Judging mental disorder in youths: Effects of client, clinician, and contextual differences.

Abstract

Using a vignette-based, mailed survey of 1,401 experienced psychologists, psychiatrists, and social workers, the authors examined how clients' race/ethnicity and clinicians' professional and social characteristics affect their judgment of mental disorder among antisocially behaving youths. Vignettes described problematic behaviors meeting the Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV; American Psychiatric Association, 1994) criteria for conduct disorder but contained contextual information suggesting either disorder or nondisorder, following DSM-IV guidelines. Clinicians depended on contextual information to decide whether a mental disorder existed, and they judged White youths to have a disorder more frequently than Black or Hispanic youths. Clinicians' occupation, theoretical orientation, and age also were associated with disorder judgments, whereas their gender, race, and experience were not. Research and training implications of these variations in clinical judgments are discussed.

Treating the Child or Syndrome: Does Context Matter for Treatment Decisions for Antisocially Behaving Youth?

“…Existing research offers evidence that experienced clinicians are sensitive to the social context surrounding adolescent antisocial behavior, and that they judge youth as less likely to have a mental disorder when context suggests the behavior might be a normal reaction to a harsh environment, rather than irrational responses resulting from internal dysfunction (Hsieh 2001;Hsieh andKirk 2003, 2005;Pottick et al 2003Pottick et al , 2007Wakefield et al 2002Wakefield et al , 2006. Other research studies have found that clinicians differentially use contextual information to weigh the importance of symptoms in judging whether a youth should be considered as having a diagnosis of conduct disorder (De Los Reyes and Marsh 2011;Marsh et al 2016), and have demonstrated that contextual information not only influences how clinicians arrive at diagnoses, but can also influence their judgments about other aspects of the clinical encounter, such as prognosis, need for professional help, and appropriateness of medication .…”

Conceptualizing Culturally Infused Engagement and Its Measurement for Ethnic Minority and Immigrant Children and Families

“…Several vignette studies have begun such investigations. For example, Pottick et al (2007) found differences among psychologists, psychiatrists, and social workers in their judgment of the existence of mental disorder in a vignette youth with symptoms of conduct disorder. In another report from the same data set, Kirk and Hsieh (2004) showed that social workers, in relation to psychologists and psychiatrists, were less likely to make a diagnosis of conduct disorder, were more likely to use other DSM-IV diagnoses (especially adjustment disorders), and were more likely to report no diagnosis.…”

“…One measurement strategy that may help to close some of the gaps of traditional survey methods described in our review is the use of analogue, vignette-based techniques which present realistic case situations on which respondents report their beliefs, feelings, attitudes, or judgments. The use of vignettes in the field of mental health has grown in recent years to include both national samples (e.g., Kirk et al 1999;Pescosolido et al 2008;Pottick et al 2003Pottick et al , 2007Wakefield et al 1999) and regional and local ones (Chavez et al 2010;Mukolo and Heflinger 2011).…”

“…In addition, these studies can systematically explore beliefs of respondents of different races or ethnicities to better understand the role of culture in the engagement process. For example, a number of researchers have examined racial differences in beliefs about mental health (e.g., seriousness of illness), help seeking (what help would be appropriate), and treatment effectiveness with vignettes depicting different forms of mental health illnesses, such as major depressive disorder or schizophrenia (Anglin et al 2008) or conduct disorder (Pottick et al 2007) or social anxiety disorder (Coles et al 2016). With comparisons of vignettes representing other mental health illnesses, physical illnesses (Patel and Bakken 2010), marital and family problems (Uomoto and Gorsuch 1984), or no clinically significant diagnosis (Thurston et al 2015), vignette studies can uncover how individuals of different races or ethnicities view mental health and helping processes.…”

“…In that way, the measurement literatures may be valuably integrated. Vignette methodology can also use single-item measures that have face validity, an aspect reflected by some studies of clinicians' judgments about mental health problems (Hsieh and Kirk 2003;Marsh et al 2016;Pottick et al 2007) or about parents' or laypersons' recognition of mental health problems and their decisions to seek help (Thurston et al 2015). Underlying behavioral beliefs, social norms and perceived control or agency of ethnic minority and immigrant families can be investigated systematically in reaction to vignettes that use controlled variations of characteristics that can be hypothesized to influence likely engagement behaviors.…”