Bias in mental health assessment and intervention: theory and evidence.

A recent surgeon general's report and various studies document racial and ethnic disparities in mental health care, including gaps in access, questionable diagnostic practices, and limited provision of optimum treatments. Bias is a little studied but viable explanation for these disparities. It is important to isolate bias from other barriers to high-quality mental health care and to understand bias at several levels (practitioner, practice network or program, and community). More research is needed that directly evaluates the contribution of particular forms of bias to disparities in the area of mental health care.

[1]  A. Lehman Quality of care in mental health: the case of schizophrenia. , 1999, Health affairs.

[2]  J. Berg,et al.  Effects of Racial Similarity and Interviewer Intimacy in a Peer Counseling Analogue. , 1988 .

[3]  T. Hu,et al.  Emergency care avoidance: Ethnic matching and participation in minority-serving programs , 1995, Community Mental Health Journal.

[4]  J. Freese,et al.  Nature, Nurture, Neither, Nor: Black-White Differences in Beliefs about the Causes and Appropriate Treatment of Mental Illness , 2000 .

[5]  S. Sue,et al.  Return rates and outcomes from ethnicity-specific mental health programs in Los Angeles. , 1995, American journal of public health.

[6]  R. Rosenheck,et al.  Black and Hispanic Veterans in Intensive VA Treatment Programs for Posttraumatic Stress Disorder , 2002, Medical care.

[7]  J. Levine,et al.  Utilization of depot neuroleptic medication in psychiatric inpatients. , 1996, Psychopharmacology bulletin.

[8]  T. Croghan,et al.  Racial variation in antidepressant treatment in a Medicaid population. , 2000, The Journal of clinical psychiatry.

[9]  C. Muntaner,et al.  Racial differences in attitudes toward professional mental health care and in the use of services. , 2000, The American journal of orthopsychiatry.

[10]  Olga V. Demler,et al.  Adequacy of treatment for serious mental illness in the United States. , 2002, American journal of public health.

[11]  A. Rothbard,et al.  Racial disparities in antipsychotic prescription patterns for patients with schizophrenia. , 2002, The American journal of psychiatry.

[12]  C. Sherbourne,et al.  The quality of care for depressive and anxiety disorders in the United States. , 2001, Archives of general psychiatry.

[13]  P. Cunningham,et al.  Determinants of ambulatory mental health services use for school-age children and adolescents. , 1996, Health services research.

[14]  A. Horvath,et al.  The working alliance: Theory, research, and practice. , 1994 .

[15]  J. Bloom,et al.  Contextual Factors Affecting Job Satisfaction and Organizational Commitment in Community Mental Health Centers Undergoing System Changes in the Financing of Care , 2002, Mental health services research.

[16]  J. Hanlon,et al.  Marked differences in antidepressant use by race in an elderly community sample: 1986-1996. , 2000, The American journal of psychiatry.

[17]  R. Novaco,et al.  Layoffs and violence revisited , 2002 .

[18]  S. Sue,et al.  The role of culture and cultural techniques in psychotherapy. A critique and reformulation. , 1987, The American psychologist.

[19]  H. Neighbors,et al.  Clinician attributions associated with the diagnosis of schizophrenia in African American and non-African American patients. , 2000, Journal of consulting and clinical psychology.

[20]  S. Sue,et al.  Research on psychotherapy with culturally diverse populations. , 1994 .

[21]  C. D. Claiborn,et al.  Effects of Black Students' Racial Identity on Perceptions of White Counselors Varying in Cultural Sensitivity. , 1986 .

[22]  L. Snowden,et al.  Minority Response to Health Insurance Coverage for Mental Health Services. , 2001, The journal of mental health policy and economics.

[23]  Windy Dryden,et al.  Handbook of Psychotherapy and Behavior Change , 1987, Journal of Cognitive Psychotherapy.

[24]  J. Alvidrez Ethnic Variations in Mental Health Attitudes and Service Use Among Low-Income African American, Latina, and European American Young Women , 1999, Community Mental Health Journal.

[25]  Kevin Fiscella,et al.  Disparities in Health Care by Race, Ethnicity, and Language Among the Insured: Findings From a National Sample , 2002, Medical care.

[26]  A. Gaw Cross-cultural psychiatry , 1982 .

[27]  Patient variable biases in clinical judgment: conceptual overview and methodological considerations. , 1989 .

[28]  C. Sherbourne,et al.  Ethnic disparities in unmet need for alcoholism, drug abuse, and mental health care. , 2001, The American journal of psychiatry.

[29]  A. Zaslavsky,et al.  Racial disparities in the quality of care for enrollees in medicare managed care. , 2002, JAMA.

[30]  S. Rosenfield Race differences in involuntary hospitalization: psychiatric vs. labeling perspectives. , 1984, Journal of health and social behavior.

[31]  S. Segal,et al.  Race, quality of care, and antipsychotic prescribing practices in psychiatric emergency services. , 1996, Psychiatric services.

[32]  S. Fiske What We Know Now About Bias and Intergroup Conflict, the Problem of the Century , 2002 .

[33]  N W Zane,et al.  Community mental health services for ethnic minority groups: a test of the cultural responsiveness hypothesis. , 1991, Journal of consulting and clinical psychology.

[34]  Frederick T. L. Leong,et al.  Barriers to Providing Effective Mental Health Services to Asian Americans , 2001, Mental health services research.

[35]  M. Olfson,et al.  Patients with schizophrenia at risk for excessive antipsychotic dosing. , 2000, The Journal of clinical psychiatry.

[36]  A. Garland,et al.  Minority populations in the child welfare system: the visibility hypothesis reexamined. , 1998, The American journal of orthopsychiatry.

[37]  D. Sclar,et al.  Ethnicity and the prescribing of antidepressant pharmacotherapy: 1992-1995. , 1999, Harvard review of psychiatry.

[38]  L. Snowden,et al.  Referral Patterns in Ethnic-Specific and Mainstream Programs for Ethnic Minorities and Whites. , 1996 .

[39]  N. Powe,et al.  Mental health service utilization by African Americans and Whites: the Baltimore Epidemiologic Catchment Area Follow-Up. , 1999, Medical care.

[40]  Jeanne L. Johnson,et al.  Barriers to Providing Effective Mental Health Services to American Indians , 2001, Mental health services research.

[41]  S. Sue,et al.  Asian-American children treated in the mental health system: A comparison of parallel and mainstream outpatient service centers. , 1994 .

[42]  S. Sue In search of cultural competence in psychotherapy and counseling. , 1998, The American psychologist.

[43]  S. Aguilar‐gaxiola,et al.  Gaps in service utilization by Mexican Americans with mental health problems. , 1999, The American journal of psychiatry.

[44]  T. Kakuma,et al.  Racial differences in treatment of psychiatric inpatients. , 1995, Psychiatric services.

[45]  Involuntary commitments to public mental institutions: issues involving the overrepresentation of blacks and assessment of relevant functioning. , 1989 .

[46]  C. Bell,et al.  Issues in the psychiatric treatment of African Americans. , 1999, Psychiatric services.

[47]  L. Snowden,et al.  Frequency and Scope of Mental Health Service Delivery to African Americans in Primary Care , 2002, Mental health services research.

[48]  David Satcher,et al.  Mental Health: Culture, Race, and Ethnicity—A Supplement to Mental Health: A Report of the Surgeon General , 2001 .