Are there racial differences in the way patients with psychotic disorders are treated at their first hospitalization?

Sohler, Nancy; Bromet, Evelyn J.; Lavelle, Janet; Craig, Thomas J.; Mojtabai, Ramin

doi:10.1017/s0033291703001363

Cited by 22 publications

(15 citation statements)

References 30 publications

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“…This suggests that despite recruiting all participants from the same settings, African Americans with bipolar disorder/mild psychosis may have been under-sampled in this dataset. This interpretation dovetails with findings from several studies that describe disparities in access to and forms of mental health treatment by race [e.g., Sohler et al, 2004;Jarvis et al, 2014;Kuno and Rothbard, 2014]. An ascertainment bias of this kind could have a broad impact on psychosis research because many studies recruit from such sites, especially large cohort studies that utilize targeted recruitment methods to offset the low base rate of psychosis in the community [Kessler et al, 2005].…”

Section: Discussionsupporting

confidence: 64%

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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Section: Discussionsupporting

confidence: 64%

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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“…This finding is in accordance with an American study examining treatment patterns for patients with psychotic disorders. The finding was that differences between patients with different ethnic backgrounds during the early stages of treatment arise most prominently before, rather than during, the patients' first hospitalization [34 ]. In a forensic setting the frequency of seclusions was correlated significantly with psychopathy, a reminder that coercion is connected to patient characteristics [35 ].…”

Section: Who and How Often?mentioning

confidence: 99%

Restraint and seclusion in psychiatric inpatient wards

Sailas

Wahlbeck

2005

Current Opinion in Psychiatry

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There is a need for novel methods to treat violence and the threat of violence on psychiatric wards. Violence is a complex phenomenon that needs to be met with a multiprofessional approach. Customer involvement in this work is required. The assessment of the effectiveness of programmes aiming to minimizing seclusion and restraint has been hampered by the lack of parallel control groups and there is a need for cluster-randomized trials. When studying these interventions, the safety of staff and patients should be included as on outcome measure.

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“…International literature in relation to this needs to be noted (Opolka et al, 2004;Sohler et al, 2004;Weich & Araya, 2004). Under-recognition of depression has been noted in some cultural contexts, as has the increased use of seclusion and perception of violence by others.…”

Section: Resultsmentioning

confidence: 99%

The Contributions of Culture and Ethnicity To New Zealand Mental Health Research Findings

Tapsell¹,

Mellsop

2007

Int J Soc Psychiatry

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While the methodologies used and the actual results gained differed across studies, there do seem to be differences in phenomenological profiles at presentation, in the diagnostic patterns, the cost of care, and the therapeutic experiences between Mâori and non-Mâori New Zealanders. These differences may reflect actual differences between certain ethnic groups, which then explain the differences in the experiences of those users, or they may reflect inadequacies on the parts of non-MAori clinicians, their diagnostic tools and the services in which they operate, in catering for Mâori patients.

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Are there racial differences in the way patients with psychotic disorders are treated at their first hospitalization?

Abstract: Differences during the early stages of treatment between black and white patients with psychotic disorders appear to arise most prominently before, rather than during, their first hospitalization.

Cited by 22 publications

References 30 publications

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

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

Restraint and seclusion in psychiatric inpatient wards

The Contributions of Culture and Ethnicity To New Zealand Mental Health Research Findings

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