Clinician-Patient Ethnicity in Psychiatric Diagnosis

Abstract

Language and ethnicity are parts of the interpersonal process that converge during psychiatric diagnosis, affecting diagnostic accuracy and concordance among clinicians. In this feasibility study, the authors videotaped two Hispanic psychiatrists conducting typical diagnostic interviews with first-time Hispanic patients (N = 10) in a community mental health clinic. Then, two non-Hispanic psychiatrists viewed the videotapes with translator assistance. All psychiatrists rendered DSM-IV diagnoses on the patients they interviewed or whose tapes they watched. On Axis I, psychiatrists did not differ, diagnosing mostly mood disorders. On Axis II, non-Hispanic psychiatrists diagnosed personality disorders more often. On Axis IV, Hispanic psychiatrists identified more psychosocial stressors, especially family-related ones. On Axis V, Hispanic psychiatrists rated patients more functionally impaired. Although limited, the findings raise several interesting questions that can be useful to clinicians and researchers diagnosing patients from their own or a different culture. Are Axis I diagnoses less subject to cultural biases than Axis II personality disorders? Does cultural proximity between patient and clinician add sensitivity to psychosocial stressors while holding patients to higher functional standards?

Key Words:

• Cross-cultural psychiatry
• diagnosis and classification
• ethnicity
• language
• Hispanics