Influence of patient race and ethnicity on clinical assessment in patients with affective disorders.
BACKGROUND
Rates of clinical diagnoses of schizophrenia in African American individuals appear to be elevated compared with other ethnic groups in the United States, contradicting population rates derived from epidemiologic surveys.


OBJECTIVE
To determine whether African American individuals would continue to exhibit significantly higher rates of clinical diagnoses of schizophrenia, even after controlling for age, sex, income, site, and education, as well as the presence or absence of serious affective disorder, as determined by experts blinded to race and ethnicity. A secondary objective was to determine if a similar pattern occurred in Latino subjects.


METHODS
Ethnicity-blinded and -unblinded diagnostic assessments were obtained in 241 African American individuals (mean [SD] age, 34.3 [8.1] years; 57% women), 220 non-Latino white individuals (mean [SD] age, 32.7 [8.5] years; 53% women), and 149 Latino individuals (mean [SD] age, 33.5 [8.0] years; 58% women) at 6 US sites. Logistic regression models were used to determine whether elevated rates of schizophrenia in African American individuals would persist after controlling for various confounding variables including blinded expert consensus diagnoses of serious affective illness.


METHODS
Six academic medical centers across the United States.


METHODS
Six hundred ten psychiatric inpatients and outpatients.


METHODS
Relative odds of unblinded clinical diagnoses of schizophrenia in African American compared with white individuals.


RESULTS
A significant ethnicity/race effect (χ(2)(2)=10.4, P=.01) was obtained when schizophrenia was narrowly defined, controlling for all other predictors. The odds ratio comparing African American with non-Latino white individuals was significant (odds ratio=2.7; 95% CI, 1.5-5.1). Similar differences between African American and white individuals occurred when schizophrenia was more broadly defined (odds ratio=2.5; 95% CI, 1.4-4.5). African American individuals did not differ significantly from white individuals in overall severity of manic and depressive symptoms but did evidence more severe psychosis.


CONCLUSIONS
African American individuals exhibited significantly higher rates of clinical diagnoses of schizophrenia than non-Latino white subjects, even after controlling for covariates such as serious affective disorder.
University of Medicine and Dentistry of New Jersey University Behavioral HealthCare and Robert Wood Johnson Medical School, Piscataway, NJ 08855, USA. garami@umdnj.edu
Michael A
MA
Gara
William A
WA
Vega
Stephan
S
Arndt
Michael
M
Escamilla
David E
DE
Fleck
William B
WB
Lawson
Ira
I
Lesser
Harold W
HW
Neighbors
Daniel R
DR
Wilson
Lesley M
LM
Arnold
Stephen M
SM
Strakowski
D000293:Adolescent; D000328:Adult; D001741:Black or African American / Q000208:ethnology; D015897:Comorbidity; D005260:Female; D006630:Hispanic or Latino / Q000208:ethnology; D006801:Humans; D007406:Interview, Psychological / Q000592:standards; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D019964:Mood Disorders / Q000175:diagnosis* / Q000453:epidemiology / Q000208:ethnology; D011569:Psychiatric Status Rating Scales / Q000592:standards; D044469:Racial Groups; D012559:Schizophrenia / Q000175:diagnosis* / Q000453:epidemiology / Q000208:ethnology; D016037:Single-Blind Method; D014481:United States / Q000208:ethnology; D044465:White People / Q000208:ethnology; D055815:Young Adult