The 130th Annual Meeting of APHA

Abstract #51016

Harold Neighbors, PhD, Center for Research on Ethnicity, Culture and Health, University of Michigan, School of Public Health, 109 S. Observatory, Ann Arbor, MI 48109, 734-936-9868, woodyn@umich.edu

Studies showing that schizophrenia is diagnosed more frequently in African Americans and that mood disorders are identified more often in European Americans have raised serious questions about ethnocentric bias in clinical judgment. Additional studies showing that clinicians using semi-structured instruments along with DSM criteria typically find no black-white differences in diagnosis have been interpreted as evidence of misdiagnosis. Taken together, these data raise questions about why clinicians underdiagnose mood disorders and overdiagnose schizophrenia in African Americans. They also highlight the role of DSM as a tool for correcting bias in clinical judgment. A total of 667 African American and European American inpatients were evaluated using a semi-structured diagnostic instrument. Significant differences in diagnosis were found for some diagnoses but not others. Multinomial logistic regression results showed that European Americans were over four times more likely than African Americans to receive a diagnosis of bipolar disorder. No differences were found for major depression or schizophrenia. Findings underscore the continued importance of clinical judgment within the context of a standardized taxonomy like DSM-IV. Because clinical judgment is the main door through which cultural context will enter the diagnostic process, academic and professional training programs must teach the appropriate use of the sociocultural information necessary to employ DSM-IV's Cultural Formulation. At the conclusion of the session, participants will be able to: 1) describe evidence consistent with the misdiagnosis hypothesis; 2) recognize the importance of clinical judgment in cultural diagnosis; 3) discuss the necessity for training programs to reduce ethnocentric bias.

Learning Objectives: At the conclusion of the session, participants will be able to

• describe evidence consistent with the misdiagnosis hypothesis;
• recognize the importance of clinical judgment in cultural diagnosis;
• discuss the necessity for training programs to reduce ethnocentric bias.

Keywords: Depression, Screening Instruments

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.