Tuesday, June 28, 2005

Blacks and Mental Illness

Racial Disparities in Pinpointing Mental Illness

John Zeber recently examined one of the nation's largest databases of psychiatric cases to evaluate how doctors diagnose schizophrenia, a disorder that often portends years of powerful brain-altering drugs, social ostracism and forced hospitalizations.

Although schizophrenia has been shown to affect all ethnic groups at the same rate, the scientist found that blacks in the United States were more than four times as likely to be diagnosed with the disorder as whites. Hispanics were more than three times as likely to be diagnosed as whites.

Zeber, who studies quality, cost and access issues for the U.S. Department of Veterans Affairs, found that differences in wealth, drug addiction and other variables could not explain the disparity in diagnoses: "The only factor that was truly important was race."

The analysis of 134,523 mentally ill patients in a VA registry is by far the largest national sample to show broad ethnic disparities in the diagnosis of serious mental disorders in the United States.

The data confirm the fears of experts who have warned for years that minorities are more likely to be misdiagnosed as having serious psychiatric problems. "Bias is a very real issue," said Francis Lu, a psychiatrist at the University of California at San Francisco. "We don't talk about it -- it's upsetting. We see ourselves as unbiased and rational and scientific."

As the ranks of America's patients and doctors become more diverse, psychiatrists such as Lu are spearheading a movement to address the problem. Clinicians need to be trained in "cultural competence," they say, to prevent misdiagnosis and harm.

Psychiatrist Heather Hall, a colleague of Lu's, said she had to correct the diagnoses of about 40 minorities over a two-year period. She estimated that one in 10 patients referred to her came with a misdiagnosis such as schizophrenia, a disorder characterized by social withdrawal, communication problems, and psychotic symptoms such as delusions and hallucinations.

I've mentioned my concern before about Blacks and mental illness. There is clearly an institutional problem here, i.e., healthcare professionals not treating Blacks as they would Whites. This is always a problem. But there is an equally huge problem on the cultural side of the equation.

Like HIV/AIDS, there is a huge, huge, huge stigma attached to mental illness. Even your run-of-the-mill depression is not easily accepted in the Black community. Whatever solultions are developed, it must be two-pronged to be effective. It must target the healthcare system and also the cultural factors.


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