Los Angeles Times: Race and mental illness: Do African Americans suffer more schizophrenia or is it bias?
Posted 02/07/2012
Diagnosed with mental illness, Nathaniel Ayers, later portrayed by Jamie Foxx in the movie "The Soloist," became an accomplished musician.
Black Americans are far more likely than their white countrymen to be labeled schizophrenic, one of psychiatry's most serious and intractable diagnoses. But a new study suggests that psychiatric bias, compounded by the squishiness of diagnostic standards in psychiatry, may account for some of that difference.
When a patient arrives in a clinic speaking incoherently, beset by delusions or hallucinations, and either severely withdrawn or manic, schizophrenia is a distinct possibility. But sometimes those same symptoms point to extreme cases of depression or bipolar disorder. Before assigning a diagnosis of schizophrenia, a physician is expected to rule out these more treatable conditions.
The new study found that in a group of 610 patients seeking treatment at six regional psychiatric clinics scattered across the nation, African American patients were diagnosed with schizophrenia more than two and a half times as often as were white patients. That was the case even when the diagnosing psychiatrists based their conclusions entirely on reports of a subject's symptoms and his or her responses to a structured interview, with any hints of the subject's race stripped away.
Even when African American patients showed significant signs of a mood disorder such as depression or bipolar disorder, it was the severity of their psychotic symptoms that jumped off the page to the color-blinded psychiatrists. For white patients, even psychiatrists blinded to race were more likely to balance signs of psychosis with signs of a mood disorder.
The article appeared Monday online in the Archives of General Psychiatry. The study also looked at Latinos with psychiatric symptoms, but found that they were assessed no differently than whites.
"In African American subjects, psychotic symptoms may be overvalued by clinicians, skewing diagnoses toward schizophrenia-spectrum conditions," the authors of the new study write. They suggest that "previous discriminatory experiences, and reactions to them, i.e. healthy paranoia," may lead some African Americans to express their fears and anxieties in ways that are interpreted as more extremely psychotic, or that delays in seeking treatment may make their psychotic symptoms more prominent than evidence of their mood instability.
The results also challenge mental health practitioners "to consistently challenge their own diagnostic assessments" when treating individuals from racial groups other than their own.
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