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Ethnicity Effects on Clinical Diagnoses Compared to Best-Estimate Research Diagnoses in Patients With Psychosis: A Retrospective Medical Chart Review

Deidre M. Anglin, Ph.D., and Dolores Malaspina, M.D., M.P.H.

Objective: Ethnicity effects on diagnoses are frequently reported and have variably been attributed to diagnostic biases versus ethnic differences in environmental exposures, and other factors.

Method: We compared best-estimate gold standard research diagnoses to clinical diagnoses (DSM-III-R and DSM-IV criteria) among 129 white, 57 African American, and 50 Hispanic patients with psychosis admitted to an inpatient research unit from 1990 to 2003.

Results: Clinical and research diagnoses showed greater agreement in Hispanic than in African American patients (white patients were intermediate). Diagnostic agreement for paranoid schizophrenia was likewise the best in Hispanic patients. While paranoid schizophrenia tended to be overdiagnosed in African American patients, it was underdiagnosed in white patients. Patterns of diagnostic agreement for schizoaffective disorder and "other" diagnoses were similar among the 3 ethnic groups.

Conclusions: Diagnostic unreliability may explain the excess of paranoid schizophrenia reported for African Americans. Further research is needed to elucidate the influence of ethnicity on clinical diagnosis before other theories to explain group differences can be reasonably proposed and reliably tested.


(J Clin Psychiatry 2008;69:941-945. Online Ahead of Print May 13, 2008.)

Received Jan. 15, 2007; accepted Oct. 25, 2007. From the Department of Psychiatry, Columbia University, New York State Psychiatric Institute (Dr. Anglin) and the Department of Psychiatry, New York University School of Medicine (Dr. Malaspina), New York, N.Y.

This research was supported by National Institute of Mental Health grant 2K24 MH01699 (Dr. Malaspina) and a Columbia University Department of Psychiatry Frontier Fund (Dr. Anglin).

The authors report no additional financial or other relationships relevant to the subject of this article.

Corresponding author and reprints: Deidre M. Anglin, Ph.D., 100 Haven Ave., Tower 3, Room 31F, New York, NY 10032 (e-mail: