Racial disparities in psychotic disorder diagnosis: A review of empirical literature

Abstract

Psychotic disorder diagnoses are common in the United States and internationally. However, racial disparities in rates of psychotic disorder diagnoses have been reported across time and mental health professions. This literature review provides an updated and comprehensive summary of empirical research on race and diagnosis of psychotic disorders spanning a 24-year period. Findings reveal a clear and pervasive pattern wherein African American/Black consumers show a rate of on average three to four higher than Euro-American/White consumers. Latino American/Hispanic consumers were also disproportionately diagnosed with psychotic disorders on average approximately three times higher compared to Euro-American/White consumers. In addition, a trend among international studies suggests that immigrant racial minority consumers receiving mental health services may be assigned a psychotic disorder diagnosis more frequently than native consumers sharing a majority racial background. Potential explanations for this phenomenon are discussed, including possible clinical bias and sociological causes such as differential access to healthcare and willingness to participate in mental health services. Directions for future research should include the exploration of disproportionate diagnoses according to race through qualitative interviewing as well as empirical investigation.

Keywords: Race; Ethnicity; Psychosis; Diagnosis; Review

Core tip: An updated review of empirical research related to race and diagnosis of psychotic disorders is provided. This manuscript concludes with addressing potential causes of racial diagnostic disparities with implications for future research. Although the topic of race and diagnosis has received increasing attention in the professional literature, a full review of empirical studies is needed to summarize patterns among research results. Due to the broad consumer implications of psychotic disorder-related misdiagnosis (e.g., social stigma, hospitalizations, psychotropic medications, relational and employment discrimination, and increased risk of suicide) better understanding of this phenomenon is clearly warranted.