Abstract
Research on race and diagnosis initially focused on black-white differences in depression and schizophrenia. Statistics showing a higher treated prevalence of schizophrenia and a lower prevalence of depression for blacks seemed to support the claim that blacks did not suffer from depression. Others argued, however, that clinicians were misdiagnosing depression in blacks. This article reviews empirical studies of racial differences in individual symptoms and summarizes the evidence on misdiagnosis. It argues that more attention must be paid to resolving two contradictory assumptions made by researchers working in the area of race and diagnostic inference: (1) blacks and whites exhibit symptomatology similarly but diagnosticians mistakenly assume that they are different; (2) blacks and whites display psychopathology in different ways but diagnosticians are unaware of or insensitive to such cultural differences. The article concludes with suggested research directions and a discussion of critical research issues.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Abedimpe, V.R. (1981). Overview: White norms and psychiatric diagnosis of black patients.American Journal of Psychiatry, 138, 279–285.
akbar, N. (1980). Mental disorders among African Americans.Black Caucus Journal, 11, 1–7.
Bell, C.C., Mehta, H. (1980). The misdiagnosis of black patients with manic depressive illness.Journal of the National Medical Association, 72, 141–145.
Bell, C.C., Mehta, H. (1980). Misdiagnosis of black patients with manic depressive illness: Second in a series.Journal of the National Medical Association, 73, 101–107.
Casas, M. (1986). Making effective use of research to impact the training of culturally sensitive mental health workers. In M. Miranda, H. Kitano (Eds.),Mental health research and practice in minority communities. Washington, DC: National Institute of Mental Health, DHHS Publication No. (ADM) 86–1466.
Craig, T., Goodman, A., Haugland, G. (1982). Impact of DSM-III on clinical practice.American Journal of Psychiatry, 139, 922–925.
DeHoyos, A., DeHoyos, G. (1965). Symptomatology differentials between Negro and white schizophrenics.International Journal of Psychiatry, 11, 245–265.
Dohrenwend, B.P., Dohrenwend, B.S. (1974). Social and cultural influences on psychopathology.Annual Review of Psychology, 25, 417–452.
Feighner, J., Herbstein, J., (1987). Diagnostic validity, in C. Last, M. Hershen (Eds.)Issues in diagnostic research. New York: Plenum Press, pp. 121–140.
Figelman, M. (1968). A comparison of affective and paranoid disorders in Negroes and Jews.International Journal of Psychiatry, 14, 277–281.
Fischer, J. (1969). Negroes and whites and rates of mental illness: Reconsideration of a myth.Psychiatry, 32, 428–446.
Frances, A., Shear, K., Fyer, M. (1987). Differential therapeutics: Clinical, teaching, research and administrative issues. InAmerican Psychiatric Association Annual Review, Volume 6. Washington, DC: American Psychiatric Association Press.
Good, B.J., Good, M.D.V. (1986). The cultural context of diagnosis and therapy: A view from medical anthropology. In M. Miranda and H. Kitano (Eds.),Mental health research and practice in minority communities. Washington, DC: National Institute of Mental Health, DHHS Publication No. (ADM) 86–1466.
Gynther, M. Fowler, R., Erdberg, F. (1971). False positives galore: The application of standard MMPI criteria to a rural, isolated, Negro sample.Journal of Clinical Psychology, 27, 234–237.
Hanson, B., Klerman, G. (1974). Interracial problems in the assessment of clinical depression: Concordance differences between black and white psychiatrists and black and white patients.Psychopharmacology Bulletin, 10, 65–66.
Helzer, J.E. (1975). Bipolar affective disorder in black and white men: A comparison of symptoms and familial illness.Archives of General Psychiatry, 32, 1140–143.
Helzer, J., Robins, L., McEvoy, L. et al. (1985). A comparison of clinical and DIS diagnoses: Physician reexamination of lay-interviewed cases in the general population.Archives of General Psychiatry, 42, 657–666.
Hendricks, L., Bayton, J., et al. (1983). NIMH's Diagnostic Interview Schedule: A test of its concurrent validity in a population of black adults.Journal of the National Medical Association, 7, 667–671.
Jones, A.C. (1985). Psychological functioning in black Americans: A conceptual guide for use in psychotherapy.Psychotherapy, 22, 363–369.
Jones, B.E., Gray, B.A., Parson, E.G. (1981). Manic depressive illness amorg poor urban blacks.American Journal of Psychiatry, 138, 654–657.
Jones, B.E., Robinson, W.M., Parson, E.B., Gray, B.A. (1982). The clinical picture of mania in manic depressive black patients.Journal of the National Medical Association, 74, 553–557.
Jones, B.E., Gray, B.A. (1986). Problems in diagnosing schizophrenia and affective disorders among blacks.Hospital and Community Psychiatry, 37, 61–65.
Kessler, R., Neighbors, H. (1986). A new perspective on the relationships among race, social class and psychological distress.Journal of Health and Social Behavior, 27, 107–115.
Kramer, M., Rosen, B., Willis, E. (1973). Definitions and distributions of mental disorders in a racist society. In C. Willie, M. Kramer, B. Brown (Eds.),Racism and mental health, Pittsburgh: University of Pittsburgh Press.
Lipton, A.A., Simon, F.S. (1985). Psychiatric diagnosis in a state hospital: Manhattan State revisited.Hospital and Community Psychiatry, 36, 368–373.
Liss, J.L., Welner, A., Robins, E., Richardson, M. (1973). Psychiatric symptoms in white and black inpatients I: Record study.Comprehensive Psychiatry, 14, 475–481.
Loring, M., Powell, B. (1988). Gender, race, and DSM-III: A study of the objectivity of psychiatric diagnostic behavior.Journal of Health and Social Behavior, 29, 1–22.
Mukherjee, S., Shukla, S., Woodle, J., Rosen, A.M., Olarte, S. (1983). Misdiagnosis of schizophrenia in bipolar patients: A multiethnic comparison.American Journal of Psychiatry, 140, 1571–1574.
Neighbors, H.W. (1987). Improving the mental health of black Americans: Lessons from the Community Mental Health Movement.The Milbank Quarterly, 65(2), 348–380.
Perry, S. (1987). The choice of duration and frequency for outpatient psychotherapy. InAmerican Psychiatric Association Annual Review, Volume 6. Washington, DC: American Psychiatric Press.
Prange, A., Vitols, M. (1962). Cultural aspects of relatively low incidence of depression in Southern Negroes.International Journal of Psychiatry, 8, 104–112.
Raskin, A., Crook, T.H., Herman, K.D. (1975). Psychiatric history and symptom differences in black and white depressed inpatients.Journal of Consulting and Clinical Psychology, 43, 73–80.
Roberts, R. (1987). Depression among black and Hispanic Americans. Paper presented at the NIMH Workshop on Depression and Suicide in Minorities, Bethesda, Maryland, December 7–8.
Ruiz, D.S. (1983). Epidemiology of schizophrenia: Some diagnostic and sociocultural considerations.Phylon, 43, 315–326.
Simon, R.J., Fleiss, J.L., Gurland, B.J., Stiller, P.R., Sharpe, L. (1973). Depression and schizophrenia in hospitalized black and white mental patients.Archives of General Psychiatry, 28, 509–512.
Singer, B. (1977).Racial factors in psychiatric intervention. San Francisco: R.E. Research Associates.
Sletten, I., Schuff, S., Altman, H., Ulett, G. (1972). A statewide computerized psychiatric system: Demographic, diagnostic and mental status data.British Journal of Social Psychiatry, 18, 30–40.
Steinberg, M.D., Pardes, H., Bjork, D., Sporty, L. (1977). Demographic and clinical characteristics of black psychiatric patients in a private general hospital.Hospital and Community Psychiatry, 28, 128–132.
Thomas, A., Sillen, S. (1972).Racism and psychiatry. New York: Bruner/Mael.
Tonks, C.M., Paykel, E.S., Klerman, G.L. (1970). Clinical depressions among Negroes.American Journal of Psychiatry, 127, 329–335.
Vernon, S., and Roberts, R. (1981). Measuring nonspecific psychological distress and other dimensions of psychopathology: Further observations on the problem.Archives of General Psychiatry, 38, 1239–1247.
Vitols, M.M., Waters, H.G., Keeler, M.H. (1963). Hallucinations and delusions in white and Negro schizophrenics.American Journal of Psychiatry, 120, 472–476.
Weissman, M., Klerman, G. (1978). Epidemiology of mental disorders: Emerging trends in the United States.Archives of General Psychiatry, 35, 705–712.
Welner, A., Liss, J.L., Robins, E. (1973). Psychiatric symptoms in white and black inpatients, II: Follow-up study.Comprehensive Psychiatry, 14, 483–488.
Williams, D.H. (1986). The epidemiology of mental illness in Afro-American.Hospital and Community Psychiatry, 37, 42–49.
Warheit, G., Holzer, C., Arey, S. (1975). Race and mental illness: An epidemiologic update.Journal of Health and Social Behavior, 16, 243–256.
Author information
Authors and Affiliations
Additional information
The authors would like to thank Dr. Clifford Broman (Michigan State University Department of Sociology), Dr. Neal Ryan (University of Pittsburgh Western Psychiatric Institute), Dr. Phillip Margolis (University of Michigan Medical Center Department of Psychiatry) and two anonymous reviewers for helpful comments on earlier drafts of this manuscript. Special thanks Ms. Johanna Lackner for editorial suggestions and helping to prepare the final version for publication.
Rights and permissions
About this article
Cite this article
Neighbors, H.W., Jackson, J.S., Campbell, L. et al. The influence of racial factors on psychiatric diagnosis: A review and suggestions for research. Community Ment Health J 25, 301–311 (1989). https://doi.org/10.1007/BF00755677
Issue Date:
DOI: https://doi.org/10.1007/BF00755677