Racial Differences in DSM Diagnosis Using a Semi-Structured Instrument: The Importance of Clinical Judgment in the Diagnosis of African Americans

Neighbors, Harold W.; Trierweiler, Steven J.; Ford, Briggett C.; Muroff, Jordana

doi:10.2307/1519777

Cited by 269 publications

(157 citation statements)

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“…Such trends have been evidenced in pediatric inpatient [28] and outpatient [27] rates. Our results for children and adolescents are also consistent with previous research that found that African American adult patients are diagnosed at higher rates with psychotic disorders and at lower rates of mood disorders while White adult patients are diagnosed with higher rates of mood disorders and lower rates of psychotic disorders across mental health settings including PES [13,29,31,36,37]. Despite the dearth of literature on diagnostic rates in pediatric PES, these findings combined with others' [27,28] suggest that such racial variations may occur across clinical settings.…”

Section: Discussionsupporting

confidence: 91%

The role of race in diagnostic and disposition decision making in a pediatric psychiatric emergency service

Muroff

Edelsohn

Joe

et al. 2008

General Hospital Psychiatry

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Objective-We investigated the influence of race/ethnicity in diagnostic and disposition decisionmaking for children and adolescents presenting to an urban psychiatric emergency service (PES).Method-Medical records were reviewed for 2991 child and adolescent African American, Hispanic/Latino, and White patients, treated in an urban PES between October 2001 and September 2002. A series of bivariate and binomial logistic regression analyses were employed to delineate the role of race in the patterns and correlates of psychiatric diagnostic and treatment disposition decisions.Results-Binomial logistic regression analyses reveal that African American (OR=2.28, p<.001), and Hispanic/Latino (OR=2.35, p<.05) patients are more likely to receive a psychotic disorder and behavioral disorders diagnoses (African American:OR=1.66, p<.001; Hispanic/Latino:OR=1.36, p<. 05) than White children/adolescents presenting to PES. African American youth compared to White youth are also less likely to receive depressive disorder (OR=0.78, p<.05), bipolar disorder (OR=. 44, p<.001), and alcohol/substance abuse disorder (OR=.18, p<.01) diagnoses. African American pediatric PES patients are also more likely to be hospitalized (OR=1.50, p<.05), controlling for other socio-demographic and clinical factors (e.g., GAF). Conclusions-The results highlight that non-clinical factors such as race/ethnicity are associated with clinical diagnostic decisions as early as childhood suggesting the pervasiveness of such disparities.

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Section: Discussionsupporting

confidence: 91%

The role of race in diagnostic and disposition decision making in a pediatric psychiatric emergency service

Muroff

Edelsohn

Joe

et al. 2008

General Hospital Psychiatry

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“…be subject to racial bias in other settings [Neighbors et al, 2003;Trierweiler et al, 2006], neither measurement nor the diagnostic process can explain diagnostic and symptom differences in the present study. The pattern of observed racial differences may hold important clues for explaining them.…”

Section: Discussionmentioning

confidence: 57%

“…It has been argued that the difference could reflect clinician or instrument bias [Neighbors et al, 2003;Trierweiler et al, 2006], although differences remained when clinicians were blinded to ethnicity information [Arnold et al, 2004]. On the other hand, race differences may reflect true differences in the incidence of psychosis, such as if they are secondary to socioeconomic or migration variables associated with both race and the presence of or risk for psychosis [Sharpley et al, 2001;Fearon et al, 2006].…”

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confidence: 99%

Symptoms of psychosis in schizophrenia, schizoaffective disorder, and bipolar disorder: A comparison of African Americans and Caucasians in the Genomic Psychiatry Cohort

Perlman

Kotov

et al. 2015

American J of Med Genetics Pt B

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Several studies have reported differences between African Americans and Caucasians in relative proportion of psychotic symptoms and disorders, but whether this reflects racial bias in the assessment of psychosis is unclear. The purpose of this study was to examine the distribution of psychotic symptoms and potential bias in symptoms assessed via semi-structured interview using a cohort of 3,389 African American and 5,692 Caucasian participants who were diagnosed with schizophrenia, schizoaffective disorder, or bipolar disorder. In this cohort, the diagnosis of schizophrenia was relatively more common, and the diagnosis of bipolar disorder and schizoaffective disorder-bipolar type was less relatively common, among African Americans than Caucasians. With regard to symptoms, relatively more African Americans than Caucasians endorsed hallucinations and delusions symptoms, and this pattern was striking among cases diagnosed with bipolar disorder and schizoaffective-bipolar disorder. In contrast, the relative endorsement of psychotic symptoms was more similar among cases diagnosed with schizophrenia and schizoaffective disorder-depressed type. Differential item function analysis revealed that African Americans with mild psychosis over-endorsed "hallucinations in any modality" and underendorsed "widespread delusions" relative to Caucasians. Other symptoms did not show evidence of racial bias. Thus, racial bias in assessment of psychotic symptoms does not appear to explain differences in the proportion of symptoms between Caucasians and African Americans. Rather, this may reflect ascertainment bias, perhaps indicative of a disparity in access to services, or differential exposure to risk factors for psychosis by race. Key words: schizophrenia; race; psychosis INTRODUCTIONOver the last 50 years, several studies have reported differences between individuals of African heritage and Caucasians in relative proportion of psychotic symptoms and diagnosis of schizophrenia versus bipolar disorder. Specifically, reports from samples ascertained in clinical settings have suggested that compared to Caucasians, individuals of African heritage have higher rates of schizophrenia [Robins and Regier, 1991;Strakowski et al., 1993Strakowski et al., , 1996Strakowski et al., , 2003Bresnahan et al., 2007;Gara et al., 2012;Kirkbride et al., 2012] 546Neuropsychiatric Genetics severe psychotic symptoms [Mukherjee et al., 1983;Strakowski et al., 2003;Arnold et al., 2004] and less severe negative symptoms [Sharpley et al., 2001]. Other studies of psychotic symptoms have found race differences in the quality and scope of hallucinations and delusions [Barrio et al., 2003;Yamada et al., 2006].To date, the underlying source of these apparent differences is unknown. It has been argued that the difference could reflect clinician or instrument bias [Neighbors et al., 2003;Trierweiler et al., 2006], although differences remained when clinicians were blinded to ethnicity information [Arnold et al., 2004]. On the other hand, race differences may reflect t...

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“…6 In a prospective birth-cohort study, African Americans were found to have much-elevated rates of schizophrenia compared with whites. 7 Furthermore, blacks with schizophrenia are overrepresented in state psychiatric hospitals. 8 Although much evidence exists to suggest that clinicians overdiagnose schizophrenia and underdiagnose mood disorders in African Americans, clinical errors alone are unlikely to account for the differences.…”

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confidence: 99%

New Evidence Regarding Racial And Ethnic Disparities In Mental Health: Policy Implications

McGuire¹,

2008

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Racial Differences in DSM Diagnosis Using a Semi-Structured Instrument: The Importance of Clinical Judgment in the Diagnosis of African Americans

Cited by 269 publications

References 68 publications

The role of race in diagnostic and disposition decision making in a pediatric psychiatric emergency service

The role of race in diagnostic and disposition decision making in a pediatric psychiatric emergency service

Symptoms of psychosis in schizophrenia, schizoaffective disorder, and bipolar disorder: A comparison of African Americans and Caucasians in the Genomic Psychiatry Cohort

New Evidence Regarding Racial And Ethnic Disparities In Mental Health: Policy Implications

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