ABSTRACT Encounters with Western psychiatric treatment and acculturation may influence causal bel... more ABSTRACT Encounters with Western psychiatric treatment and acculturation may influence causal beliefs of psychiatric illness endorsed by Chinese immigrant relatives, thus affecting help seeking. We examined causal beliefs held by 46 Chinese immigrant relatives and found that greater acculturation was associated with an increased number of causal beliefs. Further, as Western psychiatric treatment and acculturation increased, causal models expanded to incorporate biological/physical causes. However, frequency of Chinese immigrant relatives’ endorsing spiritual beliefs did not appear to change with acculturation. Clinicians might thus account for spiritual beliefs in treatment even after acculturation increases and biological causal models proliferate.
Different cultural norms for paranoia that exist among African Americans may be misconstrued and ... more Different cultural norms for paranoia that exist among African Americans may be misconstrued and fuel the overdiagnosis of schizophrenia. The present study examined whether the frequency of psychotic psychiatric diagnoses differs by race/ethnicity, particularly with regard to paranoid schizophrenia. We examined the frequency upon admission and at discharge and further explored the pattern of diagnostic changes that occurred by racial/ethnic group. The present study is a secondary analysis of diagnostic data obtained on inpatients admitted to a research unit from 1990 to 2003 with a typical length of stay from 3 to 6 months. Admission and discharge diagnoses were obtained from each chart on the sample of 238 patients, 55% (N = 130) of whom were white; 24% (N = 58), African American; and 21% (N = 50), Latino. Inpatients were grouped into 4 diagnostic categories: schizoaffective disorder, paranoid schizophrenia, schizophrenia-undifferentiated or -disorganized type, and other psychotic disorder. Upon admission, African American patients were more likely to receive a less-defined diagnosis, such as psychosis not otherwise specified, in part because they tended on average to be younger. Over the course of hospitalization, diagnoses for white patients were more likely to move toward schizoaffective at discharge (OR = 6.85, 95% CI = 1.53 to 30.66). African American patients were more likely to experience a diagnostic change to paranoid schizophrenia (OR = 4.58, 95% CI = 1.70 to 13.36). Interestingly, Latino patients were the least likely group to experience diagnostic changes during their hospitalization stay. The present preliminary findings reveal an interesting pattern of diagnostic changes that occurred over the course of hospitalization that should be followed up in a comprehensive study.
Ethnicity effects on diagnoses are frequently reported and have variably been attributed to diagn... more Ethnicity effects on diagnoses are frequently reported and have variably been attributed to diagnostic biases versus ethnic differences in environmental exposures, and other factors. We compared best-estimate gold standard research diagnoses to clinical diagnoses (DSM-III-R and DSM-IV criteria) among 129 white, 57 African American, and 50 Hispanic patients with psychosis admitted to an inpatient research unit from 1990 to 2003. Clinical and research diagnoses showed greater agreement in Hispanic than in African American patients (white patients were intermediate). Diagnostic agreement for paranoid schizophrenia was likewise the best in Hispanic patients. While paranoid schizophrenia tended to be overdiagnosed in African American patients, it was underdiagnosed in white patients. Patterns of diagnostic agreement for schizoaffective disorder and "other" diagnoses were similar among the 3 ethnic groups. Diagnostic unreliability may explain the excess of paranoid schizophrenia reported for African Americans. Further research is needed to elucidate the influence of ethnicity on clinical diagnosis before other theories to explain group differences can be reasonably proposed and reliably tested.
ABSTRACT Encounters with Western psychiatric treatment and acculturation may influence causal bel... more ABSTRACT Encounters with Western psychiatric treatment and acculturation may influence causal beliefs of psychiatric illness endorsed by Chinese immigrant relatives, thus affecting help seeking. We examined causal beliefs held by 46 Chinese immigrant relatives and found that greater acculturation was associated with an increased number of causal beliefs. Further, as Western psychiatric treatment and acculturation increased, causal models expanded to incorporate biological/physical causes. However, frequency of Chinese immigrant relatives’ endorsing spiritual beliefs did not appear to change with acculturation. Clinicians might thus account for spiritual beliefs in treatment even after acculturation increases and biological causal models proliferate.
Different cultural norms for paranoia that exist among African Americans may be misconstrued and ... more Different cultural norms for paranoia that exist among African Americans may be misconstrued and fuel the overdiagnosis of schizophrenia. The present study examined whether the frequency of psychotic psychiatric diagnoses differs by race/ethnicity, particularly with regard to paranoid schizophrenia. We examined the frequency upon admission and at discharge and further explored the pattern of diagnostic changes that occurred by racial/ethnic group. The present study is a secondary analysis of diagnostic data obtained on inpatients admitted to a research unit from 1990 to 2003 with a typical length of stay from 3 to 6 months. Admission and discharge diagnoses were obtained from each chart on the sample of 238 patients, 55% (N = 130) of whom were white; 24% (N = 58), African American; and 21% (N = 50), Latino. Inpatients were grouped into 4 diagnostic categories: schizoaffective disorder, paranoid schizophrenia, schizophrenia-undifferentiated or -disorganized type, and other psychotic disorder. Upon admission, African American patients were more likely to receive a less-defined diagnosis, such as psychosis not otherwise specified, in part because they tended on average to be younger. Over the course of hospitalization, diagnoses for white patients were more likely to move toward schizoaffective at discharge (OR = 6.85, 95% CI = 1.53 to 30.66). African American patients were more likely to experience a diagnostic change to paranoid schizophrenia (OR = 4.58, 95% CI = 1.70 to 13.36). Interestingly, Latino patients were the least likely group to experience diagnostic changes during their hospitalization stay. The present preliminary findings reveal an interesting pattern of diagnostic changes that occurred over the course of hospitalization that should be followed up in a comprehensive study.
Ethnicity effects on diagnoses are frequently reported and have variably been attributed to diagn... more Ethnicity effects on diagnoses are frequently reported and have variably been attributed to diagnostic biases versus ethnic differences in environmental exposures, and other factors. We compared best-estimate gold standard research diagnoses to clinical diagnoses (DSM-III-R and DSM-IV criteria) among 129 white, 57 African American, and 50 Hispanic patients with psychosis admitted to an inpatient research unit from 1990 to 2003. Clinical and research diagnoses showed greater agreement in Hispanic than in African American patients (white patients were intermediate). Diagnostic agreement for paranoid schizophrenia was likewise the best in Hispanic patients. While paranoid schizophrenia tended to be overdiagnosed in African American patients, it was underdiagnosed in white patients. Patterns of diagnostic agreement for schizoaffective disorder and "other" diagnoses were similar among the 3 ethnic groups. Diagnostic unreliability may explain the excess of paranoid schizophrenia reported for African Americans. Further research is needed to elucidate the influence of ethnicity on clinical diagnosis before other theories to explain group differences can be reasonably proposed and reliably tested.
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Papers by Deidre Anglin