Minorities May Be More Likely to Get Inaccurate Mental-Illness Diagnoses

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The findings are complicated and vary greatly from country to country, but overall there are some clear and troubling connections between race and mental illness. In some places, members of disadvantaged groups (a category that often overlaps neatly with ethnic minority status) appear to be more susceptible to certain mental illnesses. In the U.S., while Latinos and African-Americans are less likely to be diagnosed with mood and anxiety disorders — a result that could be explained by a lack of access to mental-health care compared to other groups — when these disorders do crop up, they’re more difficult to treat.

In a new study in Social Psychology and Personality Science, psychology researchers Ora Nakash and Tamar Saguy of the Interdisciplinary Center in Herzliya, Israel, looked at one possible mechanism for these differences: how clinicians interact with minority patients. The study involved the two major Jewish ethnic groups in Israel: Ashkenazi Jews (Ashkenazim), who are descended from Europe (sometimes with a stop in the U.S. before their families resettled in Israel) and who enjoy majority-group status in Israel, and Mizrahi Jews (Mizrahim), who are descended from Asia or Africa and “who are socially disadvantaged relative to the Ashkenazim” — on average, they have higher rates of mental illness, lower income, and lower educational attainment.

The researchers, who believe their study was the first to “consider[] diagnostic accuracy in the context of divergent social identities during early stages of… mental health treatment,” took a close look at the intake procedures of 58 patients who were seen by Ashkenazi therapists at four mental-health clinics in Israel. After their “regular” intakes, in which the patients were examined by clinicians and given a diagnosis, the patients were then given a “gold standard” structured interview — that is, one in which word choice and question order are carefully designed to scrub out as much bias as possible — by a separate clinician. 

The basic idea was to compare diagnoses given during the “natural” intakes with those revealed by the more careful structured interview. Sure enough, the two diagnoses were much more likely to match when both therapist and patient were Ashkenazi, the majority group, than when the therapist was Ashkenazi and the patient was Mizrahi — in the prior case there was mismatch 24 percent of the time, while in the latter that number jumped to 52 percent. This suggests that Mizrahim may be more likely to get a false mental-illness diagnosis in Israel, which could lead to all sorts of difficulties down the road.

There’s only so much we can take from this study. For one thing, the sample was pretty small, and for another, it took place in Israel, which like every country has its own unique issues regarding race, class, and how the two intermingle. But look at the researchers’ speculation about what’s driving their results:

Several processes may account for the difference in therapist’s attitudes and diagnostic decisions, as a function of the client’s identity. The effects may be explained by cross-cultural difficulties that are present in discordant encounters (cultural dysfluency). If this is indeed the reason, then we would expect similar results in (the relatively rare) situations involving a therapist from a disadvantaged group and a client from an advantaged group. Other processes, more directly pertaining to intergroup bias against minorities, and to asymmetrical power, are less likely to take place when the therapist belongs to a disadvantaged group.

If this is accurate, one would expect to find these sorts of effects, or versions of them at least, any place that has socioeconomically disadvantaged groups. So in other words, just about everywhere.

Minorities and Mental-Illness Diagnoses