Clinician attributions associated with the diagnosis of schizophrenia in African American and non-African American patients.

The authors examined the schizophrenia diagnosis in 292 psychiatric inpatients in a largely African American community. Clinicians completed a free-response questionnaire that described their diagnostic decisions. Psychotic symptoms such as hallucinations, which were attributed to African American and non-African American patients at different rates, did not necessarily correspond to differences in diagnostic rates. Rather, symptoms not differentially attributed between groups often corresponded with higher rates of schizophrenia for African American patients. Attributions of negative symptoms showed the largest differences between African American and non-African American patients in rates of schizophrenia diagnosis; thought disorder equalized rates of the diagnosis between the 2 groups of patients. Logistic regression analyses suggested that different aggregate decision models were applied to patients of differing race.

Psychiatric diagnosis of African Americans: diagnostic divergence in clinician-structured and semistructured interviewing conditions.

This study is a primary data collection that varied patient race and diagnosis and used two diagnostic interviewing conditions: one clinician-structured (phase one) and the other a semi-structured diagnostic instrument (phase two). Four basic research questions are addressed: What is the relationship between race and the hospital diagnosis? How is race related to diagnosis in both research interviewing conditions? Why does diagnostic concordance between the hospital diagnosis and the research diagnosis vary by research interviewing condition? Is diagnostic concordance between the hospital and research diagnosis influenced by patient race? A total of 291 patients completed an interview during phase one, while 665 patients completed an interview during phase two. Blacks were more likely to receive a hospital diagnosis of schizophrenia and less likely to be diagnosed with mood disorder. Patient race was similarly related to the research diagnoses produced in the clinician-structured research condition (phase one). Although less pronounced, a higher percentage of African Americans than whites received a diagnosis of schizophrenia using the semi-structured DSM-III-R Symptom Checklist (phase two). The black-white distribution for mood disorders showed that whites were more likely than blacks to be diagnosed with mood disorder.