Depression and Schizophrenia in Hospitalized Black and White Mental Patients

The influence of racial factors on psychiatric diagnosis: A review and suggestions for research

“…As a case in point, despite the fact that a high level of depressive symptomatology was a requirement for participation in their study, Raskin et al (1975) found that whites were more likely to receive a diagnosis of depression while blacks were more likely to be diagnosed schizophrenic. Simon et al (1973) found that 15% of whites but none of the blacks were diagnosed as having affective illness, despite the fact that there were no race differences in psychopathology as measured by the research project's symptom scales. Furthermore, there were no race differences in the project's diagnosis (which used a more structured interviewing technique) even though the hospital charts reported substantial black-white differences in depression and schizophrenia.…”

“…A number of the studies reviewed found significant differences in the diagnosis of blacks when comparing structured, controlled clinical decision-making to an unstructured clinical interview (Vitols et al, 1963;Welner et al, 1973;Simon et al, 1973;Liss et al, 1973). While it cannot be concluded that structured instruments should be viewed as the ultimate criterion of validity, an unstructured interviewing procedure is more prone to influence by unsubstantiated clinical impressions (such as, ~blacks do not get depressed", or that '~hallu-cinations and delusions occur only in schizophrenia") than a more structured approach.…”

“…For example, few of the studies previously reviewed used any type of structured research instrument and those that did are now out-dated (Simon et al, 1973;Tonks et al, 1970). Practically all of the studies (see Jones et al, 1981;Lipton &Simon, 1985 andMukherjee et al, 1983 for exceptions) were pre-DSM-III and did not use the hierarchical system for ruling out affective disorder before making a diagnosis of schizophrenia.…”

“…Only one of the investigations reviewed employed the Schedule for Affective Disorders and Schizophrenia (Mukherjee et al, 1983) and none used the Present State Exam, Psychiatric Epidemiology Research Interview nor Structured Clinical Interview for DSM-III-R. This is particularly surprising given that much of the criticism on race and diagnosis is directed against the use of unstructured clinical interviewing procedures (Adebimpe, 1981;Simon et al, 1973;Tonks et al, 1970;Mukherjee et al, 1983).…”

“…Numerous studies have attempted to investigate the process of diagnostic classification in black patients (Raskin, Crook & Herman, 1975;Tonks, Paykel & Klerman, 1970;Helzer, 1975;Simon et al, 1973;Tonks et al, 1970;Hanson & Klerman, 1974;DeHoyos & DeHoyos, 1965;Vitols et al, 1963;Liss, Welner, Robins & Richardson, 1973;: Mukherjee et al, 1983. Prange and Vitols (1962) early on raised the issue of race differences in mental disorder from a diagnostic perspective, noting that while rare, depression did occur in blacks.…”