Issues of the Bias in Diagnosis

Diagnosis = the identification of the nature of an illness / problem by examination of the symptoms
Culture Bias
1. appears to be a major bias in diagnosis with regards to people of African descent, particularly with schizophrenia
  1. Cochrane and Sashidharan (1995) - Afro-Caribbean immigrants in the UK are 7x more likely to be diagnosed with schizophrenia than white people
  2. however, doesn't give us any info about the nature of this bias; is there a bias in the diagnosing, or is there a genuine difference
2. over-diagnosis
  1. bias is the diagnostic tools used
    1. the diagnostic tool is culturally biased
    2. may overemphasise a western concept of ideal mental health
    3. 1. things that may be classed as symptoms of mental illness in one culture, may be regarded as normal in other cultures; leading to over-diagnosis of disorders
      1. Ebigno (1986) - symptoms of depression vary from culture to culture. In Nigeria, people often complain of burning sensations in the body and crawling sensations in the head
    4. 2. could lead to ignoring some genuine mental illnesses which don't occur in Western culture
      1. Koro = extreme anxiety that the penis will recede into the body, and Ghost Sickness = excessive focus on death
  2. bias in the person who is doing the diagnosis
    1. Lewis (1990) - 139 psychiatrists were shown an individual written case history; asked to make a judgement on the treatment and predict whether criminal proceedings should take place; some were told it was a black patient, others were told it was white
      1. found that the black patient was recommended drug treatment and was seen as a more violent criminal; suggests that mental health professionals can be biased in their judgement by social stereotypes
        however, psychiatrists may have diagnosed patients in ways that we didn't know about before the experiments took place
3. genuine differences
  1. stress of being a minority / immigrant
    1. stress associated with being an ethnic minority leads to higher stress levels; could trigger off a mental illness
    2. immigrants generally are of a lower social class, and have to adapt to living in a foreign culture, and may lack communication skills
    3. however, the majority of immigrants to the UK in recent history have been white, yet the bias in diagnosis only applies to black immigrants
    4. rates of serious mental illnesses are higher in British-born black people rather than their parents, or recent immigrants
      1. however, this is because they have no home as they have mixed cultures
  2. genetic factors
    1. people of African descent may have a genetic vulnerability to developing certain types of mental illness
      1. however, Nazroo (1997) found there is not more black people with schizophrenia
Gender Bias
1. Walker (1994) - women with depression outnumber men between 2 and 6 times
  1. however, no gender bias for the occurrence of bi-polar or schizophrenia
  2. this gender bias is quite recent
    1. Cochrane (1995) argues that earlier in the 19th century, men were much more likely to be admitted to hospital than women
  3. these statistics don't give us the cause of the bias
2. over-diagnosis
  1. Worell & Remer (1992) - 4 possible reasons why there may be gender bias
    1. 1. disregarding environmental context
      1. focus in diagnosis is on the symptoms rather than the individual circumstances
      2. female patients have to cope with more difficult circumstances
    2. 2. differential diagnosis on the basis on gender
      1. a patients's symptoms may be interpreted differently depending on their gender
      2. therapists exaggerate the number of men and women with disorders which conform to the gender stereotype
    3. 3. therapist misjudgement
      1. sex role stereotyping may increase the chances that the therapist will detect symptoms of submissiveness in females and aggressiveness in males
        Broverman (1981) supports the existence of gender stereotypes after health care professionals used similar words when describing a mentally healthy adult, a healthy male, and a healthy female
    4. 4. theoretical orientation
      1. therapist's theoretical biases may distort the process of diagnosis
3. genuine differences
  1. cause of the high level of depression in women is hormones; the hormones fluctuate during the month, as well as childbirth and this may possibly explain why women are more prone to depression
    1. however, Weissman (1977) - whilst there is some evidence of hormone contribution, it cannot completely account for the differences between men and women

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Issues of the Bias in Diagnosis

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