Hispanicity, Language, and Psychiatric Diagnosis

描述（由申请人提供）：医患沟通对于准确诊断至关重要，而准确诊断对于正确的精神病治疗至关重要。当临床医生和他们的病人在种族、文化和语言上存在差异时，评估精神疾病及其严重程度的问题就更容易出现。即使有翻译协助这种诊断情况，我们对种族和语言对精神病诊断的影响也知之甚少。为了研究临床医生和患者之间的种族和语言相似性和差异如何影响诊断，本修订的探索性/发展性应用程序的具体目的是：(1)比较临床医生是说英语的、非西班牙语的临床医生和双语西班牙语的临床医生时，仅西班牙语和双语西班牙语患者的临床诊断；(2)基于临床医生对患者行为的解释，探讨临床医生的诊断依据，并检查诊断访谈中的互动过程；(3)纯西班牙语和双语西班牙裔患者临床诊断和结构化访谈诊断的差异；(4)翻译人员的存在对只讲西班牙语患者的临床诊断的影响。研究设计了150名外国出生的西班牙裔成年移民寻求精神科服务，在入院时被分配给单语（英语）非西班牙裔临床医生或双语西班牙裔临床医生。训练有素的翻译人员将在与只会说英语的临床医生匹配的单语患者的访谈中进行翻译。采访将被录像。临床医生将在所有五个轴上提供DSM-IV诊断，并完成研究问卷。在录像之前或之后，还将对患者进行结构化的临床访谈。然后，第二名临床医生（对临床医生和SCID诊断一无所知）也将在所有五个轴上提供DSM-IV诊断，并根据录像带完成研究方案。在只有西班牙语的录音访谈中，第二位只会说一种语言（英语）的临床医生也将由翻译协助。数据分析包括定量和定性两种方法。

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.