Diagnostic patterns in Latino, African American, and European American psychiatric patients.
BACKGROUND
The purpose of this study was to examine whether Latino patients presenting for behavioral health treatment showed major systematic differences in presenting symptoms, clinical severity, and psychiatric diagnosis compared with European American and African American patients. Documenting such differences should have important implications for evidence-based clinical practice.


METHODS
Data were drawn from a large behavioral health service delivery system in New Jersey, and included administrative data, clinical diagnosis, a clinician-rated global level of functioning, and a self-reported symptoms and functioning scale. The study involved a clinical sample of all new admissions into the system between January 1, 2000, and August 31, 2001. To examine the main effects of ethnicity, in the context of other independent variables, logistic regression was performed for each of 3 dependent binary variables: presence or absence of major depression, a schizophrenia spectrum disorder, and bipolar disorder.


RESULTS
Consistent with previous studies, we found that African Americans were diagnosed as having a disorder in the schizophrenic disorders spectrum more frequently than did Latinos and European Americans (odds ratio, 1.80; 95% confidence interval, 1.62-2.00). Latinos were disproportionately diagnosed as having major depression, despite the fact that significantly higher levels of psychotic symptoms were self-reported by Latinos (odds ratio, 1.74; 95% confidence interval, 1.56-1.93).


CONCLUSIONS
Latinos in this study were more likely to be clinically diagnosed as having major depression than were other ethnic groups. Further research is needed to determine the reasons for these systematic differences. Possible explanations include (1) self-selection, (2) culturally determined expression of symptoms, (3) difficulties in the accurate application of DSM-IV diagnostic criteria to Latinos, (4) bias related to lack of clinicians' cultural competence, and (5) imprecision inherent in the use of unstructured interviews, possibly combined with clinician bias. Additional research is required to determine the generalizability, accuracy, and applicability of these findings and their possible mechanisms.
Minsky
Shula
S
University Behavioral HealthCare, Department of Psychiatry, Robert Wood Johnson Medical School, University of Medicine and Dentistry of New Jersey, Piscataway 08855, USA. minsky@cmhc.umdnj.edu
Vega
William
W
Miskimen
Theresa
T
Gara
Michael
M
Escobar
Javier
J
D000293:Adolescent; D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D000368:Aged; D002983:Clinical Competence; D016001:Confidence Intervals; D003866:Depressive Disorder / Q000175:diagnosis / Q000208:ethnology; D005006:Ethnicity / Q000706:statistics & numerical data*; D005260:Female; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis* / Q000208:ethnology*; D008875:Middle Aged; D015588:Observer Variation; D016017:Odds Ratio; D011569:Psychiatric Status Rating Scales; D012559:Schizophrenia / Q000175:diagnosis / Q000208:ethnology; D014481:United States / Q000208:ethnology; D044465:White People / Q000706:statistics & numerical data