Ethnic Differences in the Reliability and Validity of a Panic Disorder Screen

Abstract

Purpose. The purpose of this study was to compare the reliability and validity of the Brief Panic Disorder Screen (BPDS) in samples of African American and Caucasian American primary care patients.

Methods. The BPDS was administered to 295 patients scheduled to visit a primary care clinic for medical reasons. The presence or absence of a panic disorder diagnosis was established during a clinical interview with a psychiatrist. Measures of reliability (internal consistency) and validity (criterion validity) were compared between the two ethnic subgroups.

Findings. The BPDS demonstrated greater reliability and validity for Caucasians than African Americans. This effect was maintained even after controlling for group differences in key demographic variables. Differences between ethnic groups were apparent in both those with and those without panic disorder (PD). BPDS responses of African Americans with PD demonstrated very low internal consistency whereas a high rate of false positive PD diagnoses was related to higher than expected BPDS scores among African Americans without PD, particularly on the level of fear felt when experiencing shortness of breath or heart palpitations.

Discussion. These findings support the notion that cultural differences in the language and meaning associated with anxiety disorders contribute to the difficulty of accurately diagnosing PD in primary care populations. Additional research is needed to provide a better understanding of the cultural aspects of the anxiety experience. Such research would facilitate the development of better screening tools for panic and other anxiety disorders for ethnic minority primary care populations.

Keywords:

• Panic Disorder
• African Americans
• Primary Care
• Screening

This research was funded by NIMH grant #K08-MH10546. The authors wish to express their gratitude to the faculty and staff of the McClennan-Banks Primary Care Center and the University Diagnostic Center of the Medical University of South Carolina. In addition, the preparation of this manuscript was greatly facilitated by the support and assistance of Dr Marian Limacher, Dr Jane Douglas, Dr Douglas Barrett and the fellows and staff of the Advanced Postgraduate Program in Clinical Investigation (APPCI) in the College of Medicine at the University of Florida.