Leesha Ellis-Cox, MD, MPH: Steps to Closing the Bipolar Disorder Diagnosis Gap for Black Adults

Many African Americans had been misdiagnosed with schizophrenia for years. The misdiagnosis could be caused by something so simple as fear of the police being construed as paranoia and clinicians believing they need antipsychotics.

However, this is not the case for bipolar disorder—African Americans face barriers in receiving a diagnosis and appropriate treatment for bipolar disorder.¹ Factors contributing to the bipolar disorder diagnosis gap include the lack of Black or African American providers—who only make up 5.7% of US physicians—the social stigma, mistrust of the US healthcare system, and lack of access to care.²

In an interview with HCPLive, Leesha Ellis-Cox, MD, MPH, a board-certified child, adolescent, and adult psychiatrist maintaining a private practice in Birmingham, Alabama, discussed the contributing factors to the diagnosis gap, what other psychiatric disorders face similar setbacks, and why Black adults are more likely to receive a schizophrenia diagnosis over a bipolar disorder diagnosis.

“Part of the challenge is one psychosis in and of itself is a symptom— it is not a diagnosis,” Ellis-Cox said.

If practitioners look at psychoses as black-and-white—only a symptom of schizophrenia—they will miss ruling out a mood disorder or any other condition. Other than bipolar disorder, Black adults are often not screened for PTSD and other mood disorders such as depression.

Ellis-Cox stressed the importance of a provider examining their own biases and dealing with them with proper training, such as Harvard’s implicit bias association test. Organizations such as the Kaiser Family Foundation and the Aspen Institute also strive to break down biases.

“If we can continue to make that not a recommendation of our healthcare providers, but bake it into the fabric of medical school, the medical school curriculum, baked into the fabric of residency training, and continue to have ongoing dialogue around how to make sure that we are treating patients with the most compassionate, competent and culturally sensitive care, I think we can really start to turn the needle,” Ellis-Cox said. “But as long as healthcare providers are willing to acknowledge that bias and racism can impact how they think about patients, that’s going to be hard to move the needle.”

No relevant disclosures of Ellis-Cox were reported.

^References

1. ^{Bipolar Disorder and Black Americans. Mental Health America. https://www.mhanational.org/bipolar-disorder-and-black-americans. Accessed February 12, 2024.}
2. ^{Boyle, P. What’s Your Specialty? New Data Show the Choices of America’s Doctors by Gender, Race, and Age. AAMC. January 12, 2023. https://www.aamc.org/news/what-s-your-specialty-new-data-show-choices-america-s-doctors-gender-race-and-age. Accessed February 12, 2024.}