 |
First, we can’t
define race/ethnicity very well. Second, given crude classification, there
are problems with biased exposure and outcome assessment. For example,
biased classification of black participants such as problems in rating, use
of diagnostic criteria, and assessment of cultural differences. The authors
argue that due to the ethnic homogeneity of the raters (100% white), raters
may perceive black participants as sicker than white participants, and thus
group them in the more severe categories; The overwhelming exhibition of
severe first rank symptoms among blacks may influence raters to follow the
diagnostic stem towards schizophrenia; in addition, since diagnoses of
severe depression, schizoaffective disorder, and schizophrenia lack clear
phenomenological definitions, raters in the study and practitioners in
general may have problems differentiating boundaries of each disorder even
when using the operationalized instruments of the DSM; these instruments may
influence practitioners by allowing them to include secondary symptoms such
as hallucinations, etc. as part of the primary diagnosis; Also, cultural
diversity among blacks and whites may affect diagnosis based on fundamental
differences; Limitations of the study include a lack of generalizability of
results due to a focus on only two ethnic groups, and exclusion of substance
abusers which may have led to sampling bias…that is a significantly lower
number of blacks; Since the sample was hospital-based, most participants
were hospitalized, and therefore, sampling bias may have occurred among the
black population. |
