Ethnicity and the Diagnosis of Affective Illness

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DESCRIPTION (provided by applicant): Mood disorders are among the most common and debilitating conditions affecting humanity. Correctly identifying and treating mood disorders is critical in order to address this serious public health problem. However, African-Americans with mood disorders are significantly more likely than white patients to be misdiagnosed with schizophrenia. Consequently, African-Americans are at increased risk for receiving inadequate treatment. Failure to correctly identify African-Americans with these conditions contributes to disparities in medical care delivery between ethnic minority and majority patients. However, it is not known why African-Americans with mood disorders are more likely than whites to be misdiagnosed with schizophrenia. Previous investigators suggested that misdiagnoses of schizophrenic disorders appeared to occur because clinicians failed to elicit affective symptoms from African-Americans with mood disorders. Moreover, when mood and psychotic symptoms were both identified, clinicians appeared to minimize the affective symptoms in African-American men. These findings suggest the hypothesis that African-Americans with severe mood disorders are more likely than whites to be misdiagnosed with schizophrenia because clinicians over-emphasize psychotic symptoms at the expense of mood symptoms in the former. Consistent with this hypothesis, African- Americans are more likely to receive excess antipsychotics. Previous studies typically contrasted only African- American and white patients, so it is unknown whether this problem of misdiagnosis is unique to African-Americans or also occurs in other U.S. minorities. Although some studies reported that mood disorders were also commonly misdiagnosed as schizophrenia in Latinos, other work disagreed. Because there are few studies of these issues in Latinos, it is difficult to identify associations among diagnosis, treatment and ethnicity in this patient group. With these considerations in mind, we propose a large, regionally diverse, six-site collaborative R01 study to examine the effects of ethnicity on clinical diagnosis and treatment assignment in African-American, Latino and white patients with mood disorders. The primary objective is to test the hypothesis that clinicians over-emphasize psychotic symptoms at the expense of affective symptoms in African-Americans, leading to an excess of clinical diagnoses of schizophrenia relative to other ethnic groups. A second objective is to test the hypothesis that over-emphasis of psychotic symptoms also contributes to increased antipsychotic use in African-Americans. The final objective is to determine whether Latinos are at risk for similar problems in diagnostic assessments and treatment assignment.