By Shankar Vedantam, Washington Post Staff Writer, Tuesday, June 28, 2005
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."
...
When hospitals diversified their staffs to include Spanish-speaking
doctors, many cases of psychotic behavior were reassessed, he said:
"Half the cases were rediagnosed as depression. Some doctors think if
you don't make eye contact, you can be diagnosed. In some communities,
eye contact is a sign of disrespect."
...
"I believe bias exists, and there is a risk a psychiatrist with a
different cultural experience than a patient can misinterpret the
expression of a psychiatric symptom," he said. "If you have a very
religious group of patients and a very secular psychiatrist who thinks
beliefs in spirits or hearing the voice of God is not normal, you are
going to have misses."
...
"If you have an African American patient presenting with elevated
paranoia, that has been referred to in some quarters as healthy
paranoia based on how they perceive society," said Zeber, who works at
the Veterans Affairs Department's Health Services Research and
Development center in San Antonio. "If you base your diagnosis on that
symptom, you can be misled."
Zeber's argument is supported by a panel of academic experts who
helped draft a research agenda in 2002 for the next edition of
psychiatry's manual of mental disorders.
They wrote: "Misdiagnosis due to a different cultural perspective of
bizarreness is rather frequent." Inattention to the role that social
standards and cultural factors play in diagnosis has caused patients
to be stereotyped, they added, "with obvious negative consequences for
diagnosis and treatment."
<http://www.washingtonpost.com/wp-dyn/content/article/2005/06/27/AR2005062701496.html>
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