(April 2, 2019) African-Americans are more likely to be misdiagnosed with schizophrenia, according to research out of Rutgers University released earlier this year.
Previous research has suggested that African-Americans are diagnosed with schizophrenia at higher rates, and that physicians tend to overemphasize psychotic symptoms and under-emphasize symptoms of depression, compared to other racial-ethnic groups.
A diagnosis of schizophrenia is typically given after ruling out other mental disorders and ensuring that symptoms are not being caused by substance abuse, medication, or a medical condition. The researchers from Rutgers argue that when individuals are experiencing depressive symptoms in addition to psychotic symptoms, it is especially important to rule out potential mood disorders, such as bipolar disorder or major depression. However, the practice of diagnosis by exclusion seems to occur more often for white patients, leaving some black patients with a diagnosis that may not be accurate.
Using electronic medical records, the researchers tested whether there was evidence of these racial disparities in diagnosis and significance of symptoms for African-American patients in New Jersey. The researchers examined records of 599 African-American and 1,058 non-Latino white patients, all diagnosed with schizophrenia, from outpatient behavioral health clinics in the state between July 2017 and March 2018. Selected clinics are required to screen all patients for depression, allowing researchers to compare the incidence of major depression within both racial-ethnic groups.
Among the study population, 19% of African-American patients diagnosed with schizophrenia also screened positive for major depression, compared to just 3% of non-Latino white patients. The comparably high level of depression in black patients supports the possibility of conscious or unconscious bias in diagnosing schizophrenia, say the study authors. Additionally, African-American patients may have reservations about fully disclosing symptoms due to cultural norms or mistrust of physicians, which could contribute to inappropriate diagnoses.
The researchers note that the phenomenon could also be explained if African-American patients really do experience co-occurring schizophrenia and depression at higher rates than white patients, but that there is no available evidence suggesting this is the case.
The researchers suggest that routine screening for major depression in outpatient community clinics could help reduce the racial inequity of schizophrenia diagnosis and address the perplexing overrepresentation of co-occurring schizophrenia and major depression among African Americans. If there are real differences in how physicians weigh symptoms of mental illness in black patients, or how these patients present symptoms to physicians, it may mean an entire population of patients is not receiving the most beneficial treatment for their unique combination of symptoms. The authors explain that treatments for mood disorders and treatments for schizophrenia are markedly different, and the wrong treatment can lead to patient frustration, nonadherence to treatment regimens, increased morbidity of symptoms, and suicide. An incorrect diagnosis can also negatively affect the patient’s prognosis of outcomes in the future and lower their expectations for treatment.
References:
Jessica Walthall
Research and Advocacy Associate
Treatment Advocacy Center