Racial/Ethnic Differences in Psychiatric Diagnosis and Treatment

Significant racial/ethnic differences appear to exist in the diagnosis and treatment of psychiatric conditions across 11 private, not-for-profit United States healthcare systems, according the findings a study published online in the journal Psychiatric Services. Organizations in the study were part of the Mental Health Research Network, a consortium of research centers with a mission to improve the management of mental health conditions.

Among the results, Non-Hispanic blacks were nearly twice as likely as non-Hispanic whites to be diagnosed with schizophrenia yet significantly less likely to receive medication for treatment. “It’s concerning that we saw a higher rate of diagnosis of schizophrenia and seemingly an undertreatment in terms of pharmacotherapy for that group,” said co-author Ashli A. Owen-Smith, PhD, Assistant Professor of Health Management and Policy in the School of Public Health at Georgia State University. “In general, pharmacotherapy is an important part of the treatment plan. That’s a finding that warrants some additional research.”

A combined 7.5 million patients aged 18 or older were seen at the participating healthcare systems during 2011, among whom 1.2 million (15.6%) received a psychiatric diagnosis. Diagnoses included anxiety disorder, depressive disorder, bipolar disorder, schizophrenia spectrum disorder, and other psychoses.

Rates of diagnoses, prescription of psychotropic medications, and total formal psychotherapy sessions received were obtained from insurance claims and electronic medical record databases across all healthcare settings. Participants were white, Asian, black, Hispanic, Native Hawaiian/other Pacific Islander, Native American/Alaskan Native, or mixed-race.

“We saw that prevalence rates for depression and anxiety diagnoses were lower among racial and ethnic minorities compared to non-Hispanic whites,” said Dr. Owen-Smith. “Non-Hispanic whites were consistently higher in use of pharmacotherapy compared to other race-ethnicities. For psychotherapy, interestingly, the rates were similar or sometimes higher for racial or ethnic minorities.”

Other key findings include the following:

• Native American/Alaskan Native patients had the highest rates of any diagnosis (20.6%).
• Asian patients had the lowest rates of any diagnosis (7.5%).
• Among patients with a psychiatric diagnosis, 73% received a psychotropic medication.
• Non-Hispanic white patients were significantly more likely (77.8%) than other racial/ethnic groups to receive medication.
• Just 34% of patients with a psychiatric diagnosis received formal psychotherapy.
• Racial-ethnic differences were most pronounced for depression and schizophrenia.
• Non-Hispanic blacks were more likely to receive formal psychotherapy for their depression or schizophrenia when compared with whites.

“I think the other thing important to note is that the overall rate of psychotherapy treatment for people with serious mental illness was very low across all races/ethnicities,” said Dr. Owen-Smith. “In general, across all the health systems, people with serious mental illness aren't getting a lot of psychotherapy as a form of treatment, and maybe that's a missed opportunity for our health systems to provide care to those patients.”

The study authors note that additional research is needed to better understand underlying causes of the differences observed in their study and whether processes and outcomes of care are equitable across these diverse patient populations.