(Apr. 26, 2016) Race and ethnicity significantly influence the likelihood of being diagnosed and treated for psychiatric disease, but the reasons why remain to be determined.
Karen J. Coleman and colleagues searched for patterns by analyzing rates of diagnoses, medication prescription and psychotherapy sessions for 7.5 million adult patients enrolled in private, not-for-profit health care organizations in 11 states. The analysis is the first to examine racial-ethnic differences based on service utilization instead of patient self-reports, which are not considered entirely accurate. The Coleman analysis used de-identified medical and pharmacy record data instead.
Differences in Diagnoses
Of the 7.5 million health system patients in the analysis, 15.6% were diagnosed with one or more of nine psychiatric conditions: bipolar disorder, schizophrenia, other psychoses, depression, anxiety, substance use disorders, attention-deficit disorders, autism spectrum disorders and dementia.
Among the findings:
- Native American/Alaskan Native patients had the highest rates for all diagnoses (20.6%), followed closely by non-Hispanic whites (19.8%).
- Persons from all the other racial-ethnic minorities - Hispanic, Asian, non-Hispanic black, Native Hawaiian/other Pacific Islander - had lower rates of overall diagnosed psychiatric conditions with one clear exception:
- Non-Hispanic blacks were nearly twice as likely as non-Hispanic whites to be diagnosed with schizophrenia.
- At 7.5%, Asians were significantly less likely to be diagnosed with any diagnosis than any other race or ethnic group. They were two-thirds less likely than non-Hispanic white patients to be diagnosed with depression and also less likely to receive medication if diagnosed.
Treatment Differences
In the study population, 73% of the patients received a psychotropic medication in the study year; 34% received formal psychotherapy.
Just as they were more likely to be diagnosed, non-Hispanic whites and Native American/Alaskan Natives were more likely to receive psychotropic medications than other groups, with the exception of schizophrenia and other psychosis. Even though they were twice as likely to be diagnosed with the disease, non-Hispanic blacks were less likely to receive medication for schizophrenia or other psychosis than non-Hispanic whites. Asian patients also were less likely than whites to receive medication for other psychoses.
Overall and unlike diagnoses and treatment, no clear differences in psychotherapy treatment were found across racial and ethnic groups. When diagnoses were analyzed separately, however, patients from any racial-ethnic minority were found more likely than non-Hispanic whites to receive psychotherapy for depression. Non-Hispanic blacks were as likely as whites to receive psychotherapy though less likely to receive a medication prescription.
The Meaning in the Differences
"Our study does not provide answers to why racial-ethnic differences in the diagnosis and treatment of psychiatric conditions persist, especially for non-Hispanic black patients," the authors concluded. "There are many patient- and provider-level factors that could contribute...."
The authors cited evidence that some cultures prefer complementary and alternative medicine (such as herbal remedies) to pharmaceuticals for some conditions. They noted that factors such as immigration status, language preference, socioeconomic status and subsidized insurance coverage are all known to relate to diagnosis and medication.
Provider-level factors also are known to account for some differences, they wrote. The same mental health symptoms are more likely to result in non-Hispanic blacks being diagnosed with bipolar or schizophrenia and non-Hispanic whites being diagnosed with major depression.
"Further research is necessary to understand how patient preferences and provider practices determine the differences we have reported," the authors closed.
Doris A. Fuller
Chief of Research and Public Affairs
References:
- Coleman, K.J. et al. (15 April 2016). Racial-ethnic differences in psychiatric diagnoses and treatment across 11 health care systems in the mental health research network. PS in Advance.
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