v Jackson Women’s Health Amanda Jean Stevenson, PhD; Leslie Root, PhD JAMA Network Open

The public policy chaos fueled by the June 2022 Dobbs v Jackson Women’s Health Organization Supreme Court decision has created a critical need for objective and high-quality abortion policy evaluation research. Stevenson and Root 1 rose to this challenge by conducting a convincing analysis of recent trends in maternal mortality, motivated in part by pro-life advocate claims that the recent observed decline in pregnancy-related death is the counterintuitive result of more restrictive abortion policies post– Dobbs v Jackson Women’s Health . Using 5.75 years of monthly national maternal mortality data from January 2018 through September 2023, their decomposition approach considered spikes in mortality from COVID-19 and potential seasonal fluctuations in maternal deaths. The findings clearly demonstrate that the observed decline in maternal mortality after the 2022 Dobbs v Jackson Women’s Health ruling is the result of a resolution of the COVID-19 mortality shock, not because of new restrictive abortion laws being passed by state legislatures.

This work is among the first published analyses of the potential effects of restrictive state abortion policies in the post– Dobbs v Jackson Women’s Health aftermath. Additional research on a wide array of potential outcomes needs to be conducted to fully understand the range and magnitude of the outcomes of state-level abortion policies. Based on a plethora of prior research regarding unintended pregnancy and abortion, reduced access to abortion care is thought to decrease the incidence of abortion but also increase the risk and incidence of myriad adverse maternal and infant health outcomes. 2 Restrictive abortion policies are also expected to increase child poverty, increase the number of families that experience serious financial instability or hardship, and put additional pressures on underresourced social welfare systems. 2 In addition, there is great concern that restrictive abortion laws will negatively impact physician choice regarding where to train or practice and the availability of obstetric care across states. 3

After major public policy reforms, it is common for stakeholders—proponents and opponents alike—to look for positive and negative policy effects immediately. While easy to conduct, armchair policy impact pontification is fraught with error and false conclusions. Identifying the impact of public policy change is not a simple task. Besides the obvious cautionary chant that correlation is not causation, evaluating the degree to which public policy shifts are having both intended and unintended consequences requires sound approaches to methods, timely access to quality data, and sophisticated statistical analyses that control for underlying trends and confounding factors. 4

Furthermore, there is often discussion and debate among researchers themselves regarding how to investigate the effects of important public health, medical, and health care interventions and policies. The convening of expert panels or working groups to provide guidance regarding research priorities and best approaches to research design, data or measurement, and analyses on specific topics is long-standing. It can provide essential scientific direction to emerging issues, including ones fraught with political controversy. For example, the National Academy of Medicine has convened many methods-focused committees in challenging areas of research, including reports such as Priorities for Research to Reduce the Threat of Firearm-Related Violence (2013) and A Framework for Assessing Mortality and Morbidity After Large-Scale Disasters (2020).

There is a crucial need for investment in scientific discourse regarding how best to investigate the wide range of potential medical, public health, and social welfare effects of public policy related to abortion care. 5 An organization with authority and resources, such as the Department of Health and Human Services, the National Academy of Science, Engineering, and Medicine, or a foundation with a health-related mission, should quickly convene an ad hoc panel of experts to produce a nonpartisan, nonideological consensus document that provides guidance for objective public policy evaluation research associated with state-level restrictive abortion care policies. Such a panel could help create a priority research agenda for funders and provide guidance regarding data or measurement, research designs, statistical analyses approaches, and other methodology issues. This includes guidance for taking advantage of state differences in policy design, timing, and state contextual factors (eg, state Medicaid policy) and for subpopulation analyses since restrictive abortion laws are likely to have differential effects based on race or ethnicity, age, socioeconomic status, and geography.

In summary, the analysis by Stevenson and Root 1 provides a convincing assessment of an issue regarding abortion policy: the recent decline in maternal mortality after the Dobbs v Jackson Women’s Health ruling may be the result of a decrease in COVID-19–related maternal death rather than state legislatures’ new power to ban or severely restrict abortion care. However, there are many other important research questions regarding the health and social effects of the new abortion policy regime in the US. Investments in public policy evaluation research must be made quickly, including guidance for a priority research agenda and associated objective research designs, methods, and analysis approaches. Otherwise, the erroneous musings of amateur analysts of all ideological perspectives are likely to obscure a deep understanding of the actual effects of restrictive abortion policies on individuals and on population health outcomes, including medical care access, maternal and infant health, and the social welfare of families and children.

Published: August 27, 2024. doi:10.1001/jamanetworkopen.2024.30000

Open Access: This is an open access article distributed under the terms of the CC-BY License . © 2024 Lantz PM. JAMA Network Open .

Corresponding Author: Paula M. Lantz, PhD, MS, University of Michigan Ford School of Public Policy, 735 S State St, Ann Arbor, MI 48109-3091 ( [email protected] ).

Conflict of Interest Disclosures: None reported.

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Sex differences in health and mortality in Moscow and Denmark

• Published: 26 March 2014
• Volume 29 , pages 243–252, ( 2014 )

Cite this article

• A. Oksuzyan 1 , 2 ,
• M. Shkolnikova 2 , 3 ,
• J. W. Vaupel 1 , 2 ,
• K. Christensen 1 , 4 , 5 , 6 &
• V. M. Shkolnikov 1 , 7  

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In high income countries females outlive men, although they generally report worse health, the so-called male–female health-survival paradox. Russia has one of the world’s largest sex difference in life expectancy with a male disadvantage of more than 10 years. We compare components of the paradox between Denmark and Moscow by examining sex differences in mortality and several health measures. The Human Mortality Database and the Russian Fertility and Mortality Database were used to examine sex differences in all-cause death rates in Denmark, Russia, and Moscow in 2007–2008. Self-reported health data were obtained from the Study of Middle-Aged Danish Twins (n = 4,314), the Longitudinal Study of Aging Danish Twins (n = 4,731), and the study of Stress, Aging, and Health in Russia (n = 1,800). In both Moscow and Denmark there was a consistent female advantage at ages 55–89 years in survival and a male advantage in self-rated health, physical functioning, and depression symptomatology. Only on cognitive tests males performed similarly to or worse than women. Nevertheless, Muscovite males had more than twice higher mortality at ages 55–69 years compared to Muscovite women, almost double the ratio in Denmark. The present study showed that despite similar directions of sex differences in health and mortality in Moscow and Denmark, the male–female health-survival paradox is very pronounced in Moscow suggesting a stronger sex-specific disconnect between health indicators and mortality among middle-aged and young-old Muscovites.

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Acknowledgments

The study was supported by the US National Institute of Health, P01AG031719, and the VELUX foundation. SAHR was funded by the National Institute on Aging (Grant Number R01AG026786). None had any role in the design, execution, analysis, and interpretation of data, or writing of the study. Vladimir Shkolnikov was partly funded by the Dynasty Foundation (Russia). We are grateful to Evgeny Andreev at the New Economic School in Moscow, and Alexander Deev at the National Research Center for Preventive Medicine (NRCPM) in Moscow for massive data cleaning and processing, to Svetlana Shalnova at the NRCPM for major contributions to the collection, handling and processing various biological markers and for her help in ensuring the quality of these data, and to Viktoria Metelskaya at the NRCPM for providing consultation on the biochemical measurements.

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical standard

The study involves secondary data analysis existing survey data. The LSADT and MADT have been through review and are approved by the ethical committee assigned through the Danish National Committee on Biomedical Research and the Danish Data Protection Agency. The SAHR was approved by the Ethical Committee of the State Research Centre for Preventive Medicine, Moscow, Russia and the Institutional Review Board at Duke University, Durham, USA.

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Institute of Public Health, University of Southern Denmark, Winsloews Vej 9B, 5000, Odense, Denmark

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Oksuzyan, A., Shkolnikova, M., Vaupel, J.W. et al. Sex differences in health and mortality in Moscow and Denmark. Eur J Epidemiol 29 , 243–252 (2014). https://doi.org/10.1007/s10654-014-9893-4

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DOI : https://doi.org/10.1007/s10654-014-9893-4

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• Treating iron deficiency in patients with heart failure: what, why, when, how, where and who
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• http://orcid.org/0000-0001-7539-9958 Fraser J Graham 1 ,
• Kaushik Guha 2 ,
• http://orcid.org/0000-0002-1471-7016 John G Cleland 1 ,
• http://orcid.org/0000-0002-5288-3074 Paul R Kalra 3 , 4
• 1 British Heart Foundation Centre of Research Excellence, School of Cardiovascular & Metabolic Health , University of Glasgow , Glasgow , UK
• 2 Portsmouth Hospitals University NHS Trust , Portsmouth , UK
• 3 Cardiology , Portsmouth Hospitals University NHS Trust , Portsmouth , UK
• 4 University of Glasgow Institute of Health & Wellbeing , Glasgow , UK
• Correspondence to Dr Fraser J Graham, University of Glasgow, Glasgow, UK; fraser.graham{at}glasgow.ac.uk

For patients with heart failure and reduced or mildly reduced left ventricular ejection fraction, iron deficiency is common and associated with more severe symptoms, worse quality of life and an increased risk of hospitalisations and death. Iron deficiency can be swiftly, effectively and safely treated by administering intravenous iron, either as ferric carboxymaltose or ferric derisomaltose, which improves patient well-being and reduces the risk of hospitalisations including those for heart failure. However, the current definition of iron deficiency in heart failure has serious flaws. A serum ferritin <100 µg/L does not identify patients more likely to respond to intravenous iron. In contrast, patients with transferrin saturations <20%, most of whom are also anaemic, are more likely to have a beneficial response to intravenous iron. In this review, we summarise the available evidence for use of intravenous iron in heart failure and provide recommendations for targeted future research and practical considerations for the general cardiologist.

• Heart Failure, Systolic
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https://doi.org/10.1136/heartjnl-2022-322030

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Correction notice This article has been corrected since it was first published. Haemoglobin is now expressed in g/L in all instances.

Contributors Manuscript concept and design: PRK, FJG, KG. Manuscript writing: FJG, KG, PRK, JGC. Critical revision of manuscript for intellectual content: JGC, PRK. All authors approved the final version and are accountable for the integrity of the work.

Funding JGC is supported by the British Heart Foundation Centre of Research Excellence (RE/18/6134217). FJG and JGC have been awarded a project grant from the British Heart Foundation to assess the prevalence of iron deficiency in patients undergoing elective cardiac surgery (PG/2019/35089). PRK reports research grants from the British Heart Foundation and Pharmacosmos.

Competing interests FJG reports receipt of sponsorship from Pharmacosmos to attend an international meeting and consultancy fees from Vifor. KG has received honoraria from Novartis, AstraZeneca, Pfizer, Bayer, Boehringer Ingelheim and Servier Laboratories. JGC reports receipt of personal honoraria for lectures and advisory boards from Pharmacosmos and Vifor, and from AstraZeneca, Amgen, Bayer, Novartis and Servier. The University of Glasgow has received research grants from Pharmacosmos and Vifor. PRK reports consulting fees from Amgen, Bayer, Boehringer Ingelheim, Pharmacosmos and CSL Vifor; payment for lectures from AstraZeneca, Bayer, Novartis, Pfizer, Pharmacosmos and CSL Vifor; and support for attending meetings from Pharmacosmos.

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People with mild cases of mental ill-health may be perceived differently depending on presence of diagnostic labels

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Diagnostic labels for people experiencing what some consider to be relatively milder forms of mental-ill health may affect how others perceive them for better and worse, according to a study published August 28, 2024 in the open-access journal PLOS Mental Health by Nick Haslam from the University of Melbourne, Australia, and colleagues.

In recent years, there's been a general shift to increased diagnoses of mental ill-health. Here, Haslam and colleagues investigate the implications of diagnosing individuals presenting with mild or marginal symptoms.

In this research, symptoms were judged to be mild or marginal by members of the public, who rated different examples ranging in severity from clearly below to clearly above the diagnostic threshold as determined by a scale in a prior study.

Haslam and colleagues provided research participants (who were U.S. adults recruited from an online platform) with short vignettes describing people presenting with mild or marginal symptoms of different mental illnesses.

In Study 1, 261 participants were given three labeled ("This person has a diagnosis of ___") or unlabeled vignettes describing people presenting with symptoms of major depressive disorder (MDD), bipolar disorder (BD), or generalized anxiety disorder (GAD).

A total of 684 participants in Study 2 were given one labeled or unlabeled vignette describing someone presenting with either post-traumatic stress disorder (PTSD), obsessive-compulsive disorder (OCD), or binge-eating disorder (BED).

Participants were asked about their empathy for the described individual, their support in offering accommodations (e.g. "This person's employer should not hesitate to offer them extra time to complete work-related tasks"), their suitability for mental health treatment, the persistence of their difficulties (e.g. "This person is likely to fully recover from their problems"), and their identity (e.g. "This person's problems are an important part of who they are" [Study 2 only]).

In Study 1, labeled individuals tended to elicit more empathy and be seen as more suitable for treatment versus unlabeled individuals, but were also believed to have more persistent problems.

Study 2 differed from Study 1 in that there was no significant difference between empathy for labeled versus unlabeled individuals, but it also found that labeled individuals were seen to have less capacity to overcome their problems. Participants' ratings varied significantly depending on the described disorder, with MDD and PTSD eliciting especially high empathy and accommodation support.

The results suggest that expansive diagnostic concepts that include relatively mild symptoms may promote help-seeking, empathy, and support, but also undermine perceived agency and expectations that problems can be overcome.

It's critical to remember that the severity of symptoms of individuals with the conditions referred to in this study can change over time and "mild" is subjective. Additionally, the choice to obtain or choose a diagnostic label is a personal one and varies between individuals, conditions and communities.

The authors add, "Applying diagnostic labels to relatively mild forms of distress has mixed blessings. Our research shows that it can increase empathy and support for the person, but also make their problems seem out of their control and harder to overcome."

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