访调员感知的诚实程度可作为精神分裂症诊断中种族差异的中介因素。
Interviewer-perceived honesty as a mediator of racial disparities in the diagnosis of schizophrenia.
机构信息
School of Social Work and with Center on Race and Social Problems, University of Pittsburgh, 2117 Cathedral of Learning, Pittsburgh, PA 15260, USA.
出版信息
Psychiatr Serv. 2012 Sep 1;63(9):875-80. doi: 10.1176/appi.ps.201100388.
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).
目的
非裔美国人被诊断为患有精神分裂症的比例不成比例，导致这种差异的因素尚未得到充分理解。本研究利用 1995 年麦克阿瑟暴力风险评估研究的数据，考察了社会人口统计学特征、临床表现和感知诚实程度方面的种族差异对非裔美国人精神分裂症诊断差异的影响。
方法
研究人员使用诊断、社会人口统计学和临床评估的结构化评估方法，对接受严重精神疾病住院治疗的非裔美国人（N=215）和白人（N=537）进行了访谈。评估了访谈者对参与者诚实程度的看法对精神分裂症诊断中种族差异的影响。
结果
非裔美国人（45%）被诊断为患有精神分裂症的可能性是非裔美国人（19%）的三倍多。社会人口统计学和临床特征方面的差异在一定程度上导致了诊断率的差异。相比之下，访谈者感知的诚实程度被证明是精神分裂症诊断种族差异的一个重要预测因素。在调整感知诚实程度后，非裔美国人和白人之间的诊断差异大大减少。中介分析证实，访谈者感知的诚实程度是非裔美国人和白人之间种族与精神分裂症诊断关系的唯一一致中介因素。
结论
访谈者对非裔美国参与者诚实程度的看法是导致精神分裂症诊断差异的重要因素。非裔美国患者不诚实的看法可能反映了患者与临床医生之间不良的关系。需要采取促进患者与临床医生之间信任关系的方法，以改善寻求心理健康护理的少数族裔人群的评估和治疗。（《精神病服务》63:875-880，2012 年；doi:10.1176/appi.ps.201100388）。
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