The influence of the patients’ ethnicity, socio-demographic conditions and strain on psychiatric diagnoses given at an outpatient clinic

Abstract

Although psychiatric diagnoses are influenced by cultural and social conditions, with large global variations, the ICD and DSM systems are applied worldwide. The aims of this study were to describe the distribution of different ethnic patient groups in psychiatric outpatient services and the influence of ethnicity, demographic conditions and social strain on psychiatric diagnoses. An entire year's cohort of psychiatric outpatients (n = 839) in an outpatient register was divided into nine groups, according to country of birth. The proportion of each group in the outpatient population was compared with its corresponding proportion in the catchment area. In order to examine the relationship between socio-demographic variables and strain on the one hand, and DSM-III-R diagnoses on the other, stepwise logistic regression analyses were carried out. Swedes were the only group under-represented as outpatients (P < 0.001). Africans ran a higher risk (OR = 5.55, 95% CI = 2.56-12.04) than other ethnic groups of receiving a diagnosis of psychotic disorder--except schizophrenia--and Greek patients were more likely to receive a diagnosis of somatoform disorder (OR = 8.81, 95% CI = 4.41-17.59). Swedes were twice as likely to receive a diagnosis of personality disorder (OR = 2.16, 95% CI = 1.55-3.15). Schizophrenia was related to male gender (OR = 1.75, 95% CI = 1.04-2.94) and affective disorders to age >40 years (OR = 1.71, 95% CI = 1.22-2.40). Ethnicity has a strong impact on how diagnoses are given in cross-cultural settings. We could not confirm earlier findings of under-representation of ethnic minorities in outpatient services.

Gender-related mental health differences between refugees and non-refugee immigrants - a cross-sectional register-based study

“…The differences in psychotropic drugs purchased between immigrants of different origin are in line with studies on intake of psychotropic drugs mentioned[29] and have multiple explanations such as differences in pre- and post-migration stress, cultural variations or different levels of communication problems between patients and health care staff[27]. The Somali group had the lowest crude odds ratios for purchase of psychotropic drugs.…”

“…An additional weakness is due to the exclusion of anti-psychotic agents. The potential misclassification of specific diagnoses of mental ill health among immigrants may have caused some immigrants to be prescribed antipsychotic agents instead of anti-depressive drugs, tranquilizers or sedatives[27], which were included in the proxy variable. This risk of misclassification might be higher in some immigrant groups, creating invalid differences between immigrants of different origin.…”

“…There is always a risk of misclassification when studying specific diagnoses of mental ill health among immigrants due to inter-cultural diversity[27]. We therefore combined antidepressants, tranquilizers and sedatives into a single dichotomous outcome variable to minimise the impact of differential diagnoses in groups from different countries or areas of origin.…”

“…The utilisation of psychiatric care in high-income countries including Sweden differs between migrants and natives[27,28]. In Sweden in 1996, 1059 female and 921 male migrants from Iran, Chile, Turkey, Kurdistan, Poland and a random sample of 3001 Swedes were interviewed regarding intake of psychotropic drugs.…”

Mental health problems and post‐migration stress among multi‐traumatized refugees attending outpatient clinics upon resettlement to Norway

“…Several studies conducted in refugee outpatient populations from Scandinavia have used patients registered records (Al‐Saffar, Borgå, Wicks & Hällström, 2004; Moisander & Edston, 2003), while other studies have used non‐validated self‐reported questionnaires for diagnostic purposes (Al‐Saffar, Borgå, Edman & Hällström, 2003; Al‐Saffar, Borgå, Lawoko, Edman & Hallstrøm, 2004; Kivling‐Bodén & Sundbom 2002). These methodological procedures bring with them an uncertainty about the validity of the diagnoses.…”