Influence of Patient Race and Ethnicity on Clinical Assessment in Patients With Affective Disorders
Influence of Patient Race and Ethnicity on Clinical Assessment in Patients With Affective Disorders
复制标题
DOI：
10.1001/archgenpsychiatry.2011.2040
复制
发表时间：
2012-06-01
影响因子：
--
通讯作者：
Strakowski, Stephen M.
中科院分区：
文献类型：
--
作者：
Gara, Michael A.;Vega, William A.;Strakowski, Stephen M.
背景：与美国其他族裔相比，非洲裔美国人的精神分裂症临床诊断率似乎更高，这与流行病学调查得出的人口比率相矛盾。目的：确定非裔美国人是否会继续表现出显著更高的精神分裂症临床诊断率，即使在控制了年龄、性别、收入、地点和教育程度以及是否存在严重情感障碍之后，专家们对种族和民族视而不见。第二个目标是确定在拉丁裔受试者中是否存在类似的模式。设计：在美国6个地点进行了241名非裔美国人(平均年龄34.3[8.1]岁；57%女性)、220名非拉丁裔白人(平均[SD]年龄，32.7[8.5]岁；53%女性)和149名拉丁裔个人(平均[SD]年龄，33.5[8.0]岁；58%女性)的种族失明和非失明诊断评估。使用Logistic回归模型来确定在控制了包括严重情感疾病的盲目专家共识诊断在内的各种混杂变量后，非裔美国人精神分裂症的高发病率是否会持续。背景：全美六个学术医学中心。参与者：610名精神科住院患者和门诊患者。主要观察指标：非裔美国人与白人个体相比，非裔美国人非盲目临床诊断为精神分裂症的相对几率。结果：显著的种族/种族效应(chi(2)(2)=10.4，P=)。01)是在狭义地定义精神分裂症时得出的，控制了所有其他预测因素。非洲裔美国人与非拉丁裔白人的优势比显著(优势比=2.7；95%可信区间，1.5-5.1)。当精神分裂症被更广泛地定义时，非裔美国人和白人之间也有类似的差异(优势比=2.5；95%可信区间为1.4-4.5)。非裔美国人的躁狂和抑郁症状的总体严重程度与白人没有显著差异，但有证据表明他们患有更严重的精神分裂症。结论：即使在控制了严重情感障碍等协变量后，非洲裔美国人的精神分裂症临床诊断率也显著高于非拉丁裔白人。
Context: Rates of clinical diagnoses of schizophrenia in African American individuals appear to be elevated compared with other ethnic groups in the United States, contradicting population rates derived from epidemiologic surveys.Objective: To determine whether African American individuals would continue to exhibit significantly higher rates of clinical diagnoses of schizophrenia, even after controlling for age, sex, income, site, and education, as well as the presence or absence of serious affective disorder, as determined by experts blinded to race and ethnicity. A secondary objective was to determine if a similar pattern occurred in Latino subjects.Design: Ethnicity-blinded and -unblinded diagnostic assessments were obtained in 241 African American individuals (mean [SD] age, 34.3 [8.1] years; 57% women), 220 non-Latino white individuals (mean [SD] age, 32.7 [8.5] years; 53% women), and 149 Latino individuals (mean [SD] age, 33.5 [8.0] years; 58% women) at 6 US sites. Logistic regression models were used to determine whether elevated rates of schizophrenia in African American individuals would persist after controlling for various confounding variables including blinded expert consensus diagnoses of serious affective illness.Settings: Six academic medical centers across the United States.Participants: Six hundred ten psychiatric inpatients and outpatients.Main Outcome Measure: Relative odds of unblinded clinical diagnoses of schizophrenia in African American compared with white individuals.Results: A significant ethnicity/race effect (chi(2)(2) = 10.4, P =. 01) was obtained when schizophrenia was narrowly defined, controlling for all other predictors. The odds ratio comparing African American with non-Latino white individuals was significant (odds ratio = 2.7; 95% CI, 1.5-5.1). Similar differences between African American and white individuals occurred when schizophrenia was more broadly defined (odds ratio = 2.5; 95% CI, 1.4-4.5). African American individuals did not differ significantly from white individuals in overall severity of manic and depressive symptoms but did evidence more severe psychosis.Conclusions: African American individuals exhibited significantly higher rates of clinical diagnoses of schizophrenia than non-Latino white subjects, even after controlling for covariates such as serious affective disorder.