Psychiatric symptoms in white and black inpatients. I: Record study

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

“…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. An analysis by Liss et al (1973) found no race differences in diagnosis, but there was a stronger degree of association between symptoms and diagnosis for whites than blacks. Welner et al (1973) followed up 92 patients who were given a computer-generated diagnosis.…”

“…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.…”

“…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.…”

Racial Differences in DSM Diagnosis Using a Semi-Structured Instrument: The Importance of Clinical Judgment in the Diagnosis of African Americans

“…The application of diagnostic criteria can be influenced by clinical training and contribute to inaccuracies in the identification of pathology (Parloff, Kelman and Frank 1954;Spitzer et al 1994;Stahler and Rappaport 1986). Differential diagnosis may also stem from data that demonstrate that African American depressed patients are more likely to present with somatic complaints while white are more likely to present with depressed mood and suicidal tendencies (Adebimpe 1981;Liss et al 1973;Simon et al 1973;Vitols, Waters and Keeler 1963). These studies have also indicated that hallucinations and delusions are more frequent among African Americans, which may lead to the overdiagnosis of schizophrenia for this group.…”

“…First, the concern is grounded in a particular line of reasoning in interpreting existing diagnostic evidence. Many studies that look at diagnosis within a hospital setting have found that schizophrenia is diagnosed more frequently among African Americans and that mood disorders are diagnosed more often among whites (Lipton and Simon 1985;Liss et al 1973;Mukherjee et al 1983;Neighbors et al 1999;Raskin, Crook and Herman 1975;Simon et al 1973;Snowden and Cheung 1990;Strakowski et al 1996;Tonks, Paykel and Klerman 1970;Welner, Liss and Robins 1973;Welner et al 1972). The term "over-diagnosis" has been used to refer to the findings related to schizophrenia while "under-diagnosis" has been used to describe the findings on mood disorders.…”