THE EFFECTS OF RACE ON DIAGNOSIS AND DISPOSITION FROM A PSYCHIATRIC EMERGENCY SERVICE

Background: Previous studies have reported that racial differences exi st in patterns of clinical psychiatric diagnoses as well as the distri bution of mental health services resources. The psychiatric emergency service serves as an entry point into the mental health system, so it plays a potentially important role in addressing racial disparities in diagnosis and disposition. To address this disparity, the authors stu died two specific questions: (1) are there racial differences in diagn osis and (2) are there racial differences in disposition of patients v isiting a psychiatric emergency service? Method: Demographic and clini cal data were obtained by retrospective chart review of 490 patients r andomly selected from 9500 visits to a large psychiatric emergency ser vice during a 1-year period. All clinical information had been recorde d by the primary treaters who had no knowledge of this study. Results: Black patients were significantly more likely to be diagnosed with sc hizophrenia and substance abuse than similar white patients, although less likely to be diagnosed with a personality disorder. Black patient s were significantly more likely to be hospitalized, particularly at a public hospital, although there were no significant differences in in surance coverage or measures of suicidal or homicidal ideation. Conclu sion: Despite the availability of DSM-III-R criteria, black patients c ontinue to be disproportionately diagnosed with schizophrenia. In this sample, this diagnosis may have been given in lieu of a personality d isorder or affective illness diagnosis. Black patients are also more l ikely to be hospitalized. These observations suggest that further rese arch is needed to clarify the effects of race on the decision-making p rocess in diagnosis and disposition from the psychiatric emergency ser vice.