Assessment of Psychiatric Symptomatology in Bilingual Psychotic Patients: A Systematic Review and Meta-Analysis

Language plays an important role in psychiatric conditions. Language disturbances are core symptoms of psychiatric ailments, and language is the main diagnostic tool to assess psychopathological severity. Although the importance of language in psychiatry, the effect of bilingualism, and more specifically of using the mother language or a later acquired language at the time of assessing psychotic symptoms, has been scarcely studied and, thus, remains unclear. We conducted a systematic review and meta-analysis to ascertain whether differences exist in the severity of psychopathology in psychotic patients when assessed either in the mother language or in an acquired language. Of 3121 retrieved references from three databases (PsycINFO, MEDLINE, Embase) and complementary searches, four studies—including 283 psychotic patients—were included in the review. The meta-analytical combined effect suggested that more overall symptomatology is detected when clinical assessment is conducted in the mother language rather than in the acquired language (very low quality evidence, random effects model standardized mean difference (SMD) 0.44, 95% CI = 0.19 to 0.69, p value = 0.0006, I(2) = 90%). Considering the growing migration flows and the increasing number of bilingual people in the world population, the effect of the chosen language at the time of conducting psychopathological assessments of psychotic patients is a clinically relevant issue. Based on our findings, we recommend that clinical interviews with bilingual psychotic patients should be conducted, when feasible, in the patient’s mother language.