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Patient and clinician race, and situation information in patients’ self report as a context for diagnosis of major depression

Jordana Muroff, MSW, MA, School of Social Work, University of Michigan, 1080 South University, Ann Arbor, MI 48109-1106, (734) 763-7602, jmuroff@umich.edu

Researchers have been exploring potential explanations for higher rates of schizophrenia and lower rates of mood disorder among African Americans; patterns are reversed for White Americans. Misdiagnosis may be one explanation (Neighbors, et al, 2000). Mental health practitioners often have been found to make dispositional attributions based on clients’ problems and overlook situational and environmental contributors. Recent studies (Trierweiler, Muroff, et al, in press) have shown that the use of specific attributions and the disregard of other critical information may contribute to differential diagnosis of schizophrenia and mood disorders. This study examines clinicians' consideration of socio-cultural factors in the diagnosis of mood versus schizophrenia disorders among psychiatric inpatients from a predominantly low-income, African-American community. Following a Clinician Structured Diagnostic Interview (CSDI), clinicians completed an open-ended questionnaire, describing their diagnostic decision-making process. This study focuses on the clinicians’ reports from memory of what the patient said during the clinical interview. Clinicians’ responses were coded for the presence of situational information in the interview. Logistic regression analyses involving these codes suggest that clinicians’ and patients’ race/ethnicity contribute to clinicians’ mentioning of situation information in patients self-reports, distinguishing mood versus schizophrenia disorder. Clinicians' responses noting patients’ self-reports about specific life conditions and events and episodes of aggressive behavior directed toward the self were associated with mood disorder diagnoses.

Learning Objectives: Participants will be able to

Keywords: Depression, Culture

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.

Panel: Environmental Contributions to Mental Disorder for African Americans

The 132nd Annual Meeting (November 6-10, 2004) of APHA