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Mental Health

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Missed diagnosis of mood and anxiety disorders is more likely among black than white schizophrenics

Schizophrenia affects nearly 1 percent of the U.S. population, and people with schizophrenia often suffer from depression and anxiety as well. Comorbid depression may increase suffering and risk of suicide, and it has been associated with higher rates of relapse and hospitalization, hopelessness, and poor psychosocial skills.

Mood and anxiety disorders often are underdiagnosed and undertreated among black patients who have a diagnosis of schizophrenia, according to a recent study that was based on data from the Schizophrenia Patient Outcomes Research Team (PORT). The Schizophrenia PORT was supported in part by the Agency for Healthcare Research and Quality (contract 290-92-0054).

The PORT patient survey involved 685 patients receiving treatment for schizophrenia in one of two States (in the South and Midwest) who were interviewed between 1994 and 1996. Using data from the direct client survey of participants in the PORT study, these researchers analyzed the association of race with past and current diagnoses and with current treatment for depression, mania, and anxiety disorders. White patients with schizophrenia were significantly more likely than black patients to report lifetime diagnosis (56 vs. 41 percent), current diagnosis (37 vs. 32 percent), and current treatment (34 vs. 30 percent) for depression. White patients also were more likely than black patients to report lifetime diagnosis, current diagnosis, and current treatment of manic-depressive disorder or anxiety disorder, despite similar self-reported symptoms of these mood disorders.

Since blacks in this study reported more psychotic symptoms (for example, hallucinations and delusions) than whites, differences in symptom presentation may have caused doctors to more frequently confuse manic-depression with schizophrenia among blacks. This confusion also may be related to use of white patients' presentation of symptoms as the basis for most research and diagnostic tools on mood disorders. Nevertheless, standard care includes assertive treatment of both affective and psychotic symptoms, whether they are coexisting problems or components of the same disorder. Black patients were less likely than white patients in this study to receive such assertive care. The authors call for increased cross-cultural competence at all levels of mental health care.

More details are in "Variables associated with disparities in treatment of patients with schizophrenia and comorbid mood and anxiety disorders," by Lisa Dixon, M.D., M.P.H., Lisa Green-Paden, M.D., Janine Delahanty, M.A., and others, in the September 2001 Psychiatric Services 52(9), pp. 1216-1222.

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