Disparities in mental health treatment in US racial and ethnic minority groups: Implications for psychiatrists
Disparities in mental health treatment in US racial and ethnic minority groups: Implications for psychiatrists
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DOI：
10.1176/appi.ps.56.12.1600
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发表时间：
2005-12-01
影响因子：
3.8
通讯作者：
Vega, WA
中科院分区：
文献类型：
--
作者：
Atdjian, S;Vega, WA
众所周知，开放论坛在他们的标准上存在文化偏见(13)。例如，非裔美国人在不信任和偏执方面的得分往往更高，如果不结合背景进行考虑，这可能会导致对精神障碍的误诊。然而，如果从这些个人遭受压迫的历史背景来看，不信任可以理解为正当和规范的。同样有充分记录的是非洲裔美国人对精神分裂症的过度诊断，他们报告了假定的精神病症状，如果欧洲裔美国人报告了同样的症状，更有可能导致情绪障碍的诊断(14)。最近的报告指出，我们的偏见和陈规定型观念影响对少数族裔患者的评估，从而对治疗和结果产生影响的其他微妙但却是重要的方式(2)。值得注意的是，评估行为的精神病学框架植根于欧美的历史传统。不符合这一传统的价值体系、参照系、行为和症状表现更有可能被视为功能失调或偏离常态，或者仅仅被视为一种文化特质。甚至我们的治疗性语言也包含了这种偏见的色彩：对个人主义、竞争力和时间效率的重视；对成功的衡量标准；以及对适当的家庭结构和性别角色义务的假设。
Open Forum been known to be culturally biased in their criteria (13). For example, African Americans often score higher on measures of mistrust and paranoia, which, if not considered in context, can result in a misdiagnosis of a psychotic disorder. However, if seen through the context of the history of oppression of these individuals, mistrust can be understood as warranted and normative. Similarly well documented is the overdiagnosis of schizophrenia among African Americans who report putative symptoms of psychosis, the same symptoms that, if reported by European Americans, are more likely to result in a diagnosis of a mood disorder (14). Recent reports identify other subtle, but nonetheless consequential, ways in which our biases and stereotypes affect assessments of patients from ethnic minority groups and therefore have an impact on treatment and outcome (2). Of note, the psychiatric framework for evaluating behavior is rooted in European-American historical tradition. Value systems, frames of reference, behaviors, and symptom presentations that do not fit that tradition are more likely to be seen as dysfunctional or deviant or merely as a cultural idiosyncrasy. Even our therapeutic language contains hues of this bias: the value placed on individualism, competitiveness, and time-efficiency; the measures of success; and assumptions about appropriate family structure and gender role obligations.