Diagnosing depression in African Americans

Since the 1970s, articles have noted the increased presence of psychotic sy mptoms among depressed African Americans, the presence of diagnostic bias i dentified when structured clinical interviews are used, and the identificat ion of misdiagnosis of affective illness among chronically, mentally ill, A frican Americans. This paper reviews this literature and describes three al ternative presentations of depressive illness among African Americans that differ from the DSM TV criteria for Major Depressive Disorder: "the stoic b eliever," "the angry,'evil' one" with a personality change, and "the John H enry doer." Clinicians are encouraged to recall these presentations of depr ession when evaluating African American patients.