Cultural Differences & Mental Health (DP IB Psychology): Revision Note

Clinical bias & diagnosis

• Bias is when personal attitudes, opinions or stereotypes affect what should be a neutral and objective process when dealing with a person or group of people

  • E.g., the depiction of certain social or cultural groups in the media may be biased in terms of their perceived intelligence, ability or skills

• Clinical bias happens when a clinician's prejudice, discrimination or political views influence the diagnostic process

• Bias can be conscious (clinician is aware) or unconscious (clinician is unaware)

Consequences of clinical bias

• Patients may feel dismissed or unheard, leading them to doubt the seriousness of their symptoms

• Patients may receive the wrong treatment or no treatment at all, which could worsen their condition

Sources of clinical bias

• Bias is influenced by cultural stereotypes

  • E.g., assumptions about perceived intelligence, ability or behaviour in certain groups

• The biomedical model (common in Western, individualistic cultures) can reinforce gender and cultural biases in diagnosis

Culture bias in diagnosis of mental health

• Culture bias is the tendency to assume that one culture defines ‘normality’ so other cultures are viewed as inferior or abnormal

• This means that the members of those cultures may be treated negatively or unfairly

• Culture bias can be seen in research studies which take an etic approach, (assuming behaviours are universal), which ignore cultural relativism

• This can lead to preferential treatment of one culture and negative stereotyping of the other

Examples

• African-Caribbean people are diagnosed with schizophrenia more often than Caucasian people in the UK and USA

• Puerto Rican patients may show strong physiological stress responses (fainting, palpitations), often misdiagnosed as psychotic episodes by US clinicians

• Culture bias is more likely to affect collectivist cultures, which may rely on culture-bound concepts and traditional treatments instead of the biomedical model

• An emic approach (understanding from within the culture) is preferable to avoid misdiagnosis

Research support for cultural differences & mental health

 Jenkins-Hall & Sacco (1991)

Aim: 

• To investigate cultural bias in diagnosing depression

Participants: 

• 62 White US psychotherapists (39 female, 23 male; average age of 36 years)

• All held master’s degrees and had at least three years' practice

 Procedure: 

• Therapists watched a 3-minute video of a (fake) consultation between a client and a therapist

• The independent variable comprised four conditions:

  • A White female ‘depressed’ client

  • A Black female ‘depressed’ client

  • A White female ‘nondepressed’ client

  • A Black female ‘nondepressed’ client

• This was an independent measures design, which meant that each therapist viewed only one of the above four conditions 

• Scripts were based on standardised depression inventories (covering symptoms like low mood, loss of interest, poor sleep)

• Afterwards, therapists rated the client on depressive symptoms, social skills and psychological state

Results: 

• All depressed clients were correctly diagnosed

• Non-depressed White and Black clients were rated similarly

• Black depressed clients were rated lower for social skills and likeability and more negatively overall than White depressed clients

• Being both Black and depressed led to the most negative ratings of all

Conclusion: 

• Therapists showed racial bias: depressed Black clients were evaluated more negatively than White clients

• Such bias could lead to adverse or harmful treatment outcomes

Evaluation of cultural differences & mental health

Strengths

• These findings support previous research, reinforcing the validity of cultural differences in mental health diagnosis

• The use of standardised rating scales in the study is an example of data triangulation, which increases both the validity and reliability of the study 

Limitations

• Some of the participants may have realised that the consultations were fake, giving rise to demand characteristics, lowering the ecological validity of the study 

• Research on cultural differences is socially sensitive, as the findings risk being misused to reinforce stereotypes about minority groups

Link to concepts

Bias

• If bias is present in any diagnosis, it can have an impact on a personal level (an incorrect diagnosis and treatment) and at a global level (incorrectly reported prevalence rates and perpetuation of discrimination and prejudice)

  • This in turn may exacerbate existing mental health problems within specific cultural groups, due to individuals not being seen and heard properly by the medical community

Responsibility

• Clinicians clearly have a huge responsibility to treat each patient as an individual and to honour their cultural heritage as part of the diagnostic process

• There is no single, universal approach to diagnosis and it is only by taking an emic approach that clinicians can properly serve their patients