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Eijsbroek VC, Kjell K, Schwartz HA, Boehnke JR, Fried EI, Klein DN, Gustafsson P, Augenstein I, Bossuyt PMM, Kjell ONE. The LEADING Guideline. Reporting Standards for Expert Panel, Best-Estimate Diagnosis, and Longitudinal Expert All Data (LEAD) Studies. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.03.19.24304526. [PMID: 38699296 PMCID: PMC11065032 DOI: 10.1101/2024.03.19.24304526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2024]
Abstract
Background Accurate assessments of symptoms and illnesses are essential for health research and clinical practice but face many challenges. The absence of a single error-free measure is currently addressed by assessment methods involving experts reviewing several sources of information to achieve a more accurate or best-estimate assessment. Three bodies of work spanning medicine, psychiatry, and psychology propose similar assessment methods: The Expert Panel, the Best-Estimate Diagnosis, and the Longitudinal Expert All Data (LEAD) method. However, the quality of such best-estimate assessments is typically very difficult to evaluate due to poor reporting of the assessment methods and when they are reported, the reporting quality varies substantially. Here, we tackle this gap by developing reporting guidelines for such best-estimate assessment studies. Methods The development of the reporting guidelines followed a four-stage approach: 1) drafting reporting standards accompanied by rationales and empirical evidence, which were further developed with a patient organization for depression, 2) incorporating expert feedback through a two-round Delphi procedure, 3) refining the guideline based on an expert consensus meeting, and 4) testing the guideline by i) having two researchers test it and ii) using it to examine the extent previously published studies report the standards. The last step also provides evidence for the need for the guideline: 10 to 63% (Mean = 33%) of the standards were not reported across thirty randomly selected studies. Results The LEADING guideline comprises 20 reporting standards related to four groups: The Longitudinal design (four standards); the Appropriate data (four standards); the Evaluation - experts, materials, and procedures (ten standards); and the Validity group (two standards). Conclusions We hope that the LEADING guideline will be useful in assisting researchers in planning, conducting, reporting, and evaluating research aiming to achieve best-estimate assessments.
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Hall H. Dissociation and misdiagnosis of schizophrenia in populations experiencing chronic discrimination and social defeat. J Trauma Dissociation 2024; 25:334-348. [PMID: 36065490 DOI: 10.1080/15299732.2022.2120154] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 08/12/2022] [Indexed: 10/14/2022]
Abstract
As recently as the late 20th century, Schizophrenia, a category of mental illness with widely varying phenotypic symptoms, was believed by psychobiologists to be a genetically based disorder in which the environment played a limited etiological role. Yet a growing body of evidence indicates a strong correlation between schizophrenia and environmental factors. This theoretical paper explores the relationship between highly elevated rates of schizophrenia in some low-income minority communities worldwide and trauma-related dissociative symptoms that often mimic schizophrenia. Elevated rates of schizophrenia in racially and ethnically isolated, inner-city Black populations are well documented. This paper contains evidence proposing that this amplification in the rate of schizophrenia is mediated by childhood trauma, disorganized attachment, and social defeat. Further, evidence demonstrating how these three variables combine in early childhood to incubate dissociative disorders will also be conveyed. The misdiagnosis of dissociative disorders as schizophrenia is theorized to partially mediate the increased rate of schizophrenia in communities that experience high levels of racial/ethnic discrimination. It is argued that this misdiagnosis is often attributable to cultural misunderstanding and/or a lack of knowledge about dissociative disorders.
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Şahin D, Kambeitz-Ilankovic L, Wood S, Dwyer D, Upthegrove R, Salokangas R, Borgwardt S, Brambilla P, Meisenzahl E, Ruhrmann S, Schultze-Lutter F, Lencer R, Bertolino A, Pantelis C, Koutsouleris N, Kambeitz J. Algorithmic fairness in precision psychiatry: analysis of prediction models in individuals at clinical high risk for psychosis. Br J Psychiatry 2024; 224:55-65. [PMID: 37936347 DOI: 10.1192/bjp.2023.141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2023]
Abstract
BACKGROUND Computational models offer promising potential for personalised treatment of psychiatric diseases. For their clinical deployment, fairness must be evaluated alongside accuracy. Fairness requires predictive models to not unfairly disadvantage specific demographic groups. Failure to assess model fairness prior to use risks perpetuating healthcare inequalities. Despite its importance, empirical investigation of fairness in predictive models for psychiatry remains scarce. AIMS To evaluate fairness in prediction models for development of psychosis and functional outcome. METHOD Using data from the PRONIA study, we examined fairness in 13 published models for prediction of transition to psychosis (n = 11) and functional outcome (n = 2) in people at clinical high risk for psychosis or with recent-onset depression. Using accuracy equality, predictive parity, false-positive error rate balance and false-negative error rate balance, we evaluated relevant fairness aspects for the demographic attributes 'gender' and 'educational attainment' and compared them with the fairness of clinicians' judgements. RESULTS Our findings indicate systematic bias towards assigning less favourable outcomes to individuals with lower educational attainment in both prediction models and clinicians' judgements, resulting in higher false-positive rates in 7 of 11 models for transition to psychosis. Interestingly, the bias patterns observed in algorithmic predictions were not significantly more pronounced than those in clinicians' predictions. CONCLUSIONS Educational bias was present in algorithmic and clinicians' predictions, assuming more favourable outcomes for individuals with higher educational level (years of education). This bias might lead to increased stigma and psychosocial burden in patients with lower educational attainment and suboptimal psychosis prevention in those with higher educational attainment.
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Affiliation(s)
- Derya Şahin
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Lana Kambeitz-Ilankovic
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany; and Department of Psychology, Faculty of Psychology and Educational Sciences, Ludwig-Maximilian University, Munich, Germany
| | - Stephen Wood
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Victoria, Australia; and Orygen, the National Centre of Excellence for Youth Mental Health, Melbourne, Victoria, Australia
| | - Dominic Dwyer
- Department of Psychology, Faculty of Psychology and Educational Sciences, Ludwig-Maximilian University, Munich, Germany; and Orygen, the National Centre of Excellence for Youth Mental Health, Melbourne, Victoria, Australia
| | - Rachel Upthegrove
- Institute for Mental Health and Centre for Brain Health, University of Birmingham, Birmingham, UK; and Early Intervention Service, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | | | - Stefan Borgwardt
- Department of Psychiatry (University Psychiatric Clinics, UPK), University of Basel, Basel, Switzerland; and Department of Psychiatry and Psychotherapy, University of Lübeck, Lübeck, Germany
| | - Paolo Brambilla
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; and Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Eva Meisenzahl
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Stephan Ruhrmann
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Frauke Schultze-Lutter
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany; Department of Psychology, Faculty of Psychology, Airlangga University, Surabaya, Indonesia; and University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Rebekka Lencer
- Department of Psychiatry and Psychotherapy, University of Lübeck, Lübeck, Germany; and Institute for Translational Psychiatry, University of Münster, Münster, Germany
| | - Alessandro Bertolino
- Department of Basic Medical Science, Neuroscience and Sense Organs, University of Bari Aldo Moro, Bari, Italy
| | - Christos Pantelis
- Melbourne Neuropsychiatry Centre, University of Melbourne & Melbourne Health, Melbourne, Victoria, Australia
| | - Nikolaos Koutsouleris
- Department of Psychology, Faculty of Psychology and Educational Sciences, Ludwig-Maximilian University, Munich, Germany; Max-Planck Institute of Psychiatry, Munich, Germany; and Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Joseph Kambeitz
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
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Anglin DM, Lui F. Racial microaggressions and major discriminatory events explain ethnoracial differences in psychotic experiences. Schizophr Res 2023; 253:5-13. [PMID: 34750038 PMCID: PMC11056996 DOI: 10.1016/j.schres.2021.10.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 10/21/2021] [Accepted: 10/25/2021] [Indexed: 11/27/2022]
Abstract
Few empirical studies have examined whether exposure to major racial discrimination explains ethnoracial disparities in psychosis outcomes and none to our knowledge have done so in the U.S. or have examined the role of other forms of racism such as racial microaggressions. The present study examined ethnoracial differences in self-reported psychotic experiences (PE) among 955 college students in an urban environment in the Northeastern U.S., and the degree to which major experiences of racial discrimination and racial microaggressions explains ethnoracial differences in PE. Mean scores on self-report inventories of PE and distressing PE (i.e., Prodromal Questionnaire (PQ)), major experiences of racial discrimination (EOD), and racial and ethnic microaggressions (REMS) were compared across 4 ethnoracial groups (White, Black, Asian, and Latina/o). Results from parallel mediation linear regression models adjusted for immigrant status, age, gender, and family poverty using the Hayes PROCESS application indicated ethnoracial differences in PE were explained independently by both forms of racism. Specifically, Black young people reported higher mean levels of PE, and distressing PE than both White and Latina/o people and the difference in PE between Black and White and Black and Latino/a young people was significantly explained by both greater exposure to racial microaggressions and major racial discriminatory experiences among Black people. This study re-emphasizes the explanatory role of racism, in its multiple forms, for psychosis risk among Black young populations in the US. Anti-racism interventions at both structural and interpersonal levels are necessary components of public health efforts to improve mental health in Black populations.
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Affiliation(s)
- Deidre M Anglin
- Department of Psychology, The City College of New York, City University of New York, 160 Convent Avenue, North Academic Center, New York, NY 10031, United States of America; The Graduate Center, City University of New York, 365 5th Avenue, New York, NY, 10016, United States of America.
| | - Florence Lui
- Memorial Sloan-Kettering Cancer Center, 641 Lexington Ave., New York, NY 10022, United States of America
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Bommersbach TJ, Rhee TG, Stefanovics EA, Rosenheck RA. Comparison of Black and white individuals who report diagnoses of schizophrenia in a national sample of US adults: Discrimination and service use. Schizophr Res 2023; 253:22-29. [PMID: 34088549 DOI: 10.1016/j.schres.2021.05.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Revised: 05/22/2021] [Accepted: 05/27/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND While there is increasing recognition of disparities in healthcare for Black Americans, there have been no comparisons in a nationally representative U.S. sample of Black and White adults with clinical diagnoses of schizophrenia. METHODS Using nationally representative survey data from the National Epidemiologic Survey on Alcohol and Related Conditions-III, we compared Black (n = 240, 36.2%) and White (n = 423, 63.8%) adults who report having been told by a physician that they have schizophrenia. Due to the large sample size, effect sizes (risk ratios and Cohen's d), rather than p-values, were used to identify the magnitude of differences in sociodemographic and clinical characteristics, including experiences of discrimination and service use. Multivariate analyses were used to identify independent factors. RESULTS Black individuals with diagnoses of schizophrenia reported multiple sociodemographic disadvantages, including lower rates of employment, educational attainment, income, marriage, and social support, with little difference in incarceration, violent behavior, and quality of life. They reported much higher scores on a general lifetime discrimination scale (Cohen's d = 0.75) and subscales representing job discrimination (d = 0.85), health system discrimination (d = 0.70), and public race-based abuse (d = 0.55) along with higher rates of past year alcohol and drug use disorders, but lower rates of co-morbid psychiatric disorders. Multivariable-adjusted regression analyses highlighted the independent association of Black race with measures of discrimination and religious service attendance; less likelihood of receiving psychiatric treatment (p = 0.02) but no difference in substance use treatment. CONCLUSION Black adults with schizophrenia report numerous social disadvantages, especially discrimination, but religious service attendance may be an important social asset.
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Affiliation(s)
- Tanner J Bommersbach
- Department of Psychiatry, Yale University School of Medicine, 300 George Street, Suite 901, New Haven, CT, USA.
| | - Taeho Greg Rhee
- Department of Psychiatry, Yale University School of Medicine, 300 George Street, Suite 901, New Haven, CT, USA; U.S. Department of Veterans Affairs New England Mental Illness Research, Education, and Clinical Center, 950 Campbell Avenue, West Haven, CT, USA; Department of Public Health Sciences, University of Connecticut School of Medicine, 263 Farmington Avenue, Farmington, CT, USA
| | - Elina A Stefanovics
- Department of Psychiatry, Yale University School of Medicine, 300 George Street, Suite 901, New Haven, CT, USA; U.S. Department of Veterans Affairs New England Mental Illness Research, Education, and Clinical Center, 950 Campbell Avenue, West Haven, CT, USA
| | - Robert A Rosenheck
- Department of Psychiatry, Yale University School of Medicine, 300 George Street, Suite 901, New Haven, CT, USA; U.S. Department of Veterans Affairs New England Mental Illness Research, Education, and Clinical Center, 950 Campbell Avenue, West Haven, CT, USA
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Garb HN. Race bias and gender bias in the diagnosis of psychological disorders. Clin Psychol Rev 2021; 90:102087. [PMID: 34655834 DOI: 10.1016/j.cpr.2021.102087] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 07/16/2021] [Accepted: 09/17/2021] [Indexed: 11/28/2022]
Abstract
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.
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Affiliation(s)
- Howard N Garb
- Joint Base San Antonio-Lackland, San Antonio, TX, United States of America.
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Hamilton JE, Heads AM, Meyer TD, Desai PV, Okusaga OO, Cho RY. Ethnic differences in the diagnosis of schizophrenia and mood disorders during admission to an academic safety-net psychiatric hospital. Psychiatry Res 2018; 267:160-167. [PMID: 29908484 DOI: 10.1016/j.psychres.2018.05.043] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Revised: 03/24/2018] [Accepted: 05/18/2018] [Indexed: 01/26/2023]
Abstract
U.S. Hispanics, now the single largest minority group in the country, face unique mental health disparities. The current study utilizes Andersen's Behavioral Model of Health Service Use to examine ethnic disparities in receiving a schizophrenia or mood disorder diagnosis at psychiatric hospital admission. Our retrospective cohort study examined electronic health record data at an academic safety-net psychiatric hospital for adult patients (n = 5571) admitted between 2010 and 2013. Logistic regression with block-wise entry of predisposing, enabling and need variables was used to examine ethnic disparities in receiving a schizophrenia diagnosis at admission. The block of need factors was the strongest predictor of receiving a schizophrenia diagnosis compared to predisposing and enabling factors. Compared to non-Hispanic whites, Hispanics and African Americans had a greater likelihood of receiving a schizophrenia diagnosis at admission. Additionally, patients diagnosed with schizophrenia had elevated positive and negative symptoms and were more likely to be male, single/unmarried, homeless, high inpatient service utilizers, involuntarily hospitalized, and to exhibit functional impairment at psychiatric hospital admission. To address elevated positive and negative symptoms of schizophrenia, functional impairment, social withdrawal, and high inpatient service utilization, promising psychosocial interventions should be adapted for racial and ethnic minority populations and utilized as an adjuvant to antipsychotic medication.
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Affiliation(s)
- Jane E Hamilton
- Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA; UTHealth Harris County Psychiatric Center, Houston, TX, USA.
| | - Angela M Heads
- Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Thomas D Meyer
- Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Pratikkumar V Desai
- Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Olaoluwa O Okusaga
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA; Michael E. DeBakey VA Medical Center, Houston,TX, USA
| | - Raymond Y Cho
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA; Michael E. DeBakey VA Medical Center, Houston,TX, USA
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Conley D, Malaspina D. Socio-Genomics and Structural Competency. JOURNAL OF BIOETHICAL INQUIRY 2016; 13:193-202. [PMID: 27251402 DOI: 10.1007/s11673-016-9716-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Accepted: 02/28/2016] [Indexed: 06/05/2023]
Abstract
Adverse developmental exposures and pathologies of the social environment make vastly greater contributions to the leading health burdens in society than currently known genotypic information. Yet, while patients now commonly bring information on single alleles to the attention of their healthcare team, the former conditions are only rarely considered with respect to future health outcomes. This manuscript aims to integrate social environmental influences in genetic predictive models of disease risk. Healthcare providers must be educated to better understand genetic risks for complex diseases and the specific health consequences of societal adversities, to facilitate patient education, disease prevention, and the optimal care in order to achieve positive health outcomes for those with early trauma or other social disadvantage.
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Affiliation(s)
- Dalton Conley
- Department of Sociology, Princeton University; and the National Bureau of Economic Research, 153 Wallace Hall, Princeton, NJ, 08540, USA.
| | - Dolores Malaspina
- Departments of Psychiatry and Child and Adolescent Psychiatry, NYU Langone Medical Center, New York, NY, USA
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Shaltout TE, Alali KA, Bushra S, Alkaseri AM, Jose ED, Al-Khainji M, Saleh R, Salama Dahir A, Shaltout H, Al-Abdullah M, Rizk NM. Significant association of close homologue of L1 gene polymorphism rs2272522 with schizophrenia in Qatar. Asia Pac Psychiatry 2013; 5:17-23. [PMID: 23857787 DOI: 10.1111/appy.12014] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2012] [Accepted: 09/25/2012] [Indexed: 01/28/2023]
Abstract
INTRODUCTION Previous reports have found that polymorphisms in the close homologue of L1 (CHL1) gene located on chromosome 3p26 are associated with schizophrenia among different ethnic populations. The aim of this study was to examine the associations of single nucleotides polymorphisms (SNPs) of the CHL1 gene locus, including rs2055314 (C/T), rs2272522 (C/T) and rs331894 (A/G), with schizophrenia in the Qatari population. METHODS An association case control study was carried out on 86 Qatari schizophrenic patients from the Psychiatry Hospital, Hammed Medical Corporation, Qatar and 88 Qatari unrelated, healthy, control subjects. Schizophrenia was diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders - Fourth Edition (DSM-IV) criteria for schizophrenia by two independent psychiatrists. Genotyping of the SNPs rs2055314 (C/T), rs2272522 (C/T) and rs331894 (A/G) was conducted using the 5' nuclease assay with the TaqMan MGB probe and an ABI 7500. RESULTS Individuals with the rs2272522 TT genotype had approximately 4.2 times greater risk of schizophrenia compared to individuals with the CC genotype (OR = 4.21; 95% CI: 1.12-15.53; P = 0.047). In addition, individuals carrying a T allele of the rs2272522 SNP had a significantly increased risk of schizophrenia (1.78 times) among the population (P = 0.028). SNPs rs2055314 and rs331894 had no significant association with schizophrenia. Pairwise linkage disequilibrium (LD) between the three polymorphisms was modest in the schizophrenic group. DISCUSSION The rs2272522 polymorphism was found to exhibit a highly significant association with schizophrenia in the Qatari population. This finding supports the hypothesis that cell adhesion molecules may be involved in the etiology of this disease among Qatari patients.
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Affiliation(s)
- Taher E Shaltout
- Department of Psychiatry, Hamad Medical Corporation, Doha, Qatar
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Abstract
This article explored the origins and implications of the underdiagnosis of affective disorders in African-Americans. MEDLINE and old collections were searched using relevant key words. Reference lists from the articles that were gathered from this procedure were reviewed. The historical record indicated that the psychiatric perception of African-Americans with affective disorders changed significantly during the last 200 years. In the antebellum period, the mental disorders of slaves mostly went unnoticed. By the early 20th century, African-Americans were reported to have high rates of manic-depressive disorder compared with whites. By the mid-century, rates of manic-depressive disorder in African-Americans plummeted, whereas depression remained virtually nonexistent. In recent decades, diagnosed depression and bipolar disorder, whether in clinical or research settings, were inexplicably low in African-Americans compared with whites. Given these findings, American psychiatry needs to appraise the deep-seated effects of historical stereotypes on the diagnosis and treatment of African-Americans.
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Eack SM, Bahorik AL, Newhill CE, Neighbors HW, Davis LE. Interviewer-perceived honesty as a mediator of racial disparities in the diagnosis of schizophrenia. Psychiatr Serv 2012; 63:875-80. [PMID: 22751938 PMCID: PMC3718294 DOI: 10.1176/appi.ps.201100388] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVE African Americans are disproportionately diagnosed as having schizophrenia, and the factors that contribute to this disparity are poorly understood. This study utilized data from the 1995 MacArthur Violence Risk Assessment Study to examine the impact of racial differences in sociodemographic characteristics, clinical presentation, and perceived honesty on disparities in the diagnosis of schizophrenia among African Americans. METHODS Researchers using structured assessments of diagnostic, sociodemographic, and clinical measures interviewed African Americans (N=215) and whites (N=537) receiving inpatient care for a severe mental illness. The impact of interviewers' perceptions of the participants' honesty on racial disparities in the diagnosis of schizophrenia was assessed. RESULTS African Americans (45%) were more than three times as likely as whites (19%) to be diagnosed as having schizophrenia. Disparities in sociodemographic and clinical characteristics modestly contributed to disparities in diagnostic rates. In contrast, interviewer-perceived honesty proved to be a significant predictor of racial disparities in schizophrenia diagnoses. After adjustment for perceived honesty, diagnostic disparities between African Americans and whites were substantially reduced. Mediator analyses confirmed that interviewer-perceived honesty was the only consistent mediator of the relationship between race and schizophrenia diagnosis. CONCLUSIONS Interviewers' perceptions of honesty among African-American participants are important contributors to disparities in the diagnosis of schizophrenia. Clinicians' perceptions of dishonesty among African-American patients may reflect poor patient-clinician relationships. Methods of facilitating a trusting relationship between patients and clinicians are needed to improve the assessment and treatment of persons from minority groups who are seeking mental health care. (Psychiatric Services 63:875-880, 2012; doi: 10.1176/appi.ps.201100388).
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Affiliation(s)
- Shaun M Eack
- School of Social Work and with Center on Race and Social Problems, University of Pittsburgh, 2117 Cathedral of Learning, Pittsburgh, PA 15260, USA.
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Alexandre J, Ribeiro R, Cardoso G. Ethnic and clinical characteristics of a Portuguese psychiatric inpatient population. Transcult Psychiatry 2010; 47:314-21. [PMID: 20603391 DOI: 10.1177/1363461510369191] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
The present study examined the association between ethnicity and clinical characteristics of patients admitted to a psychiatric inpatient unit in Portugal. The only ethnicity-related terms routinely recorded in the medical records were "Black" (mainly from the African Portuguese-speaking countries of Cape Verde, Angola, Guinea, Sao Tome and Mozambique) and "White." Black immigrants appeared to be over-represented, comprising 19.6% of inpatients; and were younger and more frequently male when compared with White inpatients. They were more frequently diagnosed with schizophrenia and acute or transient psychosis, and less frequently diagnosed with delusional and personality disorders than White inpatients. These results are consistent with previous studies in the US and UK, and highlight the need for more culturally sensitive care in mental health services.
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Affiliation(s)
- Joana Alexandre
- Serviço de Psiquiatria, Hospital Fernando Fonseca, Amadora, Portugal.
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