Hispanicity, Language, and Psychiatric Diagnosis

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DESCRIPTION (provided by applicant): Clinician-patient communication is essential for accurate diagnosis which in turn is vital to proper psychiatric treatment. When clinicians and their patients differ in ethnicity, culture and language, problems in assessing psychiatric disorders and their severity are more apt to arise. Even with translators assisting in such diagnostic situations, we know very little about the impact of ethnicity and language on psychiatric diagnosis. In order to examine how ethnic and linguistic similarity and difference between clinicians and patients affect diagnosis, this revised exploratory/developmental application has as its specific aims to (1) To compare clinician-rendered diagnoses of Spanish-only and bilingual Hispanic patients when clinicians are English-speaking, non-Hispanic clinicians and bilingual Hispanic clinicians; (2) explore clinicians' rationales for diagnoses based on their interpretations of patients' behaviors, and examine interactional process during diagnostic interviews; (3) differences between clinician-rendered and structured-interview diagnoses for Spanish-only and bilingual Hispanics; and (4) effects of translator presence in clinician-rendered diagnoses of Spanish-only patients. The study design has 150 foreign-born adult Hispanic immigrants seeking psychiatric services assigned at intake to either a monolingual (English) non-Hispanic clinician or a bilingual Hispanic clinician. A trained translator will translate during interviews of monolingual patients who are matched with English-only clinicians. Interviews will be videotaped. Clinicians will render DSM-IV diagnoses on all five axes, and complete research questionnaires. A structured clinical interview will also be administered to patients before or after the videotaping. Then, a second clinician (blind to the clinician and SCID diagnoses) will also render DSM-IV diagnoses on all five axes and complete research protocol based on the videotape. In Spanish-only taped interviews, the second clinician who will be monolingual (English) will also be assisted by the translator. Data analysis consists of both quantitative and qualitative approaches.