Clinical Biases in Diagnosis

Clinical Biases in Diagnosis

• Clinical bias: Stereotypes, confirmation bias, bias from gender, socioeconomic status, and ethnicity, can impact clinician's diagnoses.

• Consequences of bias: Misdiagnosis and ineffective treatment are potential outcomes.

Confirmation Bias

• Mechanism: Confirmation bias arises from schemas that help understand and predict situations. Clinicians may "see" what they expect to see. It's influenced by stereotypes and social norms.

• Temerlin (1970) study: Participants shown a video of a healthy individual; after hearing a respected psychologist suggest psychosis, 60% of clinicians diagnosed the individual as psychotic compared to none in a control group. This demonstrates how pre-existing diagnoses and information impact diagnostic objectivity.

Gender Bias in Diagnosis

• Potential for misdiagnosis: Women may be overdiagnosed with anxiety, while men may not receive an accurate anxiety diagnosis because of clinician assumptions about gender differences in prevalence of anxiety.

• Transgender individuals: Due to known higher suicide rates in this population, clinicians may misdiagnose a trans person with depression or suicidal ideation if similar symptoms presented.

• Gender schema: Gender stereotypes may influence if, when, and how particular disorders are diagnosed in males and females. It's unclear if observed gender differences in diagnosis are genuine or reflect gender stereotypes.

Hypotheses on Gender Difference in Depression Prevalence

• Hypothesis difficulty of refutation: Easiest to refute might be the idea that depression prevalence differences are solely attributable to income disparities. Hardest to refute may be that women simply think more about problems than men.

• Biological/Social factors impact: Hormonal fluctuations, particularly after puberty, possibly increase susceptibility to depression but a direct link is not consistently established. Social stressors, as argued by Brown & Harris, may play a stronger role.

• Overdiagnosis as a possibility: Studies (Amenson & Lewinsohn) show equal help-seeking and diagnosis rates of depression in men and women with equal self-reported symptoms. Overdiagnosis is a possibility but difficult to empirically prove.

• Swami (2012) study: Participants were more likely to judge a male vignette as not having a mental health disorder, even though descriptions met diagnostic criteria for depression according to the DSM IV and the ICD-10. This suggests a gender bias in general population judgment.

Cultural Bias in Diagnosis

• Cultural considerations: Cultural differences affect symptom experience and expression, but biases in diagnosis can also affect identification of illness.

Li-Repac Study Summary

• Study aim: Evaluate the role of stereotyping in diagnosis by comparing white and Chinese American therapists of European and Chinese male subjects.

• Patient characteristics: Ten male patients (5 European American, 5 Chinese) diagnosed with various mental illnesses; all Chinese subjects were born in China or Hong Kong.

• Clinicians: Five European American, five Chinese American males; some European American clinicians had no prior experience with Asian clients.

• Methodology: Semi-structured interviews (video recorded), assessment instruments for personal traits and signs of pathology. Clinicians randomly assigned videos to assess for normality, and rate four videos each.

• Findings: European American clinicians perceived and diagnosed Chinese subjects as more depressed, lower in self-esteem and less socially competent, and with a lower capacity for interpersonal relationships, while Chinese American clinicians reported more severe pathology when judging quiet clients.

• Significance: These findings demonstrate that diagnosis isn't neutral. Cultural considerations are critical for accurate assessment.

Etic vs. Emic Approach

• Etic approach: Assumes universal psychological disorders and diagnoses using standardized instruments.

• Emic approach: Incorporates cultural context, using local insights and practices to adapt diagnostic tools

Socioeconomic Bias in Diagnosis

• Socioeconomic factors: Stressors are more common in impoverished communities; this can affect both mental health and diagnosis.

• Midtown Manhattan study (Srole et al, 1961): High levels of diagnosed mental illness were found in individuals of lower socioeconomic strata.

• Johnstone (1989): Lower-class patients were given more serious diagnoses, more often hospitalized, and more frequently prescribed drug therapy over psychotherapy – though those in the lower class may be less able to benefit from verbal therapies because of their literacy.

• Vulnerability models: Lower socioeconomic status potentially results in mental illness due to a lack of protective factors.

Explore the various clinical biases that can affect diagnosis, including stereotypes and confirmation biases related to gender and ethnicity. This quiz examines the implications of these biases on treatment outcomes and features notable studies demonstrating their impact on clinician decisions.