Bailey Rahn K, Jaquez-Gutierrez Marisela C, Madhoo Manisha
Meharry Medical College, Nashville, Tennessee (Dr Bailey); South Florida ADHD Center, Doral (Dr Jaquez-Gutierrez); and Shire Development LLC, Wayne, Pennsylvania (Dr Madhoo).
Prim Care Companion CNS Disord. 2014 Jul 3;16(4). doi: 10.4088/PCC.14r01627. eCollection 2014.
To review the sociocultural factors that may affect the diagnosis and management of attention-deficit/hyperactivity disorder (ADHD) in African American and Hispanic minorities seen in the primary care setting in the United States.
Searches on MEDLINE and PubMed were conducted in April and September 2012 on ADHD and its related problems and disabilities. A general search was conducted using the terms (attention deficit hyperactivity disorder OR attention deficit/hyperactivity disorder OR ADHD OR AD/HD) AND (ethnicity OR cultural OR culture). Issues of particular relevance to racial and ethnic minorities utilizing health care services were researched using the string (black OR African OR Hispanic OR Latino OR minority OR racial) combined with terms relating to access, insurance, comorbidity, high-risk behavior, treatment compliance, and nonpharmacologic modalities. Searches were limited to English-language citations, and no date parameters were used. References identified as pertinent to this review were selected for citation.
STUDY SELECTION/DATA EXTRACTION: Information revealing contrasts between minorities and the US non-Hispanic white population was organized in distinct categories, such as access to medical care and insurance, cultural attitudes, and the effects of stigmatization. The authors also provide perspectives for the primary care physician from their own clinical experience.
Rates of diagnosis of in the United States are higher for non-Hispanic whites than for minorities, yet true prevalence is probably similar across racial-ethnic groups. When the stigma of mental illness is added to the challenges faced by racial/ethnic minorities or immigrant status, patients may be especially sensitive. Underuse of clinical services may reflect economic limitations on access to care, cultural attitudes toward mental illness, and the effects of real or perceived prejudice and stigmatization.
Primary care clinicians in the United States should seek to become more aware of cultural factors that could interfere with the recognition and management of ADHD.
回顾在美国初级保健机构中，可能影响非裔美国人和西班牙裔少数族裔注意力缺陷多动障碍（ADHD）诊断与管理的社会文化因素。
2012年4月和9月在MEDLINE和PubMed上检索了ADHD及其相关问题和残疾情况。使用（注意力缺陷多动障碍或注意力缺陷/多动障碍或ADHD或AD/HD）以及（种族或文化或文化）等术语进行了全面检索。利用医疗保健服务的种族和少数族裔特别相关问题，通过（黑人或非洲人或西班牙裔或拉丁裔或少数族裔或种族）与获取、保险、共病、高危行为、治疗依从性和非药物治疗方式等相关术语组合进行研究。检索仅限于英文文献，未设置日期参数。选定与本综述相关的参考文献进行引用。
研究选择/数据提取：揭示少数族裔与美国非西班牙裔白人之间差异的信息被整理为不同类别，如获得医疗保健和保险的情况、文化态度以及污名化的影响。作者还根据自身临床经验为初级保健医生提供了观点。
在美国，非西班牙裔白人的ADHD诊断率高于少数族裔，但各种族/族裔群体的实际患病率可能相似。当精神疾病的污名与种族/族裔少数群体或移民身份所面临的挑战叠加时，患者可能会格外敏感。临床服务利用不足可能反映出获得护理的经济限制、对精神疾病的文化态度以及真实或感知到的偏见和污名化的影响。
美国初级保健临床医生应努力更加了解可能干扰ADHD识别与管理的文化因素。
