Role of clinical biases in diagnosis Flashcards
Reporting bias
reporting bias
You only seek professional help for mental illnesses if u believe u have one
If u have a mental illness, but refuse to accept it, this could lead to reporting bias- certain symptoms appear in population, but theyre not reported, so it looks like statisitcally, a certain disorfer isnt prevlant in the population
Kleinman claims that theres a diff between a disease (bio malfunction) and and illness (ones reaction to the disease). Unlike disease, illness is heavily influenced by culture
furnham and malik
Aim: To investigate cross cultural beliefs abt depression
Trying to find explanation for why british asians never diagnosed with depression
Could be bc of rporting bias
Since rporting bias is caused by culturally mediated perception of a disorder, a study on cross cultural differences could potentially reveal hidden mechanisms of reporting bias
Method
Approx 150 female subjects from middle class background: either middle aged or younger, were ppt
Half ppt were classified as native briiths (born and educated in britain), half were of asian origin and received education from those countries
Ppt filled out questionnaire that targetted symptos of mental illnesses and beliefs about depression and antidepressive behaviors
Result
Perception of depression differed from asian and british ppt
Asian women tended to agree that
having job outside home helps keep women from being depressed
When depressed, its better to talk to family than freidns
Feeling depressed is no different from feeling depressed about something
Differences less pronounced in younger women
Globalisation gradually influences younger representatives of traditional cultures
Aisan middle aged women reported being depressed significantly less
Could be bc of their perceptions of depression
Conclusion
Asian middle aged women being less depressed could be bc of underlying individualist vs collectivist dimension. Asians have increased family role in the east, and have tendency to explain distress as not being able to fit into society, (e.g not having a job)
Somatization
When u express psychological disturbances in the form of physical symptoms
Linked to reportig bias, bc in social groups where somatization is prevalant, potential patients could report illness to physicians rather than mental health professionals
BUT, some ppl argue Somatization might be an example of culturally different meanifestation of mental illness
Lin carter kleinman
Reviewed clinical records of chinese, filipino, vetnamese and laotian patients in US primary care to determine whetehr or not there was somatization
They made sure to separate refugees and immigrants
Half of patients were born and raised in Vietnam, and were forced to migrate as refugees due to war
Half had lived in china, taiwan, or HK, and it was their conscious choice to emigrate to US
Somatization
Defined as vague somatic symptoms, e.g headache, abdominal pain, dizzy, insomnia
Results
Somatization diagnosed in 35% of patients
Refugees more likely to have somatization
Ppl w somatization were more likely than ppl with physical disorders to have large household size and lower levels of education
Both variables (household and school) point to how ‘traditional’ the cultural background of patient is
They were more likely to be proficient in enflish (maybe due to lack of social support in new country)
COnclusion
Somatization was one of the most important clinical problems in asian refugees and immigrants
More traditional society is, the more they seem prone to somat
Refugee status is also important contributor
Expression of symptoms
Its been stablished that diagnosis rates of mental illness are diff for diff cultures
these could be due to factors such as:
Genuine differences
Biased judgement of clinician
Altered behavior of patient in clinical context
If its altered behavior, then we can talk abt cross cultural differences in the expression of systems
Especially if patient and clinican come from diff cultural backgrounds, pateient might modify behavior unintentially to try and fit clinician’s schemas
Payne
Showed approx 200 clinical workers and therapists 4 specifically designed vids and asked them to make judgement
In 2 vids: actors played role of depressed man w symptoms of MDD
In other 2 vids: actor displayed culturally expressed african american symptoms of depression
Symptoms based on studies that identified diff in symptoms between depressed afircan americans and caucasians
Actor was either african american or caucasian, but were similar age and appearance wise, and dressed identically
Racial diffs in clincial diagnosis may be bc of:
Clinican’s racial bias
Genuine diff in prevalance and expression of disorders
According to paynes study, clinician bias hypothesis would suggest:
African american and caucasian patients exhibit similar depression symptoms, but clinicians judge these differently bc of personal prejudice, cultural ignorance, etc
On the other hand, the cultural variance hypothesis would suggest
Black and white clients epxress symptoms diff, but clinicians not sensitive to these cultural diff (which leads to bias)
NOTE that both explanations assume client has the disorder (depression), its only the way symptoms are expressed that differs
Reults
Classic symptoms vid
Black and white actors not misdiagnosed often
Culturally expressed symptoms
Both black and white actors misdiagnosed often
Results didnt support clinican racial bias hypotehesis
No sig diff between clients of either race if they presented same symptoms
Clinicians misdiagnosed more when culturally expressed depressive symtpoms presented
Conc
Study supports cultural varaition hyptoehsis, and not clincial racial bias hyptoehsis
Seems like its not race itself that produces bias, but culturally specific expression of sysmptoms
Good, as racial bias in daignosis exiss, but at least its not caused by overt racism
Study suggests clinicians can be better trained to recognize cultually specific expressions of symptoms, which could decrease bias and increase validity of diagnosis
