Race Bias, Social Class Bias, and Gender Bias in Clinical Judgment

Studies on race bias, social class bias, and gender bias are reviewed. Topics include psychodiagnosis and rating level of adjustment, the description of personality traits and psychiatric symptoms, the prediction of behavior, and treatment planning. Replicated findings include race bias in the differential diagnosis of schizophrenia and psychotic affective disorders, gender bias in the differential diagnosis of histrionic and antisocial personality disorders, race bias and gender bias in the prediction of violence, and social class bias in the referral of clients to psychotherapy. Recommendations for decreasing bias include (a) being aware of when biases are likely to occur, (b) adhering to diagnostic criteria, and (c) using statistical prediction rules to predict behavior.

[1]  V R Adebimpe,et al.  Overview: white norms and psychiatric diagnosis of black patients. , 1981, The American journal of psychiatry.

[2]  H. Myers,et al.  Diagnostic judgments as a function of client and therapist race , 1988 .

[3]  J. Fleiss,et al.  Depression and schizophrenia in hospitalized black and white mental patients. , 1973, Archives of general psychiatry.

[4]  R. Cohen,et al.  Race bias in the diagnosis and disposition of violent adolescents. , 1980, The American journal of psychiatry.

[5]  P. Wolleat,et al.  Effects of Sex in Judgments of a Simulated Counseling Interview. , 1978 .

[6]  W. Sacco,et al.  Effect of client race and depression on evaluations by white therapists , 1991 .

[7]  H. Ashton Psychotropic-Drug Prescribing for Women , 1991, British Journal of Psychiatry.

[8]  D. Billingsley Sex bias in psychotherapy: an examination of the effects of client sex, client pathology, and therapist sex on treatment planning. , 1977, Journal of consulting and clinical psychology.

[9]  S. Abramowitz,et al.  Racial attribution effects on clinical judgment: A failure to replicate among white clinicians , 1980, American journal of community psychology.

[10]  L. Teri Effects of sex and sex-role style on clinical judgment , 1982 .

[11]  B. Bernstein,et al.  Therapist expectancies: client gender, and therapist gender, profession, and level of training. , 1982, Journal of clinical psychology.

[12]  D. Mcniel,et al.  Correlates of accuracy in the assessment of psychiatric inpatients' risk of violence. , 1995, The American journal of psychiatry.

[13]  A. Farmer,et al.  Labelling and illness in primary care: comparing factors influencing general practitioners' and psychiatrists' decisions regarding patient referral to mental illness services , 1992, Psychological Medicine.

[14]  S. Rosenfield Sex roles and societal reactions to mental illness: the labeling of "deviant" deviance. , 1982, Journal of health and social behavior.

[15]  A comparison of female and male neurotic depressives. , 1976, Journal of clinical psychology.

[16]  R. Sternberg,et al.  Intelligence: Knowns and unknowns. , 1996 .

[17]  E. Rothblum,et al.  Effects of clients' obesity and gender on the therapy judgments of psychologists. , 1991 .

[18]  W. Denton,et al.  Gender bias in marital therapy: A multidimensional scaling analysis , 1988 .

[19]  An analog study with beginning therapists suggesting bias against "activity" in women. , 1982 .

[20]  H. Garb The representativeness and past-behavior heuristics in clinical judgment. , 1996 .

[21]  S. Abramowitz The Politics Of Clinical Judgment: What Nonliberal Examiners Infer About Women Who Do Not Stifle Themselves. , 1973 .

[22]  Edward P. Mulvey,et al.  A comparison of actuarial methods for identifying repetitively violent patients with mental Illnesses , 1996 .

[23]  K. Wells,et al.  Gender differences in depression detection: A comparison of clinician diagnosis and standardized assessment. , 1991 .

[24]  R. Dawes,et al.  Heuristics and Biases: Clinical versus Actuarial Judgment , 2002 .

[25]  H. Clarizio,et al.  Socioeconomic bias in special education placement decisions , 1981 .

[26]  Diana Li-Repac Cultural Influences on Clinical Perception , 1980 .

[27]  H. Prout,et al.  Sex bias in clinical judgment among school psychologists , 1991, Psychology in the Schools.

[28]  Fredrick C. Redlich,et al.  Social class and mental illness: Community study. , 1958 .

[29]  H. Steadman,et al.  Role incongruence and gender variation in the provision of prison mental health services. , 1989, Journal of health and social behavior.

[30]  P. Lannon,et al.  Accuracy of clinicians' expectancies for psychiatric rehospitalization , 1983, American journal of community psychology.

[31]  S. Abramowitz,et al.  Socially-Charged Pupil and Psychologist Effects On Psychoeducational Decisions , 1977 .

[32]  C. Russell,et al.  Mother-blaming in family therapy: An empirical investigation , 1992 .

[33]  T. Trepper,et al.  The influence of therapist values, religiosity and gender in the initial assessment of sexual addiction by family therapists , 1995 .

[34]  J. A. Wright,et al.  Brief Reports Influence of Client Socioeconomic Status on Selected Behaviors, Attitudes, and Decisions of Counselors , 1977 .

[35]  N. Ambady,et al.  Thin slices of expressive behavior as predictors of interpersonal consequences: A meta-analysis. , 1992 .

[36]  S. Kalichman,et al.  Factors influencing the reporting of father-child sexual abuse: Study of licensed practicing psychologists. , 1989 .

[37]  H. Garb,et al.  Clinical judgment, clinical training, and professional experience. , 1989, Psychological bulletin.

[38]  R. Littlewood Psychiatric diagnosis and racial bias: empirical and interpretative approaches. , 1992, Social science & medicine.

[39]  N. Betz,et al.  Gender differences in counselors' attitudes toward and attributions about incest. , 1993 .

[40]  G. Lewis,et al.  Are British Psychiatrists Racist? , 1990, British Journal of Psychiatry.

[41]  Jeffrey M. Schwartz,et al.  Value-related effects on psychiatric judgment. , 1975, Archives of general psychiatry.

[42]  G. Stricker Implications of research for psychotherapeutic treatment of women. , 1980, The American psychologist.

[43]  H. Garb Sex bias and the diagnosis of borderline personality disorder. , 1995 .

[44]  Howard N. Garb,et al.  Judgment research and neuropsychological assessment: A narrative review and meta-analyses. , 1996 .

[45]  J. McDermott,et al.  Cross-Cultural Differences in Parent-Child Assessment: U.S.a. and Japan , 1982, The International journal of social psychiatry.

[46]  D. M. Dailey Are social workers sexists? a replication , 1980 .

[47]  R. Drake,et al.  Clinicians' practices in personality assessment: does gender influence the use of DSM-III axis II? , 1990, Comprehensive psychiatry.

[48]  T. Widiger,et al.  Broverman et al. revisited: An artifactual sex bias. , 1987 .

[49]  G. Zellman The impact of case characteristics on child abuse reporting decisions. , 1992, Child abuse & neglect.

[50]  B Kleinmuntz,et al.  Why we still use our heads instead of formulas: toward an integrative approach. , 1990, Psychological bulletin.

[51]  N. Wrobel Effect of patient age and gender on clinical decisions , 1993 .

[52]  Saundra Tomlinson-Clarke,et al.  Counselor and Client Ethnicity and Counselor Intake Judgments. , 1993 .

[53]  A. Porter,et al.  Interclinician agreement and bias in school psychologists' diagnostic and treatment recommendations for a learning disabled child , 1982 .

[54]  D. Routh,et al.  Social class bias in clinical judgment. , 1972, Journal of Consulting and Clinical Psychology.

[55]  T. Widiger,et al.  Sex bias in the diagnosis of histrionic and antisocial personality disorders. , 1989, Journal of consulting and clinical psychology.

[56]  S. Lamb,et al.  Sex bias in the diagnosis of borderline personality disorder and posttraumatic stress disorder , 1994 .

[57]  H. Clarizio,et al.  Sex bias in the diagnosis of learning disabled students , 1986 .

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

[59]  M. L. Smith Sex bias in counseling and psychotherapy. , 1980, Psychological bulletin.

[60]  S. Morin,et al.  Psychologists' Attitudes toward Homosexual Psychotherapy Clients , 1978 .

[61]  M. Kahn,et al.  Interpreter bias on the Rorschach Test as a function of patients' socioeconomic status. , 1970, Journal of projective techniques & personality assessment.

[62]  R. Elk,et al.  Depression in Schizophrenia: A Study of Prevalence and Treatment , 1986, British Journal of Psychiatry.

[63]  H. Garb Toward a second generation of statistical prediction rules in psychodiagnosis and personality assessment , 1994 .

[64]  T. Trull,et al.  Diagnosis and clinical assessment. , 1991, Annual review of psychology.

[65]  A. Peter,et al.  Social class and diagnostic suggestion as variables in clinical judgment. , 1975 .

[66]  S. Umbenhauer,et al.  Patient race and social class: attitudes and decisions among three groups of mental health professionals. , 1978, Comprehensive psychiatry.

[67]  A. Agresti,et al.  EFFECTS OF GENDER AND AGE ON PSYCHOLOGISTS' REPORTING OF CHILD SEXUAL ABUSE , 1995 .

[68]  E. Newberger,et al.  Child abuse incidence and reporting by hospitals: significance of severity, class, and race. , 1985, American journal of public health.

[69]  Robin Sesan Sex bias and sex-role stereotyping in psychotherapy with women: Survey results. , 1988 .

[70]  L. Schover Male and female therapists' responses to male and female client sexual material: An analogue study , 1981, Archives of sexual behavior.

[71]  T. Widiger,et al.  Sex differences among the personality disorders: An exploration of the data. , 1995 .

[72]  H. Herrera,et al.  On controlling for patient psychopathology in naturalistic studies of sex bias: a methodological demonstration. , 1981, Journal of consulting and clinical psychology.

[73]  J. Rabinowitz,et al.  Factors influencing disposition decisions for patients seen in a psychiatric emergency service. , 1995, Psychiatric services.

[74]  A. Rosen,et al.  Misdiagnosis of schizophrenia in bipolar patients: a multiethnic comparison. , 1983, The American journal of psychiatry.

[75]  M. Loring,et al.  Gender, race, and DSM-III: a study of the objectivity of psychiatric diagnostic behavior. , 1988, Journal of health and social behavior.

[76]  V. Derlega,et al.  Sex Differences in Diagnosis and Treatment Recommendations for Antisocial Personality and Somatization Disorders , 1989 .

[77]  L. Fitzgerald,et al.  The (Mis)Treatment of Men: Effects of Client Gender Role and Life-Style on Diagnosis and Attribution of Pathology. , 1990 .

[78]  D. Broverman,et al.  Sex-role stereotypes and clinical judgments of mental health. , 1970, Journal of consulting and clinical psychology.

[79]  K. Henry,et al.  The role of labeling processes in diagnosing borderline personality disorder. , 1983, The American journal of psychiatry.

[80]  T. Merluzzi,et al.  Influence of Client Race on Counselors' Assessment of Case Materials. , 1978 .

[81]  J. Sattler,et al.  Ethnicity, socioeconomic status, and pattern of WISC scores as variables that affect psychologists' estimates of "effective intelligence". , 1976, Journal of clinical psychology.

[82]  J. Feinblatt,et al.  Sex roles and the psychiatric referral process , 1976 .

[83]  R. Dawes,et al.  Sex bias, diagnosis, and DSM-III , 1986 .

[84]  B. Dowds,et al.  Cognitive mediators between patients' social class and therapists' evaluations. , 1977, Archives of general psychiatry.

[85]  Gwendolyn Steyens Bias in the Attribution of Hyperkinetic Behavior as a Function of Ethnic Identification and Socioeconomic Status. , 1981 .

[86]  F. B. Nalven,et al.  The effects of subjects' age, sex, race, and socioeconomic status on psychologists' estimates of "true IQ" from WISC scores. , 1969, Journal of Clinical Psychology.

[87]  G. L. Paul,et al.  Urban psychiatric commitments: disability and dangerous behavior of black and white recent admissions. , 1989, Hospital & community psychiatry.

[88]  E. Huebner,et al.  Influence of Race and Test Data Ambiguity Upon School Psychologists' Decisions. , 1986 .

[89]  C. Ridley Diagnosis as a Function of Race Pairing and Client Self-Disclosure , 1986 .

[90]  J. Fischer,et al.  Are social workers sexists , 1976 .

[91]  H. Martin,et al.  Judgments about candidates for psychotherapy: the influence of social class and insight-verbal ability. , 1970, Journal of health and social behavior.

[92]  B. E. Jones,et al.  Problems in diagnosing schizophrenia and affective disorders among blacks. , 1986, Hospital & community psychiatry.

[93]  R. Hoffnung,et al.  Attitudes toward the lower- and middle-class psychiatric patient as a function of authoritarianism among mental health students. , 1970, Journal of Consulting and Clinical Psychology.

[94]  C. Austad,et al.  The salience of sex role instructions to mental health professionals , 1987 .

[95]  T. Oakland,et al.  Factors influencing teachers' and psychologists' recommendations regarding special class placement , 1979 .

[96]  E. Mulvey,et al.  The accuracy of predictions of violence to others. , 1993, JAMA.

[97]  L. Penner,et al.  Sexism among psychotherapists: a case not yet proven. , 1980, Journal of consulting and clinical psychology.

[98]  F. J. Hansen,et al.  Sex differences in clinical judgments of male and female therapists , 1990 .

[99]  Stephen Lee,et al.  Social class, diagnosis, and prognosis for psychotherapy. , 1970 .

[100]  Beth E. Haverkamp,et al.  Confirmatory bias in hypothesis testing for client-identified and counselor self-generated hypotheses , 1993 .

[101]  H. Garb The incremental validity of information used in personality assessment. , 1984 .

[102]  N. Betz,et al.  An Investigation of the Effects of Client Sex and Presenting Problem in Referral from Intake. , 1979 .

[103]  R. Spitzer,et al.  Sex bias in the diagnosis of personality disorders: Conceptual and methodological issues , 1991 .

[104]  J. Masling,et al.  Noblesse oblige effect: the interpretation of Rorschach responses as a function of ascribed social class. , 1972, Journal of consulting and clinical psychology.

[105]  L. Bachrach The Carter Commission's contributions to mental health service planning. , 1994, Hospital & community psychiatry.

[106]  D. Bramel,et al.  Interaction of client class and gender in biasing clinical judgement. , 1981, The American journal of orthopsychiatry.

[107]  S. Abramowitz,et al.  Sex Bias in Clinical Judgment: Later Empirical Returns , 1980 .

[108]  H. Clarizio,et al.  Discrepant team decisions: the effects of race, gender, achievement, and IQ on LD eligibility , 1994 .

[109]  S. López,et al.  Gender bias in clinical judgment: An assessment of the analogue method's transparency and social desirability , 1993 .

[110]  P. Werner,et al.  Predicting Violence in Newly Admitted Inmates , 1990 .

[111]  L. Cohen,et al.  The extent of sex bias in clinical treatment recommendations. , 1981 .

[112]  D. Franklin,et al.  Differential Clinical Assessments: The Influence of Class and Race , 1985, Social Service Review.

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

[114]  J. Rabinowitz,et al.  Clinical Decision Making of Short- Versus Long-Term Treatment , 1995 .

[115]  J. Trachtman Socio-economic class bias in Rorschach diagnosis: contributing psychosocial attributes of the clinician. , 1971, Journal of personality assessment.

[116]  C. Abramowitz,et al.  The politics of clinical judgment: Early empirical returns. , 1977 .

[117]  Teresa A. Buczek Sex biases in counseling: Counselor retention of the concerns of a female and male client. , 1981 .

[118]  R. Warner THE DIAGNOSIS OF ANTISOCIAL AND HYSTERICAL PERSONALITY DISORDERS: An Example of Sex Bias , 1978, The Journal of nervous and mental disease.

[119]  M. Mclaughlin,et al.  Effects of client — therapist ethnic homophily on therapists' judgments , 1980 .

[120]  L. Weitz,et al.  Effects of patient racial attribution on black clinicians' inferences , 1976, American journal of community psychology.

[121]  G. Leinhardt,et al.  Sex and race differences in learning disabilities classrooms. , 1982, Journal of educational psychology.

[122]  J. M. Settin Clinical judgment in geropsychology practice. , 1982 .

[123]  M. Smith Influence of client sex and ethnic group on counselor judgments. , 1974 .

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

[125]  T. Widiger,et al.  Sex bias in the diagnosis of personality disorders: A different approach , 1995 .

[126]  H. Koplewicz,et al.  Hospitalizing the suicidal adolescent: an empirical investigation of decision-making criteria. , 1995, Journal of the American Academy of Child and Adolescent Psychiatry.

[127]  C. Abramowitz Blaming the Mother: An Experimental Investigation of Sex-Role Bias in Countertransference , 1977 .

[128]  J. G. Jones,et al.  Socioeconomic Bias in the Diagnosis of Mental Retardation , 1973, Exceptional children.

[129]  D. Lewis,et al.  Psychiatric Diagnoses and Racial Bias: An Empirical Investigation , 1989 .

[130]  T. Widiger,et al.  Sex and gender bias in self-report personality disorder inventories: item analysis of the MCMI-II, MMPI, and PDQ-R. , 1995, Journal of personality assessment.