The effects of race and information variance on disagreement between psychiatric emergency service and research diagnoses in first-episode psychosis.
BACKGROUND
Previously, we reported that patient race was associated with disagreement between research and clinical diagnoses. To extend this work, we studied whether disagreement was specifically due to associations of patient race with information or criterion variance.


METHODS
Ninety-nine patients consecutively admitted through the University of Cincinnati Psychiatric Emergency Service (PES) for a first hospitalization for psychosis were evaluated using the Structured Clinical Interview for DSM-III-R. Diagnoses made in the PES were compared with those obtained from the structured interview. We examined the contributions of information variance and criterion variance to the association between race and diagnostic agreement of PES and research diagnoses.


RESULTS
Agreement in PES and research diagnoses was present in only 42% of patients. Diagnostic agreement was less common in non-white patients than white patients, even after controlling for other sociodemographic and clinical variables. Information variance was the cause of diagnostic disagreement in 58% of cases and was associated with patient race. Criterion variance, occurring in 42% of cases, was not associated with race.


CONCLUSIONS
Patient race may contribute to the diagnostic process in the psychiatric emergency service by influencing the information obtained from patients during clinical evaluations.
Strakowski
S M
SM
Department of Psychiatry, University of Cincinnati College of Medicine, Ohio 45267-0559, USA.
Hawkins
J M
JM
Keck
P E
PE
McElroy
S L
SL
West
S A
SA
Bourne
M L
ML
Sax
K W
KW
Tugrul
K C
KC
D004637:Emergency Services, Psychiatric / Q000706:statistics & numerical data; D006760:Hospitalization; D006801:Humans; D011569:Psychiatric Status Rating Scales / Q000706:statistics & numerical data*; D011618:Psychotic Disorders / Q000175:diagnosis* / Q000523:psychology; D044469:Racial Groups