Therapists are twice as like misdiagnose socially disadvantaged people as having a mental illness when compared to advantaged groups, says research by Sage Publications. The paper was published online in Social Psychological and Personality Science.
Researchers found that therapists were twice as likely to misdiagnose mental illness in patients from disadvantaged groups of different ethnicities or races when compared to members of advantaged groups. Ora Nakash, a clinical psychologist at the Interdisciplinary Center in Herzliya, Israel, conducted the research in order to discover how the social identities of her clients affected her decision-making when diagnosing patients.
“For example, a white therapist can interpret affect disregulation symptoms of a client who is also white as rooted in financial pressures and diagnose him/her as having transient adjustment disorder,” she said. “Conversely, if the client is African-American, the same symptoms might be seen as proof of the client’s persistent borderline personality disorder.”
Nakash has done a previous study to determine whether the social identity of the therapist impacted the diagnostic decision making process. She found that even though similar information was gathered during the mental health intake process, clinicians made their diagnoses based on the patient’s race or ethnicity. For this study, Nakash and colleague Tamar Saguy investigated three mental health clinics in large cities that serve mostly low to middle class populations. The study looked at the Ashkenazi (Jews of European/American descent) and the Mizrahi (Jews of Asian/African descent) patients.
“These ethnic groups are interesting both in the context of the Israeli society, as they make up the majority of the Jewish population in Israel, but also in the broader context of mental health disparities,” Nakash said. “We know that minority groups, including migrants and ethnic minorities in many Western societies, tend to receive lower quality mental health care and may suffer from greater risks for mental illness.
Patients were followed during their intake sessions with their therapists and then asked to complete a separate structures diagnostic interview with an independent reviewer. Therapists also completed study measures immediately after their sessions. An independent review compared the therapist’s evaluation with the data from an independent review to measure the accuracy of the therapist’s diagnosis.
Nakash and Saguy said they were surprised that the huge discrepancies in the accuracy of the diagnoses they found. “Even in a clinical setting, which offers conditions to overcome bias in decision-making – motivation to help, and time and space to collect ample information to overcome stereotypical thinking – we see that misdiagnosis is almost twofold when a socially advantaged therapist meets a socially disadvantaged client compared to seeing a socially advantaged client.”
Nakesh said that the study shows that the medical community should rethink clinical training and increase the diversity of mental health care providers.
