Race and Hospital Diagnoses of Schizophrenia and Mood Disorders

Disparities in mental health services are currently the focus of consumers, providers, policymakers, and researchers (Dougherty, 2004; Snowden, 2003). This attention stems in part from the President's New Freedom Commission on Mental Health (2003), which formulated the goal of eliminating disparities in mental health services as one of six interrelated goals necessary to transform America's mental health system. Studies have consistently shown that African Americans are disproportionately represented in state psychiatric hospitals and have raised questions about bias in involuntary hospitalization derived from ethnic and racial stereotypes (Lawson, Hepler, Holladay, & Cuffel, 1994; Milazzo-Sayre et al., 2001; Snowden & Cheung, 1990). Although the percentage of people receiving treatment in state psychiatric hospitals has drastically declined under deinstitutionalization, in comparison with all other mental health organizations, state psychiatric hospitals still provide the highest percentage of inpatient psychiatric services in the United States. In the year 2000, state psychiatric hospitals provided care for 30 percent of the inpatient population, an estimated 54,808 people (Manderscheid et al., 2004). About one-third of the admissions to state psychiatric hospitals involve individuals with schizophrenia (Milazzo-Sayre et al., 2004). Several studies on state psychiatric hospitals have reported higher rates of diagnosis of schizophrenia among African American clients than among white clients (Flaskerud & Hu, 1992; Lawson et al., 1994; Pavkov, Lewis, & Lyons, 1989; Snowden & Cheung, 1990). Strakowski and colleagues (1993), for example, found that African American clients were five times more likely than were white clients to be diagnosed with schizophrenia. However, research on the prevalence of mental disorders in the general population has found no significant difference in the rate of schizophrenia between the African American population and the white population when socioeconomic status is controlled (Keith, Regier, & Rae, 1991). The higher rates of schizophrenia diagnosis among African Americans is referred to as "overdiagnosis" (Snowden & Cheung) and has been recognized as a significant disparity in mental health services (U.S. Department of Health and Human Services [HHS], 1999; HHS, 2001). Cultural differences between mental health clinicians and African American clients, clinician bias, and racial differences in symptom presentations have been suggested as possible determinants for overdiagnosis of schizophrenia (Lawson et al.; Flaskerud & Hu; Snowden, 2003; Strakowski et al., 1993; Whaley, 1997). The relationship between race and psychiatric hospital diagnoses is investigated in the present study. LITERATURE REVIEW Overdiagnosis of schizophrenia among African Americans is believed to increase the risks of inappropriate interventions in terms of treatment with the wrong medications; specifically treatment with antipsychotic medications instead of antidepressants (Lawson, 1996). Once diagnosed with schizophrenia, African American clients are at higher risks than are white clients for receiving both excessive prescribed dosages of medications (Walkup et al., 2000) and older rather than newer medications (Kuno & Rothbard, 2002; Mallinger, Fisher, Brown, & Lamberti, 2006; Mark, Palmer, Russo, & Vasey, 2003). Overdiagnosis of schizophrenia is generally believed to occur in conjunction with three broad factors: (1) underdiagnosis of mood disorders in African Americans, (2) co-occurring substance abuse or dependence, and (3) client characteristics (Adebimpe, 1994; Baker & Bell, 1999; Neighbors, Trierweiler, Ford, & Muroff, 2003; Strakowski et al., 1993). Several studies on race and diagnosis of schizophrenia have used unstructured or semistructured clinical interviews to diagnose psychiatric disorders (Neighbors et al., 2003; Neighbors et al. …