S103. ASSESSING MOOD SYMPTOMS IN PSYCHOSIS: EXAMINING DIFFERENCES IN MOOD SYMPTOM PRESENTATION AMONGST RACIAL AND ETHNIC MINORITIES WITH PSYCHOSIS
Authors: Bolden Khalima , Lombardi Sarah , Xiong Susie , Niendam Tara 
Published: May 2020

Background

Previous studies have shown that African Americans are more likely than Caucasians to receive a diagnosis of schizophrenia. Once diagnosed, African Americans are slower to seek treatment, more likely to underutilize mental health services, tend to display lower rates of medication adherence, and respond more slowly to psychosocial interventions. This disparity in diagnoses is due to multiple factors. One notable issue is the under-diagnosis of mood symptoms in African Americans with psychosis. Specifically, studies have shown that African Americans are more likely than Caucasians to receive a non-affective psychosis diagnosis, even though the rates of current mood episodes between the Caucasians and African Americans are similar. This is seen more with regards to depressive symptoms than those of mania. These disparities in diagnosis may contribute to decreased treatment efficacy, erosion of trust in treatment providers, and increased attrition in African Americans. Therefore, this issue is one deserving of further understanding. In the current study we sought to explore differences in mood diagnoses in a sample of help-seeking individuals with comorbid psychosis spectrum and mood symptoms.

Methods

A sample of 537 individuals were selected from an outpatient clinic serving lower income individuals with Medicaid. Investigators reviewed records from previous providers and compared them with gold-standard semi-structured assessments. A researcher who received training in cultural humility and differences in mood symptom presentation across racial and ethnic minorities was blinded to demographics and reviewed each client’s records and determined if individuals presented with significant mood symptoms that would criteria for a major mood diagnosis (MDE, Bipolar Disorder, Schizoaffective Disorder, Persistent Depressive Disorder, and Disruptive Mood Dysregulation Disorder). Of the 537 records reviewed 167 individuals endorsed mood symptoms during the structured assessment and to at least 1 outside provider. The sample of clients was then analyzed to determine whether mood symptoms were under-diagnosed (i.e. symptoms appear to warrant a mood diagnosis that was not given by the previous provider).

Results

The sample of 167 individuals with mood symptoms was sufficiently diverse; 25% were Caucasian, 45% were African American, 20% Other, 1% Asian or Pacific Islander. We performed a Chi Square Test of Independence to ascertain whether or not Race had an impact on the likelihood that participants would have under diagnosed mood symptoms. The relationship between variables was statistically significant, χ2 (1) = 3.964, p &lt; .05. Of the 53 individuals who were under diagnosed 61% were African American compared to 13% that were Caucasian.

Discussion

The results of this study indicate a differential rate of diagnosing mood symptoms in African Americans with psychosis compared to Caucasians. These discrepancies may indicate a need for understanding cultural differences in symptoms presentation (e.g. apathy vs. sadness, greater somaticization in minorities, etc.). This study indicates a need for further investigation to better understand factors impacting differences in diagnosis of mood symptoms in African Americans.