Leo R J, Sherry C, Jones A W
Department of Psychiatry, School of Medicine and Biomedical Sciences, State University of New York, Buffalo 14215, USA.
Gen Hosp Psychiatry. 1998 May;20(3):175-82. doi: 10.1016/s0163-8343(98)00019-x.
A retrospective review of psychiatric consultations was conducted for African-American and Caucasian patients for a 2-year period. Reasons for referral, assigned diagnoses, accuracy rates, and discordance and concordance rates were assessed. Referrals for depression comprised 24.6% of all consults for Caucasian and African-American inpatients. Only 40.3% of patients referred for depression were diagnosed with a depressive disorder; 54.4% of patients diagnosed with depressive disorders were referred for other reasons. African-American patients were referred for evaluation of depression and diagnosed with depressive disorders significantly less often than Caucasian patients. No significant differences were obtained between African-Americans and Caucasians in the accuracy rates of patients referred for depression. Discordance and concordance rates for the two groups were comparable. Diagnoses assigned to African-Americans and Caucasians incorrectly referred for depression did not differ significantly. For depressed African-Americans and Caucasians referred for reasons other than depression, the only difference noted was in the referral rates for adjustment of psychotropics. The nonpsychiatric staff fails to recognize depression and often refer depressed patients inappropriately. Depressed patients are primarily referred for suicide assessment and disruptive behaviors. Referrals for depression may be a secondary concern to nonpsychiatric staff. In addition, cultural variables and racial differences between hospital staff and patients may account for the differences in referral patterns. Awareness of the needs of African-American patients is required.
对非裔美国人和白人患者进行了为期两年的精神科会诊回顾性研究。评估了转诊原因、指定诊断、准确率以及不一致率和一致率。抑郁症转诊占白人及非裔美国住院患者所有会诊的24.6%。转诊为抑郁症的患者中只有40.3%被诊断为抑郁症；被诊断为抑郁症的患者中有54.4%是因其他原因转诊的。非裔美国患者因抑郁症接受评估并被诊断为抑郁症的情况明显少于白人患者。在转诊为抑郁症患者的准确率方面，非裔美国人和白人之间没有显著差异。两组的不一致率和一致率相当。错误转诊为抑郁症的非裔美国人和白人患者的诊断没有显著差异。对于因抑郁症以外的原因转诊的非裔美国人和白人抑郁症患者，唯一注意到的差异在于精神药物调整的转诊率。非精神科工作人员未能识别抑郁症，经常不恰当地转诊抑郁症患者。抑郁症患者主要因自杀评估和破坏性行为而被转诊。抑郁症转诊可能是非精神科工作人员的次要关注点。此外，医院工作人员与患者之间的文化变量和种族差异可能解释了转诊模式的差异。需要了解非裔美国患者的需求。
