Psychiatric Disorders Underdiagnosed in ED

national average of 20-28%.

Both Caucasians and African-Americans were underdiagnosed in the EDs, but the study found a much larger underdiagnosis for African-Americans. The odds of Caucasians having a psychiatric diagnosis were 1.85 times that of African-Americans, and twice as many Caucasians as African-Americans received a psychiatric diagnosis as the primary diagnosis. The researchers attributed this disparity to three things: the fact that Caucasian doctors are more familiar with the mental disorder symptoms of Caucasians, the tendency of African-Americans to be less trusting and less willing to disclose emotional problems to people of different racial groups, and doctor bias. These results were reported in the February issue of the Journal of Consulting and Clinical Psychology by Seth Kunen, Ph.D., Psy.D., of the Louisiana State University Emergency Medical Residency Program (Baton Rouge, USA; www.lsu.edu), and colleagues.

To better understand the underdiagnosis pattern, the researchers conducted informal interviews with more than 50 emergency department doctors. These cited lack of psychiatric expertise, a belief that many mental disorders are relatively unimportant threats to health, and the inability to provide continuity of care for their patients.

As emergency medicine moves from its historical origin as a trauma specialty to its developing role as a primary care provider for millions of people each year, the researchers say it is imperative that emergency departments expand their staffs to include mental health professionals such as psychologists, since hospital-based doctors may not have the training, interest, or time to deal with mental health issues.

"The psychiatric underdiagnosing we have documented is potentially the most damaging for the more vulnerable minorities and the poor who rely on emergency departments for much of their primary health care needs,” say the authors. "This underdiagnosing contributes to needless emotional suffering because many of the more common disorders, such as depression and anxiety, respond well to psychotherapy and pharmacologic interventions.”




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