Addressing Racial Disparities in Bipolar Disorder Treatment

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A misdiagnosis of schizophrenia will limit the opportunity for treatment with lithium and/or mood-stabilizing medications.
A misdiagnosis of schizophrenia will limit the opportunity for treatment with lithium and/or mood-stabilizing medications.

The results of a retrospective literature review published in Bipolar Disorders indicated that patients of African ancestry with bipolar disorder were more often misdiagnosed with other psychological conditions and less often included in genomic studies than individuals of non-African ancestry.

Investigators first identified potential racial biases in the diagnostic criteria used to characterize bipolar disorder. According to a medical record review performed in 1983, a greater proportion of African American and Hispanic individuals with bipolar disorder were previously misdiagnosed with schizophrenia compared with white individuals (P <.0005). Similarly, a 2004 study found that African Americans were 4 times more likely to be given a misdiagnosis of schizophrenia compared with white Americans with similar symptoms (odds ratio (OR) 4.05; 95% CI, 3.91-4.19). Based on their review, investigators concluded that the use of an expert panel reviewing diagnostic criteria appeared to yield fewer incidences of misdiagnosis compared with clinical diagnosis and structured interview.

In addition, researchers reviewed literature to investigate treatment disparities in those of African descent compared with those of European descent. Past studies indicated that African American patients were prescribed antipsychotic medications at a higher rate (P <.007) and were significantly less likely to have an outpatient follow-up visit within 90 days of their diagnosis (P =.009) compared with white patients. Investigators hypothesized that a lack of culturally competent providers and a dearth of personalized treatment regimens may be responsible for suboptimal treatment of bipolar disorder in African American patients.

Scientists also conducted a review of recruitment disparities in existing genetic studies on the neurobiology of bipolar disorder. As an example, genome-wide association studies performed by the international Psychiatric Genomics Consortium had an overwhelming number of participants of European ancestry (n=9784) compared with those of African ancestry (n=345). The lack of genomic studies with diverse cohorts limits the scientific understanding of bipolar disorder in patients of non-European ancestry.

Researchers treated these data as a call to action to both improve treatment for those of African ancestry and to conduct genomic research on more diverse populations. Investigators further emphasized the need for future studies on socioeconomic and cultural factors on the accessibility of healthcare to patients of all backgrounds.

Reference

Akinhanmi MO, Biernacka JM, Strakowski SM, et al. Racial disparities in bipolar disorder treatment and research: a call to action [published online March 12, 2018] Bipolar Disord. doi: 10.1111/bdi.12638

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