Differential Diagnosis for Depression and Schizophrenia Spectrum Disorders: Is clinician diagnostic judgment influenced by race?

There is a robust literature documenting differential rates of diagnoses made for affective and schizophrenia spectrum disorders between black and white men in practical settings. However, a consensus identifying the source of these observed differences in rates between these two groups has yet to be reached. One potential contributor to the differential diagnostic rates between black and white men is the clinical decision making of practitioners. The current study uses a vignette methodology to narrow this gap by surveying a sample of licensed clinicians and clinicians in-training. The study extended prior literature in two important ways. First, the case vignette described a complex presentation of major depressive disorder, along with mistrust (e.g., subthreshold paranoia). Further, te vignette was accompanied by an image of the client that was presented as either a black or white man. Contrary to our hypotheses, analyses demonstrated that clinicians more often correctly assigned a diagnosis of depression than schizophrenia disorder. The only difference that emerged was for schizoaffective disorder for which clinicians assigned higher ratings for the white male vignette than the black male vignette. This study largely rules out simple racial bias in diagnosis as the cause of real-world differences. It encourages more concentrated research targeted at identifying the source of real-world differences as they apply to psychopathology and demographic groups.