Overdiagnosis of Schizophrenia in Black People

Schizophrenia is a serious mental illness. It affects about 2.4 million people in the United States. The risk of developing schizophrenia depends on many things, including trauma, the use of recreational drugs, and more.^1-4

In addition, a person's race may also play a role in whether they develop schizophrenia. According to United States statistics, Black people are more than twice as likely to receive a schizophrenia diagnosis compared to white people.^1-4

Reasons for overdiagnosis in Black people

A few things could explain why Black people are more likely to be diagnosed with schizophrenia. These include:^1,4

• Childhood background and current status (environmental factors)
• Racial bias
• Wrong decisions about what is causing a person's symptoms (misdiagnosis)

Environmental factors

Environmental factors can put someone at a higher risk for schizophrenia. Some of these factors include:^1,3

• Using recreational drugs
• A difficult childhood
• Poverty
• Certain infections

Traumatic events and post-traumatic stress disorder (PTSD) are more common in Black people. Trauma and PTSD can increase the risk for schizophrenia. Other factors like poverty and discrimination can make it harder to get access to healthcare services. As a result, Black people may not get treatment on time. This makes symptoms worse.¹

Racial bias against Black people

If a doctor is biased, they might diagnose Black people more than they should based on the evidence. In the United States, the majority of people who work in mental healthcare are white. Even when a doctor tries to remove racial bias from their work, there might still be implicit bias. This means that doctors may unknowingly treat people of color differently, which can impact the trust and communication between them.¹

White doctors might lack the empathy to fully relate to the experiences of Black people. Discrimination and prejudice experienced by Black people throughout history have contributed to a longstanding mistrust of the healthcare system. This healthy mistrust might be seen as paranoia by white doctors.¹

Misdiagnosis

Misdiagnosis may also be a reason why more Black people are diagnosed with schizophrenia. For example, according to recent data, Black people with major depression are more likely to be misdiagnosed with schizophrenia. Implicit biases and stereotypes held by healthcare professionals can influence decision-making and may lead to misinterpretations of symptoms and behaviors. That can lead to Black people with major depression being wrongly diagnosed with schizophrenia.^1,3

Biological factors

Research suggests that biological factors are probably not the reason for overdiagnosis of schizophrenia in Black people.¹

Biological factors are things related to your body that are linked to developing a disease. Biological factors can affect the chances of developing schizophrenia. For example, we know that the risk of schizophrenia increases if certain genes (part of DNA) are present.¹

But we do not see a link between these genes and skin color. That is, Black people are not more likely to have these genes.¹

Possible solutions

Doctors could create better ways to diagnose schizophrenia. Since major depression may be mistaken for schizophrenia, steps should be taken to rule out depression. During diagnosis, doctors could use a stricter, more standardized interview process. This could help avoid implicit bias and make sure certain symptoms are not ignored.³

In many cases, white doctors may not be as familiar with the experiences of Black people. Or Black people may not be as open with a white doctor. So, it can be beneficial for Black people to meet with a Black doctor. Providing anti-racism training to all doctors could also make them more aware of the challenges faced by Black people.¹