A Naturalistic Study of Racial Disparities in Diagnoses at an Outpatient Behavioral Health Clinic

Psychiatr Serv. 2019 Feb 1;70(2):130-134. doi: 10.1176/appi.ps.201800223. Epub 2018 Dec 10.


Objective: The authors examined electronic medical record (EMR) outpatient data to determine whether African Americans with schizophrenia or schizoaffective disorder were more likely than non-Latino whites to screen positive for major depression.

Methods: EMR data for 1,657 patients at Rutgers University Behavioral Health Care certified community outpatient clinics were deidentified and accrued for 9 months starting July 1, 2017. A Fisher's exact test was used to compare differences in the proportion of patients with positive screens for major depression (cutoff score of ≥15 on the nine-item Patient Health Questionnaire) among African-American and non-Latino white patients diagnosed as having schizophrenia or schizoaffective disorder.

Results: Among patients diagnosed as having schizophrenia, African Americans were more likely than non-Latino whites (p<.003) to screen positive for major depression. The between-group difference in positive screens was not significant among patients diagnosed as having schizoaffective disorder.

Conclusions: The results are consistent with findings from a large body of literature suggesting that racial differences in the diagnosis of schizophrenia in the United States result in part from clinicians underemphasizing the relevance of mood symptoms among African Americans compared with other racial-ethnic groups. If the results are replicated, a case could be made that routine screening for major depression in community mental health settings could reduce racial disparities in schizophrenia diagnoses.

Keywords: Diagnosis/classification (DSM); Schizoaffective disorders; Schizophrenia.

Publication types

  • Observational Study

MeSH terms

  • Adult
  • Ambulatory Care / statistics & numerical data*
  • Black or African American / statistics & numerical data*
  • Depressive Disorder, Major / diagnosis*
  • Electronic Health Records / statistics & numerical data
  • Female
  • Healthcare Disparities / statistics & numerical data*
  • Humans
  • Male
  • Mental Health Services / statistics & numerical data*
  • Middle Aged
  • Psychotic Disorders / diagnosis*
  • Retrospective Studies
  • Schizophrenia / diagnosis*
  • United States
  • White People / statistics & numerical data*