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ER Diagnosis of Schizophrenia More Likely in African American and Latino Children and Adolescents: Presented at AACAP

By Paula Moyer

TORONTO, CANADA -- October 31, 2005 -- Schizophrenia is three times more likely to be the diagnosis in African American and Latino children and adolescents than in their white counterparts when they are seen in the psychiatric emergency department, according to findings presented here at the joint meeting of the American and Canadian Academies of Child and Adolescent Society (AACAP/CACAP).

The implications of the discrepancy are still not known, said Gail A. Edelsohn, MD, Director of Child and Adolescent Psychiatry, Thomas Jefferson University, Philadelphia, Pennsylvania, United States, during a presentation on October 19^th.

"Is this really a bias, is this really a disparity, or do these children have more psychosocial adversity, or more biologic factors that make them?" said Dr. Edelsohn.

Dr. Edelsohn and her co-investigators will continue to study the relationship of ethnicity and diagnosis, she said. Because the population in the United States is becoming more ethnically diverse, finding the reason for the gap in diagnosis is urgent, she added.

Their study is a follow-up on a recent Surgeon General's Report, which pointed out disparities by ethnicity regarding access to mental health care as well as the distribution of diagnoses.* The investigators wanted to know if the distribution of diagnoses among children and adolescents compared with the distribution of diagnoses among adult populations in the literature.

They reviewed psychiatric emergency visits to their facility from 1997 to 1998, which consisted of 1524 visits for 1362 patients who were 13 to 17 years old. The investigators took into account patients' age, sex, ethnicity, voluntary or involuntary arrival status, the involvement of child protection services, and violent behavior (used a weapon, fought with or without an implement, inflicted property damage, or made threats).

The investigators categorized patients' diagnoses into the categories of affective disorders, schizophrenia or psychosis, attention deficit hyperactivity disorder (ADHD), conduct disorder or oppositional defiant disorder, adjustment disorder, and "all others" (anxiety disorders, pervasive developmental disorders, learning disorders, and substance abuse disorders).

The investigators analyzed the diagnoses across demographic categories and then by both violence and ethnicity, as well as by arrival status and involvement of child protection services.

Of the 1362 patients, 58% were male. Among these patients, 60% were African American, 24% were white, 15% were Latino, and 1% belonged to another ethnic group.

Among the 1524 visits, 33% were diagnosed as an affective disorder, and 9% were considered to have schizophrenia or psychosis. Among the others, 16% were diagnosed with ADHD, 26% were considered to have either conduct or oppositional defiant disorder, 8% were categorized as adjustment disorder, and 7% were "all other" diagnoses."

African Americans were 3.3 times as likely as whites to be diagnosed with schizophrenia or psychosis, and Latinos were 2.9 times more likely than whites to have these dignoses (P < .001 for both). Compared with white patients, the odds of having an affective disorder were 0.69 for African Americans and 0.84 for Latinos (P < .005 for both). These results persisted after the investigators controlled for gender, age, substance abuse, involvement of protective services, and arrival status.

Ethnicity and gender did not play a role in whether patients were hospitalized or discharged, Dr. Edelsohn said. Many of the variables did not significantly alter the likelihood of a schizophrenia or psychosis diagnosis, including substance abuse and the involvement of protective services. However, an involuntary arrival status was marginally significant in making a diagnosis of affective disorder more likely, she said.

Although violence was not linked to such a diagnosis, patients with a history of violence were more likely to be hospitalized (P = .009). A diagnosis of schizophrenia or psychosis also significantly increased the chances of a hospitalization (P = .001).

"We know that depression can look different based on the ethnic group," Dr. Edelsohn said. "Latins and Asians present with somatic complaints; Africans present with anger."

The psychiatrist who encounters such patients needs to have a cultural context for their behaviors so that the diagnosis is accurate, she said.

* Mental Health: Culture, Race, and Ethnicity. A Supplement to Mental Health: A Report of the Surgeon General. 2001, U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Mental Health Services, Rockville, Md. http://www.surgeongeneral.gov/library/mentalhealth/cre/


[Presentation title: Ethnicity, Diagnosis, and Disposition in a Pediatric Psychiatric Emergency Service. Abstract A22]

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