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

Abstract

ABSTRACT:Research on race and diagnosis initially focused on black-white differences in depression and schizophrenia. Statistics showing a higher treated prevalence of schizophrenia and a lower prevalence of depression for blacks seemed to support the claim that blacks did not suffer from depression. Others argued, however, that clinicians were misdiagnosing depression in blacks. This article reviews empirical studies of racial differences in individual symptoms and summarizes the evidence on misdiagnosis. It argues that more attention must be paid to resolving two contradictory assumptions made by researchers working in the area of race and diagnostic inference: (1) blacks and whites exhibit symptomatology similarly but diagnosticians mistakenly assume that they are different; (2) blacks and whites display psychopathology" in different ways but diagnosticians are unaware of or insensitive to such cultural differences. The article concludes with suggested research directions and a discussion of critical research issues.

Depressive Symptoms of Whites and African Americans Aged 60 Years and Older

“…Prevalence estimates from the National Institute of Mental Health Epidemiologic Catchment Area (ECA) Program were consistent with lower prevalence of depression among African Americans (Robins & Regier, 1991;Somervell, Leaf, Weissman, Blazer, & Bruce, 1989), although the differential in rates of depression were not as pronounced as in other studies (e.g., Vernon & Roberts, 1982, and in studies reviewed by Neighbors and colleagues [Neighbors, Jackson, Campbell, & Williams, 1989]). Clinical investigators have noted the tendency to diagnose African American patients with schizophrenia or schizoaffective disorder rather than depression (Jones & Gray, 1986).…”

Ethnicity and differential access to care for eating disorder symptoms

“…Help-seeking patterns may differ among ethnic groups for a variety of reasons, ranging from a differential in perceived seriousness of the symptoms or illness to a differential in perceived clinician receptivity, empathy, and trustworthiness (Cooper-Patrick et al, 1999;Doescher, Saver, Franks, & Fiscella, 2000). The etiology of clinician error is similarly broad and ranges from clinician prejudice (van Ryn & Burke, 2000), to clinician unawareness of or insensitivity to cultural differences in presentations of psychopathology (Neighbors, Jackson, Campbell, & Williams, 1989), to selective information processing for clinical decision making (e.g., use of subjective judgments about base rates of illness among certain patient groups; Lopez, 1989). The specific ways in which ethnicity influences help-seeking and disclosure patterns for eating disorders have only recently begun to be studied.…”

Culture–bound syndromes and the neglect of cultural factors in psychopathologies among Africans

“…[82][83][84][85] Furthermore, many scholars have criticized Europe and North America for their great influence on models and classification of mental illness without taking into consideration non-western cultures. [86][87][88] For instance, ICD-10 8 has been criticized in cross cultural terms because out of 47 psychiatrists involved in drawing up the first draft, only two of them were from Africa. 61,89 Thus, there are those who question why clinically significant and distressing symptom patterns seen as "bound" to non-Western cultures retain the status of syndrome (CBS) while other symptom patterns seen as clearly bound to Western culture are classified as "disorders".…”