Tri-Ethnic Differences: an Examination of Associated Symptoms Within an Inpatient Setting

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The study examined the interactions among race, gender, age, length of stay, legal status on admission, clinical symptoms, and psychiatric diagnosis. The study analyzed archived data from a sample of inpatients admitted to a large urban teaching psychiatric mental health facility between January 1, 2004 and December 31, 2007. The extant literature suggests that African Americans are more likely to have a discharge diagnosis of a psychotic disorder and Caucasians are more likely to have a mood disorder; but it is not clear whether there is a predominant psychiatric diagnosis for Hispanics. The literature also suggests there may be differences in patient-reported versus clinician-identified symptoms. Archived data were included from patients who were 18 years or older and who self-identified as African American, Caucasian, or Hispanic. The archived data included completed admission and discharge data from the Physician-Rated Anchored Brief Psychiatric Rating Scale (BPRS-A), the Nurse-Rated Affective Disorder Rating Scale (ADRS), and the patient self-reported Brief Symptom Inventory (BSI). The study used analyses of covariance (ANCOVA) to analyze continuous variables and Chi-square analyses to explore categorical variables. Descriptive analyses were conducted on demographic and study variables to evaluate data integrity, to assess homogeneity, and to quantify normality. Relative and absolute difference scores were computed within ethnicity x gender subgroups. Findings from the study of 1,115 cases demonstrated significant and persistent differences across ethnic and gender categories confirming general findings from earlier studies (Lawson et al., 1994; Mukherjee et al., 1983; Neighbors et al., 1989; Strakowski et al., 1996). In addition, the study also demonstrated significant differences in clinical evaluations of physicians and nurses of the same patients. Using an innovative methodology, relative and absolute difference scores were computed between the patient’s evaluation and that of both physician and nurse providers. A comparison of the distributions of the difference scores across providers and ethnicity x gender groups provided insight into the differences in agreement/disagreement patterns by clinician when gender and ethnic factors were involved. The findings indicated clear patterns of differences between the study participants’ self-evaluations and the clinician-evaluations of the patient. Physicians appear to show a bias against females and minorities, rating them in a more negative manner. There also is a similar, but less dramatic, pattern of negative assessment by nurses. The study findings demonstrate the need for enhanced awareness of the impact of race during psychiatric diagnostic processes and emphasize the need for culturally specific research.

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Culture, Psychiatry, Psychiatric Mental Health

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