RACE AND PSYCHIATRIC DIAGNOSIS IN ELDERLY INPATIENTS

Abstract

There are limited data on differential rates of various psychiatric diagnoses between ethnocultural groups of elderly individuals. There may be higher rates of dementia and lower rates of depression in elderly African-Americans compared to Caucasians. The former may relate to the effects of education, acculturation, and the presence of medical comorbidity, while the latter may relate to diagnosticians' skills in recognizing depression in African-American patients. The purpose of this study was to examine the issue of race and rates of psychiatric diagnoses in elderly patients more closely. The sample included 23,758 veterans age 60 or over admitted to VA acute inpatient units nationally in 1994. Psychiatric diagnosis responsible for length of stay determined inclusion into one of six diagnostic groups: cognitive, mood, psychotic, substance abuse, anxiety, and “other” (mostly personality) disorders. In a subanalysis, the authors also examined rates of psychiatric diagnosis among patients admitted to psychiatric bedsections only. Results from the entire sample included higher percentages of African-American (AA) elderly patients with cognitive disorders and substance abuse diagnoses (22.3% and 36.6%) than Hispanic (H) (15.2% and 30.3%) or Caucasian (C) (18.2% and 32.8%) elderly patients; fewer AA elderly patients with mood or anxiety diagnoses (8.1% and 1.7%) than H (20.7% and 4.2%) or C (18.6% and 3.9%) elderly patients; more AA (25.1%) and H (24.3%) elderly patients with psychotic diagnoses as compared to C elderly patients (18.8%); and similar percentages of other disorders between races (AA=6.1%, H=5.3%, C=7.7%) (X2=373.60; d.f.= 10; P<0.001). In contrast, in the inpatient psychiatric sample, we found similar percentages of cognitive disorders between races (AA=6.1%, H=7.2%, C=6.7%). However, this subanalysis also found higher percentages of AA elderly patients with substance abuse diagnoses (47.1%) than H (30.7%) or C (36.8%) elderly patients; fewer AA elderly patients with mood or anxiety diagnoses (12.4% and 2.5%) than H (26.8% and 4.8%) or C (25.6% and 4.5%) elderly patients; more AA (27.3%) and H (25.2%) elderly patients with psychotic diagnoses as compared to C elderly patients (19.1%); and similar percentages of other disorders between races (AA=4.6%, H=5.2%, C=7.3%) (X2=239.83; d.f.= 10; P<0.001). The findings suggest that there are differences in the rates of psychiatric diagnoses among ethnocultural groups, and in particular that there are strikingly lower rates of mood disorder diagnoses in African Americans. Differential rates of psychiatric diagnoses may reflect genetic differences, differences in exposure to risk factors or differences in symptoms or presentations of psychiatric illness, as well as communication barriers, different illness concepts, confounding factors such as lower socioeconomic status or education, or ethnocentric bias of diagnosticians. Thus, future studies should examine both patient and provider factors.