Provided by David Satcher, M.D., Ph.D.
Surgeon General of the United States of America
Chapter 2
Overview of Cultural Diversity and Mental Health Services
Clinician Bias
Advocates and experts alike have asserted that bias in clinician judgment is one
of the reasons for overutilization of inpatient treatment by African Americans.
Bias in clinician judgment is thought to be reflected in overdiagnosis or
misdiagnosis of mental disorders. Since diagnosis is heavily reliant on
behavioral signs and patients’ reporting of the symptoms, rather than on
laboratory tests, clinician judgment plays an enormous role in the diagnosis of
mental disorders. The strongest evidence of clinician bias is apparent for
African Americans with schizophrenia and depression. Several studies found that
African Americans were more likely than were whites to be diagnosed with
schizophrenia, yet less likely to be diagnosed with depression (Snowden &
Cheung, 1990; Hu et al., 1991; Lawson et al., 1994).
In addition to problems of overdiagnosis or misdiagnosis, there may well be a
problem of underdiagnosis among minority groups, such as Asian Americans, who
are seen as “problem-free” (Takeuchi & Uehara, 1996). The presence and extent of
this type of clinician bias are not known and need to be investigated.
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