Gender bias in clinical judgment: An assessment of the analogue method's transparency and social desirability

Race bias and gender bias in the diagnosis of psychological disorders

Bias is said to occur when validity is better for one group than another (e.g., when diagnoses are more valid for male or female clients). This article provides (a) a methodological critique of studies on race bias and gender bias in diagnosis and (b) a narrative review of results from studies with good internal validity. The results suggest that race bias occurs for the diagnosis of conduct disorder, antisocial personality disorder, comorbid substance abuse and mood disorders, eating disorders, posttraumatic stress disorder, and the differential diagnosis of schizophrenia and psychotic affective disorders. Other results suggest that gender bias occurs for the diagnosis of autism spectrum disorder, attention deficit hyperactivity disorder, conduct disorder, and antisocial and histrionic personality disorders. The way that symptoms are expressed (e.g., Black cultural expressions of depression) appears to have a significant effect on diagnoses. It may be possible to decrease bias by expanding the use of (a) mental health screening, (b) self-report measures including some psychological tests, (c) structured interviews, and (d) statistical prediction rules. Finally, evidence exists that (a) the diagnosis of personality disorders should be made using dimensional ratings and (b) training in cultural diversity and debiasing strategies should be provided to mental health professionals.

An Investigation of Diagnostic Accuracy and Confidence Associated with Diagnostic Checklists as Well as Gender Biases in Relation to Mental Disorders

This study examines the utility of checklists in attaining more accurate diagnoses in the context of diagnostic decision-making for mental disorders. The study also aimed to replicate results from a meta-analysis indicating that there is no association between patients’ gender and misdiagnoses. To this end, 475 psychotherapists were asked to judge three case vignettes describing patients with Major Depressive Disorder (MDD), Generalized Anxiety Disorder, and Borderline Personality Disorder. Therapists were randomly assigned to experimental conditions in a 2 (diagnostic method: with using diagnostic checklists vs. without using diagnostic checklists) × 2 (gender: male vs. female case vignettes) between-subjects design. Multinomial logistic and linear regression analyses were used to examine the association between the usage of diagnostic checklists as well as patients’ gender and diagnostic decisions. The results showed that when checklists were used, fewer incorrect co-morbid diagnoses were made, but clinicians were less likely to diagnose MDD even when the criteria were met. Additionally, checklists improved therapists’ confidence with diagnostic decisions, but were not associated with estimations of patients’ characteristics. As expected, there were no significant associations between gender and diagnostic decisions.

Medical student judgments of adolescents with alcohol use disorders (AUD)

The clinical encounter presents opportunities for detection and intervention of adolescent alcohol use disorders (AUDs).

AIMS

Investigate (a) identification rate of AUDs, (b) whether AUD identification predicts clinical judgment, and (c) patient characteristics influences on clinical judgment. Medical students (n=123) read a case study and completed questions on diagnosis and clinical judgment. Twenty-five percent of participants identified AUD adolescents, who were more negatively rated than non-AUD adolescents. Prior clinical experience and addiction training predicted AUD identification. Patient race and gender influenced clinical judgment ratings. Addictions training is needed to improve identification rates. Study limitations are noted.

Judgments of culpability in a filicide scenario

Previous research has indicated that potential jurors are likely to use personal biases, such as those based on gender and ethnicity, in their judgments of culpability of criminal defendants in addition to, or instead of, the facts of the crime. The present paper seeks to extend this literature to the crime of filicide; to examine whether male defendants are judged more harshly than female defendants, as is the case for domestic violence and sexual abuse. 214 participants were provided with a scenario of filicide in which the gender of the perpetrator, the gender of the child, and the family's social class were randomly assigned. Participants were asked to rate the culpability of the defendant in the case. Results indicated that, unlike for other violent crimes, participants did not use gender or social class biases in their judgments of criminal culpability.

Does students' exposure to gender discrimination and sexual harassment in medical school affect specialty choice and residency program selection?

PURPOSE

To examine the role of gender discrimination and sexual harassment in medical students' choice of specialty and residency program.

METHOD

Anonymous, self-administered questionnaires were distributed in 1997 to fourth-year students enrolled in 14 public and private U.S. medical schools. In addition to reporting the frequency of gender discrimination and sexual harassment encountered during preclinical coursework, core clerkships, elective clerkships, and residency selection, students assessed the impact of these exposures (none, a little, some, quite a bit, the deciding factor) on their specialty choices and rankings of residency programs.

RESULTS

A total of 1,314 (69%) useable questionnaires were returned. Large percentages of men (83.2%) and women (92.8%) experienced, observed, or heard about at least one incident of gender discrimination and sexual harassment during medical school, although more women reported such behavior across all training contexts. Compared with men, significantly (p </= .01) more women who reported exposure indicated that gender discrimination and sexual harassment influenced their specialty choices (45.3% versus 16.4%) and residency rankings (25.3% versus 10.9%). Across all specialties, more women than men experienced gender discrimination and sexual harassment during residency selection, with one exception: a larger percentage of men choosing obstetrics and gynecology experienced such behavior. Among women, those choosing general surgery were most likely to experience gender discrimination and sexual harassment during residency selection. Interestingly, correlations between exposure to gender discrimination and sexual harassment and self-assessed impact on career decisions tended to be larger for men, suggesting that although fewer men are generally affected, they may weigh such experiences more heavily in their choice of specialty and residency program.

CONCLUSION

This study suggests that exposure to gender discrimination and sexual harassment during undergraduate education may influence some medical students' choice of specialty and, to a lesser degree, ranking of residency programs.

The influence of gender and ethnicity on judgments of culpability in a domestic violence scenario

Using an experimental analog design, in this study we examined 503 European American, African American, and Latino undergraduate students' responses to a domestic violence scenario in which the ethnicity and gender of the perpetrator were manipulated. Results indicated that participants perceived perpetration of domestic assault significantly more criminal when committed by a man than when committed by a woman. That finding was robust across European Americans, African Americans, and Latinos and was expressed by both genders. Also, European American participants expressed significantly more criticism toward African American perpetrators of assault than they did toward European American and Latino perpetrators of the exact offense, suggestive of racial bias consistent with stereotypes about African Americans being excessively aggressive. Finally, Latino participants expressed significantly more sympathy toward women who assault their husbands than toward assaulting husbands. Implications of the findings are discussed.

Clinicians' hypotheses regarding clients' problems: are they less likely to hypothesize sexual abuse in male compared to female clients?

Sixty-one clinical psychologists completed a questionnaire about a detailed case summary of an adult client which incorporated a number of indicators that the client may have been sexually abused. The gender of the client was manipulated. Significantly more clinicians hypothesized that the female client (compared to the male client) had been sexually abused in childhood. Clinicians who were more recently qualified, and clinicians who identified their predominant theoretical orientation as psychodynamic (rather than cognitive-behavioral), were more likely to hypothesize sexual abuse, although these effects were only statistically significant for the female clients. The majority of clinicians hypothesizing sexual abuse in the female client rated the abuse as the most important issue to address in therapy; this was not the case for the male client. These findings are discussed in relation to the literature suggesting that the apparent low number of male victims of sexual abuse currently being seen by the helping professions may in part be accounted for by a lack of awareness in clinicians as to the possibility that males, including their male clients, are sexually abused.