Severely Depressed African-Americans are More Likely to be Misdiagnosed as Schizophrenic

According to a new study from Rutgers University, African-Americans with severe depression are more likely than Whites to be misdiagnosed as having schizophrenia.

For their study, the researchers examined medical records of 1,657 people (599 Blacks and 1,058 Whites) at a community behavioral health clinic that screened for major depression as part of its assessment for schizophrenia in new patients. The results found that clinicians failed to effectively weigh mood symptoms when diagnosing schizophrenia among African-Americans, suggesting that racial bias, whether conscious or subconscious, is one factor in the diagnosis of schizophrenia in this population.

“By definition, schizophrenia is a diagnosis of exclusion: Clinicians must rule out other potential causes of symptoms, including mood disorders, before the diagnosis of schizophrenia is given,” said Michael Gara, a professor of psychiatry at Rutgers Robert Wood Johnson Medical School and a faculty member at Rutgers University Behavioral Health Care. “However, there has been a tendency for clinicians to overemphasize the relevance of psychotic symptoms and overlook symptoms of major depression in African-Americans compared with other racial or ethnic groups. No studies show that African-Americans with schizophrenia are more likely to also have major depression.”

The findings suggest that clinicians put more emphasis on psychotic than depressive symptoms in African-Americans, which skews diagnoses toward schizophrenia even when these patients show similar depressive and manic symptoms as White patients.

“Inaccurate diagnosis can have serious consequences,” Dr. Gara said. “Mood disorder treatments differ from those for schizophrenia, and the prognosis for these conditions is typically more positive than for schizophrenia. These patients who may have major depression with psychotic features or bipolar disorder and who are misdiagnosed with schizophrenia do not receive the optimal treatment, putting them at risk for the worsening of the underlying disease process or for suicide. Also, the side effects of medication taken for schizophrenia, such as diabetes and weight gain, can be serious.”

The full study, “A Naturalistic Study of Racial Disparities in Diagnoses at an Outpatient Behavioral Health Clinic,” was published in the journal Psychiatric Services. It may be accessed here.

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