Exploring the racial diagnostic bias of schizophrenia using behavioral and clinical-based measures

Abstract

There is evidence that African Americans are 2.4 times more likely to be diagnosed with a schizophrenia-spectrum diagnosis compared with White individuals, who are more likely to receive an affective diagnosis. The reason for these diagnostic discrepancies is unclear, however, 2 explanations have garnered attention: epigenetic differences and systematic error or bias in the diagnostic process. The latter is the focus of the present study and it is hypothesized that the bias involves cultural insensitivity on the part of the clinician. The present study has investigated bias-driven diagnostic disparities between African Americans and White individuals, by using traditional symptom rating scales, clinical diagnoses, and objective, behaviorally based measures. Data was aggregated from 3 separate studies conducted on outpatients (N = 251) with schizophrenia-spectrum or affective disorders. The present study used computationally derived acoustic markers of speech to tap hallmark negative symptoms (e.g., blunted affect or alogia) and behavioral-based markers of language failures to tap disorganization. Clinician symptom ratings were made using the Brief Psychiatric Rating Scale. Our findings confirmed the diagnostic bias between African Americans and White individuals though there were no differences on clinician symptom ratings. On the other hand, the computerized and behavioral measures revealed more speech disorder and less blunted affect in African Americans versus White individuals. Moderation analysis suggests that behaviorally based measures impact the relationship between race and diagnosis; however, this was largely unsupported for race and clinical symptom ratings. Further research is needed to disentangle normative variations from psychopathology. (PsycINFO Database Record (c) 2019 APA, all rights reserved).