Racial disparities in psychotic disorder diagnosis: A review of empirical literature

Abstract

Psychotic disorder diagnoses are common in the United States and internationally. However, racial disparities in rates of psychotic disorder diagnoses have been reported across time and mental health professions. This literature review provides an updated and comprehensive summary of empirical research on race and diagnosis of psychotic disorders spanning a 24-year period. Findings reveal a clear and pervasive pattern wherein African American/Black consumers show a rate of on average three to four higher than Euro-American/White consumers. Latino American/Hispanic consumers were also disproportionately diagnosed with psychotic disorders on average approximately three times higher compared to Euro-American/White consumers. In addition, a trend among international studies suggests that immigrant racial minority consumers receiving mental health services may be assigned a psychotic disorder diagnosis more frequently than native consumers sharing a majority racial background. Potential explanations for this phenomenon are discussed, including possible clinical bias and sociological causes such as differential access to healthcare and willingness to participate in mental health services. Directions for future research should include the exploration of disproportionate diagnoses according to race through qualitative interviewing as well as empirical investigation.

Psychosis in Systemic Lupus Erythematosus: Results From an International Inception Cohort Study

“…The majority of psychotic events were directly attributed to SLE, had a tendency to occur early in the course of the disease, and were more frequent in male patients. Psychosis was also more frequent in patients of African ancestry, as is also the case for non‐SLE patients with the same race/ethnicity . The outcome of lupus psychosis, as determined by both physicians and patients, was positive and emphasizes the importance of diagnosing and treating this rare manifestation of NPSLE.…”

Ketamine Role in Schizoaffective Disorder Depressive Type

“…Thus, it is thought that ketamine would not be appropriate as a treatment option for patients with schizophrenia and schizoaffective disorder [4]. However, considering the controversy over the diagnosis of schizoaffective disorder and the over diagnosing of mood disorders with psychotic features, especially in African American population [8][9][10][11], it may be worthwhile to explore the feasibility of ketamine as a treatment option for severe depression in these patients, possibly as a last resort.…”

“…The challenge is even greater for African Americans and women [8]. It is known that psychotic disorders are over diagnosed in African American populations [10,11]. Moreover, in a study of a Danish population of over 2 million, Laursen et al reported that the chance of a bipolar woman being admitted with the diagnosis of schizoaffective disorder was 103 times higher than the general population of the same age [8].…”

The Depression/Schizophrenia Continuum: Does Cytoskeletal Tensegrity Play a Role?

“…Another piece of evidence suggesting the depression/ schizophrenia continuum comes from population studies. African-Americans have higher rates of schizophrenia (Schwartz and Blankenship 2014) than the general population yet have decreased rates of depression (Dunlop et al, 2003). Thus their mental health is "frame-shifted" with respect to the Western component of the population.…”