William B. Lawson, MD, PhD, DLFAPA Professor and Chair Department of Psychiatry Howard University College of Medicine Washington, DC (202)

Grants: Envivo, Assurex,Companion DX, Health Analytics Speaker Bureau: Otsuka Discussion of off-label or investigational use: yes

 In diagnosis  In treatment  In access to care  Greater than for other ethnic groups  Increasing  Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care—Report of the Institute of Medicine of the National Academies,  US racial and ethnic minorities are less likely to receive even routine medical procedures, and they experience a lower quality of health services  Supplemental Surgeon General’s report on mental health of minorities,  No substantial difference in prevalence  Significant illness burden  Lack of access

 Unintentional injuries, mainly motor vehicle crashes, were the fifth leading cause of death for the total population, but they were the leading cause of death for minorities aged 1 to 44 years.  The death rate for HIV/AIDS was 4.5 for the total population but 39.9 for African American men aged 25 to 44 years.  Homicide remains the number one cause of death for young African American males  Substance abuse and mental disorders associated with increased risk for all the above

 Suicide was the third leading cause of death for Black Americans between the ages of 15 and 24.  Young males (ages 20-24) had the highest rate of suicide in the black population, per 100,000.  Black Americans have a lifetime prevalence rate of attempted suicide of 4.1%, similar to the general population rate of 4.6%.2

 Association with Myocardial Infarction Depressed individuals far more likely to die from an MI  40 % OF THOSE WITH DIABETES MELLITUS  Common in obesity  Risk Factor in Breast and Other Cancers  Stroke and depression

 OVER DIAGNOSIS OF SCHIZOPHRENIA  Bipolar Disorder, PTSD overdiagnosed as schizophrenia  SUBSTANCE ABUSE COMORBIDITY IGNORED

Patients in a State Hospital Afr Am (n = 56)White (n = 117) Percent SchizophreniaBipolar DisorderMajor DepressionOther Strakowski SM, et al. J Clin Psychiatry.1993;54:

 Objective: To determine whether African American individuals would continue to exhibit significantly higher rates of clinical diagnoses of schizophrenia, even after controlling for age, sex, income, site, and education, as well as the presence or absence of serious affective disorder,as determined by experts blinded to race and ethnicity.  A secondary objective was to determine if a similar pattern occurred in Latino subjects.

SAPS = Scale for Assessment of Positive Symptoms; SANS = Scale for Assessment of Negative Symptoms. Source: Lawson WB, in preparation. Percentage of Patients With Psychotic Features

 PSYCHOSIS  Thought to be more common  PARANOIA  Healthy?  CONSPIRACY THEORIES  Rooted in reality?

 The relationship between the cultural mistrust inventory and psychopathology as measured by the SAPS, MADRS and YMRS was examined in the 244 African American patients with severe affective disorders. 104 male and 144 female (age range 18-43) from the 6 regional site study were included. We found that the cultural mistrust inventory is significantly related to total psychosis(r=.15) hallucinations/delusions(r=.14) and depression (r=.20), (p<.05), but not mania or bizarre behavior, when controlling for demographics.

 Emergency Room Visits  California  Maryland

 % In California ER SchizophreniaBipolar disoder White Black Total N=146,960 % In Maryland ER SchizophreniaBipolar disorder White Black

 Controlling for gender, family income, age, insurance payer  Odds ratio African Americans to have Schizophrenia 1.89  Bipolar 0.46

The correctional system has become the new asylum for the mentally ill after deinstitutionalization The war on drugs led to an explosion in the nonviolent offender population African Americans are disproportional in this population where mood disorders, and PTSD are often missed

Relationship between stress and unhealthy behavior Jackson JSJackson JS, Knight KM, Rafferty JA.Knight KMRafferty JA Am J Public Health.Am J Public Health May;100(5): Epub 2009 Oct 21. Race and unhealthy behaviors: chronic stress, the HPA axis, and physical and mental health disparities over the life course. BlacksWhites s

 Self treatment with drugs  Drug related violence  Increased risk of traumatic experiences  Increased risk of mental problems

 WhatsMyM3 is a validated, three-minute tool that screens for symptoms of depression, bipolar disorder, PTSD, and anxiety, and can be used to monitor changes in symptom severity over time. A screen for alcohol is now part of the test. The tool is also available for iPhone and Android smartphones.depressionbipolar disorderPTSD  It differs from other mental health screening tools, such as the PHQ-9 and the MDQ, in that these are all unidimensional — they only measure one domain of symptoms, like depression or bipolar disorder. The M3 is multidimensional, measuring four areas of symptoms in one quick tool.health  Furthermore, when compared to results from the standardized interview tool, the Mini International Neuropsychiatric Interview (link is external) (the MINI measures for 15 different mental illness diagnoses), WhatsMyM3 provides a total mental health score that is 83 percent sensitive in finding true positives and 76 percent specific in finding true negatives. In addition to the total score, there are four subscores, one each for depression, bipolar, PTSD, and anxiety. Mini International Neuropsychiatric Interview (link is external)

 Between 1999 and 2006, professionals from racial- ethnic minority groups increased from 17.6% to 21.4% in psychiatry, from 8.2% to 12.9% in social work, and from 6.6% to 7.8% in psychology.  Progress in Improving Mental Health Services for Racial-Ethnic  Minority Groups: A Ten-Year Perspective  Catherine DeCarlo Santiago, Ph.D.; Jeanne Miranda, Ph.D.  Psychiatric Services 2014; doi: /appi.ps