African-Americans with severe depression are more likely to be misdiagnosed with schizophrenia, according to a new Rutgers University study.
The study, “A Naturalistic Study of Racial Disparities in Diagnoses at an Outpatient Behavioral Health Clinic,” which was published in the journal Psychiatric Services, examined the medical records of 1,657 people at a community behavioral health clinic that included screening for major depression as part of its assessment for schizophrenia in new patients.
“By definition, schizophrenia is a diagnosis of exclusion: Clinicians must rule out other potential causes of symptoms, including mood disorders, before the diagnosis of schizophrenia is given,” said Michael Gara, a professor of psychiatry at Rutgers Robert Wood Johnson Medical School and a faculty member at Rutgers University Behavioral Health Care. “However, there has been a tendency for clinicians to overemphasize the relevance of psychotic symptoms and overlook symptoms of major depression in African-Americans compared with other racial or ethnic groups. No studies show that African-Americans with schizophrenia are more likely to also have major depression.”
The study, which looked at 599 Blacks and 1,058 non-Latino whites, found that clinicians failed to effectively weigh mood symptoms when diagnosing schizophrenia among African-Americans, suggesting that racial bias, whether conscious or subconscious, is one factor in the diagnosis of schizophrenia in this population.
Other factors include genetics, poverty and discrimination, as well as symptoms caused by infections and malnutrition early in life.
“Individuals from a racial minority group also might feel hopelessness or mistrust when being assessed by someone from a racial majority group, which could affect how they act and how the clinician interprets symptoms,” Gara said.