Diagnosing Co-Occurring Substance-Related Disorders: Agreement Between SCID, Hispanic Clinicians, and Non-Hispanic Clinicians
J Clin Psychiatry 2007;68(11):1655-1662
© Copyright 2014 Physicians Postgraduate Press, Inc.
Purchase This PDF for $40.00
If you are not a paid subscriber, you may purchase the PDF.
(You'll need the free Adobe Acrobat Reader.)
Receive immediate full-text access to JCP. You can subscribe to JCP online-only ($86) or print + online ($156 individual).
With your subscription, receive a free PDF collection of the NCDEU Festschrift articles. Hurry! This offer ends December 31, 2011.
If you are a paid subscriber to JCP and do not yet have a username and password, activate your subscription now.
As a paid subscriber who has activated your subscription, you have access to the HTML and PDF versions of this item.
Click here to login.
Did you forget your password?
Still can't log in? Contact the Circulation Department at 1-800-489-1001 x4 or send email
Objective: Given the composition of the mental health and substance abuse workforce in the United States, Hispanic immigrants are often assigned to non-Hispanic, English-speaking clinicians. This produces challenges in communication and in understanding linguistic and cultural nuances and greatly impacts the accuracy of diagnoses and the delivery of appropriate services. With the inclusion of objective criteria in diagnostic categories, clinician-to-clinician agreement ought not to be impacted by the ethnicity of the client or the clinician. Both practice and research, however, suggest that this is not the case, particularly when diagnosing co-occurring mental health and substance abuse disorders. We explored the degree to which Hispanic and non-Hispanic clinicians agreed with each other and with the Structured Clinical Interview for DSM-IV-TR, Research Version (SCID) when diagnosing co-occurring substance-related disorders.
Method: Using a naturalistic design, 88 adult clients were videotaped in diagnostic intake interviews (utilizing the DSM-IV-TR) with Hispanic or non-Hispanic clinicians. Videotapes were then viewed and rated by clinicians who were ethnically cross-matched to those on tape. Clients were also administered the SCID. Data were collected from September 15, 2003, through February 7, 2005.
Results: Non-Hispanic clinicians diagnosed significantly more substance-related disorders than Hispanic clinicians, and both Hispanic and non-Hispanic clinicians significantly under-diagnosed substance-related diagnoses compared to the SCID. Clinicians had very low diagnostic reliability with each other and with the SCID. Implications for the assessment, diagnosis, and treatment of co-occurring substance-related disorders are discussed.
Conclusion: Findings seem to concur with past research suggesting that clinicians may be influenced by factors other than the diagnostic criteria (e.g., cultural and social biases) when diagnosing, and that they may make erroneous attributions of pathology when diagnosing across cultures.