The issues related to recruiting African American psychiatric inpatients are discussed in the context of a study on the influence of ethnicity on psychiatric diagnosis. Ethnically diverse psychiatric residents interviewed 960 Black and White inpatients in 2 urban psychiatric hospitals. Despite the obstacles cited in the literature about recruiting and retaining African Americans into research, 78% of this sample were African American. In addition, interview completion and refusal rates did not differ by patient ethnicity. Results suggest that matching interviewer and patient ethnicity did not influence African Americans' likelihood of participating in or of refusing an interview. This article summarizes a number of guidelines that others may find useful in conducting clinical research with African Americans, ranging from the formation of academic-public liaisons to interviewer training.

The authors examined the schizophrenia diagnosis in 292 psychiatric inpatients in a largely African American community. Clinicians completed a free-response questionnaire that described their diagnostic decisions. Psychotic symptoms such as hallucinations, which were attributed to African American and non-African American patients at different rates, did not necessarily correspond to differences in diagnostic rates. Rather, symptoms not differentially attributed between groups often corresponded with higher rates of schizophrenia for African American patients. Attributions of negative symptoms showed the largest differences between African American and non-African American patients in rates of schizophrenia diagnosis; thought disorder equalized rates of the diagnosis between the 2 groups of patients. Logistic regression analyses suggested that different aggregate decision models were applied to patients of differing race.

The study suggested the possibility of racial disparities in referral to aftercare and a complex relationship between referral and rehospitalization. Both these findings warrant further investigation that gives particular attention to individual-level indicators of need and system-level barriers to and facilitators of psychiatric care.

The authors examined clinician race differences in symptom attribution patterns in diagnosing psychiatric inpatients from a low-income, African American community. Different decision models were applied to patients based on clinician race. African American clinicians diagnosed schizophrenia with higher odds than non-African American clinicians when they believed hallucinations were present and avoided that diagnosis with lower odds when they considered substance abuse issues. Non-African American clinicians usually related the attribution of negative symptoms to the diagnosis of schizophrenia while African American clinicians did not make this linkage. The study highlights the need for more detailed examination of cultural influences on diagnostic judgments.

This research examined clinicians' consideration of situational factors in diagnostic decisions of mood vs. schizophrenia disorders among psychiatric inpatients from a low-income, African American community. Clinicians completed questionnaires describing their diagnostic decisions. Responses reflecting the usage of situational information were investigated. African American clinicians used situational information more than non-African American clinicians. However, this increased attention to situational information was not uniquely associated with a particular diagnostic decision for African American clinicians. In contrast, consideration of situational attributions by non-African American clinicians did increase the probability of a mood diagnosis. Logistic regression analyses suggested differential application of a diagnostic standard among African American and non-African American clinicians. Implications for enhancing the cultural sensitivity of diagnosis practices are discussed.