Diagnosing co-occurring substance-related disorders: agreement between SCID, Hispanic clinicians, and Non-Hispanic clinicians
OBJECTIVE:Given the composition of the mental health and substance abuse workforce in the United States, Hispanic immigrants are often assigned to non-Hispanic, English-speaking clinicians. This produces challenges in communication and in understanding linguistic and cultural nuances and greatly impacts the accuracy of diagnoses and the delivery of appropriate services. With the inclusion of objective criteria in diagnostic categories, clinician-to-clinician agreement ought not to be impacted by the ethnicity of the client or the clinician. Both practice and research, however, suggest that this is not the case, particularly when diagnosing co-occurring mental health and substance abuse disorders. We explored the degree to which Hispanic and non-Hispanic clinicians agreed with each other and with the Structured Clinical Interview for DSM-IV-TR, Research Version (SCID) when diagnosing co-occurring substance-related disorders. METHOD/METHODS:Using a naturalistic design, 88 adult clients were videotaped in diagnostic intake interviews (utilizing the DSM-IV-TR) with Hispanic or non-Hispanic clinicians. Videotapes were then viewed and rated by clinicians who were ethnically cross-matched to those on tape. Clients were also administered the SCID. Data were collected from September 15, 2003, through February 7, 2005. RESULTS:Non-Hispanic clinicians diagnosed significantly more substance-related disorders than Hispanic clinicians, and both Hispanic and non-Hispanic clinicians significantly under-diagnosed substance-related diagnoses compared to the SCID. Clinicians had very low diagnostic reliability with each other and with the SCID. Implications for the assessment, diagnosis, and treatment of co-occurring substance-related disorders are discussed. CONCLUSION/CONCLUSIONS:Findings seem to concur with past research suggesting that clinicians may be influenced by factors other than the diagnostic criteria (e.g., cultural and social biases) when diagnosing, and that they may make erroneous attributions of pathology when diagnosing across cultures.
Using interpreters in diagnostic research and practice: pilot results and recommendations
OBJECTIVE:This pilot study examined the impact and role of interpreters in videotaped and some live diagnostic interviews of Hispanic outpatients in an urban psychiatric service. METHOD/METHODS:The study, conducted from June 2002 to February 2004, included 98 bilingual or Spanish-speaking monolingual adult Hispanic outpatients who participated in live or videotaped diagnostic interviews with English-speaking, non-Hispanic (N = 33) or Hispanic (N = 16) clinicians. Interpreters provided assistance to patients and to non-Hispanic clinicians in 71 cases. After completing live interviews or watching videotaped interviews with interpreter assistance, clinicians independently filled out questionnaires asking for diagnoses and other information (questions about the clinical encounter and rating of symptom severity). RESULTS:Clinicians reported high confidence in their assessments because interpreters provided unbiased, accurate information. Without interpreters, clinicians reported that patient diagnoses and functioning would have been assessed as less severe or the same. Interpreters helped patients with limited English navigate mostly videotaped interviews and respond to clinician queries. Interpreters brokered cultural expressions and colloquialism, distinguished easily misunderstood words and concepts, and were challenged by patients with cognitive deficits and thought disorders. CONCLUSIONS:Findings point to functions, process, and logistics of interpretation, including reaching for linguistic and conceptual fidelity and acting as unobtrusive, disciplined participants to maintain diagnostic accuracy. Recommendations for assuring useful research-quality data are applicable to diagnostic practice.