Differences in patterns of symptom attribution in diagnosing schizophrenia between African American and non-African American clinicians.

Trierweiler, Steven J.; Neighbors, Harold W.; Munday, Cheryl C.; Thompson, Estina E.; Jackson, James S.; Binion, Victoria J.

doi:10.1037/0002-9432.76.2.154

Cited by 42 publications

(42 citation statements)

References 26 publications

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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: 58%

“…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].…”

Section: Introductionmentioning

confidence: 99%

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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: Discussionmentioning

confidence: 58%

Section: Introductionmentioning

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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“…These situational attributions were more likely to be assessed by AA clinicians but were not associated with the diagnosis of mood disorders. In another study of 292 inpatients, although rates of schizophrenia diagnosis were equal between AA and non-AA clinicians, AA clinicians were more likely to diagnose schizophrenia when hallucinations were present (OR = 32.39, P b .001) and non-AA clinicians were more likely to diagnose schizophrenia when negative symptoms were present (OR = 8.51, P b .001; Trierweiler et al, 2006).…”

Section: Race and The Provider-patient Dyadmentioning

confidence: 94%

The Role of Treatment Setting and High Acuity in the Overdiagnosis of Schizophrenia in African Americans

Hampton

2007

Archives of Psychiatric Nursing

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“…We also reasoned that the validity of diagnoses is somewhat questionable in the setting of active substance abuse. [171][172][173][174][175] To overcome this problem, we have limited the review to RCTs and studies with similarly rigorous methodology but have included (in separate sections) studies with samples of less than 50% schizophrenia-spectrum diagnoses. With respect to specific treatments for SUD, 6 RCT's were available that included more than 50% of individuals with schizophrenia.…”

Section: Psychosocial Interventions For Alcohol and Substance Use Dismentioning

confidence: 99%

The 2009 Schizophrenia PORT Psychosocial Treatment Recommendations and Summary Statements

Dixon

Dickerson

Bellack

et al. 2009

Schizophrenia Bulletin

684

534

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Differences in patterns of symptom attribution in diagnosing schizophrenia between African American and non-African American clinicians.

Cited by 42 publications

References 26 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

The Role of Treatment Setting and High Acuity in the Overdiagnosis of Schizophrenia in African Americans

The 2009 Schizophrenia PORT Psychosocial Treatment Recommendations and Summary Statements

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