An analysis of mental health care in the US has found that African Americans are more likely to be misdiagnosed with schizophrenia than white patients.

The Rutgers University study builds on years of evidence that clinicians’ racial biases — whether conscious or unconscious — affect the types of mental-health diagnoses ethnic minority patients receive.

The latest research found that about 20 percent of African Americans who had been diagnosed with schizophrenia also screened positive for major depression — nearly six times the percentage ratio for white patients.


The data indicates some of the African American patients may have been misdiagnosed, said Michael Gara, coauthor of the study and a professor of psychiatry at Rutgers’ Robert Wood Johnson Medical School.

Schizophrenia is a diagnosis of exclusion, he explained. Clinicians must rule out other potential causes of symptoms first, such as mood disorders, before the diagnosis of schizophrenia is given.

But research shows there’s a tendency for clinicians to overemphasize the relevance of psychotic symptoms, such as hallucinations, and overlook symptoms of major depression in African Americans compared with other racial or ethnic groups.

“Let’s face it, people stereotype,” Gara said. “It’s not necessarily malicious. They do it implicitly. It’s automatic.”

Large population-based studies have found no significant difference in the likelihood of African Americans and whites having schizophrenia. But in practice, the diagnosis disparities persist.

During a clinical interview, an African American patient might report psychotic symptoms like hearing voices and “the clinician might stop right there and say, ‘He’s clearly psychotic,’ and make a diagnosis,” Gara added. “But maybe there were a lot of mood symptoms and they never looked for those.” 

In the study, which was published in the journal Psychiatric Services, researchers examined the medical records of more than 1,600 people at a community behavioral clinic. About 600 were African American and about 1,000 were white.

Past research has found that black patients are 17 times more likely to be diagnosed with conditions such as schizophrenia or bipolar disorder.

In the UK, the Equality and Human Rights Commission recently highlighted how black adults are least likely to have access to counselling, therapy or medication and are most likely to be detained for their mental health.