Need factors strongly predicted the diagnosis of schizophrenia and mood disorders among US Hispanics and African Americans, according to a study published in Psychiatry Research. This retrospective cohort study examined many factors contributing to ethnic disparities in these diagnoses.
Researchers grouped patients (n=5571) by ethnicity into US Hispanics (14.6%), African Americans (44.8%), and non-Hispanic whites (40.7%) and utilized the Andersen Behavioral Model of Health Services Use to examine ethnic disparities. According to this classification system, predisposing factors included ethnicity, language, age, gender, and marital status; enabling factors were barriers to receiving health services, such as insurance status, homelessness, and involuntary hospital admittance; and need factors were the severity and presentation of symptoms and known substance abuse.
Overall, 33.6% of the patients were diagnosed with schizophrenia and 66.4% were diagnosed with mood disorders. Patients with schizophrenia more often had an impaired Brief Psychiatric Rating Scale score and a lower Global Assessment of Functioning score. Of the patients diagnosed with schizophrenia, many showed need factors of positive symptoms, hallucinations, and disorganization as well as need factors of negative symptoms, such as reduced affect and emotional withdrawal. The relationship between a schizophrenia diagnosis and US Hispanic ethnicity was marginally significant.
These findings suggest the “[a]vailability and accessibility of needed outpatient services may serve as an enabling factor for continued disparities in severity of symptoms at admission further complicating diagnosis and treatment.” Further studies need to evaluate the relationship between available outpatient resources and clinician diagnosis.
Hamilton JE, Heads AM, Meyer TD, Desai PV, Okusaga OO, Cho RY. Ethnic differences in the diagnosis of schizophrenia and mood disorders during admission to an academic safety-net psychiatric hospital. Psychiatry Res. 2018; 267: 160-167. doi: 10.1016/j.psychres.2018.05.043