Misdiagnoses More Common for Socially Disadvantaged Groups

Socially disadvantaged groups are twice as likely to receive mental health misdiagnoses, according to research published in the journal Social Psychological and Personality Science.

Researchers from the Interdisciplinary Center in Herzliya, Israel focused on mental health clinics serving low to middle class populations, and specifically patients who were Jews of Asian/ African descent (Mizrahi) and Jews of European/ American descent (Ashkenazi) in 3 cities in Israel. The researchers investigated the accuracy of diagnostic decisions, which they believed were likely to substantially impact the patient’s prognosis, in order to determine what contributed to mental health disparities.

“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,” Ora Nakash, PhD, explained in a press release. “Conversely, if the client is African American, the same symptoms might be seen as proof of the client's persistent borderline personality disorder.”

The researchers attended the mental health intake sessions and afterward asked the patients to complete an independent interview with an interviewer. The therapists were also instructed to complete study measures after the interview session. By comparing the therapist’s evaluation to the patient’s assessment, the researchers were able to ascertain a measure of diagnostic accuracy.

“While the clients’ accounts of the quality of the working alliance did not differ by ethnicity, socially advantaged therapists reported worse working alliance with clients belonging to disadvantaged (relative to advantaged) groups,” the authors wrote. “They further found disadvantaged clients as less warm.”

The researchers attributed several processes to the difference in therapists’ attitudes and diagnostic decisions as a function of the client’s identity, such as cross cultural differences that are present in discordant encounters.

“Although mental health disparities are a multifaceted phenomenon, processes related to the social identities of clients and the extent to which these identities match the ones of the treating therapist can affect the quality of the clinical interactions,” the authors continued.

Prior research from the authors found that even when similar information is collected during a mental health intake, clinicians weighted the information differently to assign a diagnosis depending on patients’ ethnicity or race. The researchers aimed to examine if the therapist’s social identity may impact the decision making process as well.

“If members of disadvantaged groups are more frequently misdiagnosed relative to advantaged group members as indicated by our findings, it is no surprise that the quality of the mental health services they receive, and their mental health outcomes, are worse,” Nakash concluded. “I believe clients should ask about their therapist's experience and training working with diverse client population. The ultimate goal of our work is to develop intervention programs for therapists training to improve diagnostic accuracy in the work with diverse client population.”