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*214. Racial Disparities in Diagnosis for Veterans with Psychosis
Gillon, L, SMITREC; Blow.FC, SMITREC; Valenstein, M, HSR&D COE Ann Arbor/SMITREC; Zeber, J, SMITREC; McCarthy,J, SMITREC
Objectives: Numerous studies have commented on ethnic differentials in the diagnosis of serious mental illness. These disparities may be due to differences in underlying prevalence, cultural differences in the way symptoms are expressed, or biases in the way clinicians assess or understand patients' symptomatic presentations. Diagnosing schizophrenia instead of bipolar disorder has clear treatment implications; making the correct diagnosis is key in providing appropriate care.
In this study, we used FY 99 data from the Serious Mental Illness Treatment Evaluation and Research Center (SMITREC) Psychosis Registry to investigate differences in the diagnosis of schizophrenia and bipolar disorder by ethnic group in a large national sample of veterans with psychosis.
Methods: The national VA Psychosis Registry was developed using data from the VA Patient Treatment File (PTF), census data files, and Outpatient Care Files (OPC) located at the Austin Automation Center (AAC). We used FY99 data from the Registry which included all veterans receiving a diagnosis of schizophrenia other than latent schizophrenia (ICD-9 295.x, excluding 295.5), affective psychoses other than major depression ( ICD-9 296.x, excluding 296.2 or 296.3) or other psychoses (ICD-9 297.x, and 298.x) in either an inpatient or outpatient setting between October 1, 1998 and September 30, 1999 (N=191,606).
We examined differences in the diagnosis of schizophrenia or bipolar disorder by ethnic group (Caucasion, African American, or Hispanic.)
Results: Sixty-one percent (n= 116,880) of patients in the psychosis registry were White/Caucasions, 21% (n=39,662) were African Americans, 6% (n=11,496) were Hispanics, and 0.9% (n=1,724) were in "other" ethnic groups, including Native American and Asian. For 11% of the patients, ethnic group was unknown. African-Americans and Hispanics were much more likely to be diagnosed with schizophrenia than White/Caucasions and much less likely to be diagnosed with bipolar disorder (c2=6840.1; df =2; p<0.0001). 69% of African Americans and 68% of Hispanics were diagnosed with schizophrenia compared to 50% of White/Caucasians. In contrast, just 17% of African-Americans and 18% of Hispanics but 38% of Whites were diagnosed with bipolar disorder.
Conclusions: There are striking ethnic disparities in the diagnosis of schizophrenia versus bipolar disorder in the VHA-- a differential that has clear implications for pharmacologic treatment, prognostic expectations, and patient/family education. As the VHA attempts to provide quality treatment to all of its patients, it is imperative that we understand the factors that lead to these diagnostic disparities.
Impact: This presentation is a first step in confronting this compelling issue and highlights the importance of monitoring for racial/ethnic disparities in diagnosis and treatment within the VHA.