The proposed project attempts to account for the finding reported in the literature of an overdiagnosis of schizophrenia and an underdiagnosis of depression in black psychiatric patients using epidemiological methods. Three symptom scales of the Psychiatric Epidemiology Research Interview (PERI) measure paranoia, Distrust (DST), Perceived Hostility of Others (PHO) and False Beliefs and Perceptions (FBP), and represent a range of severity from distrust to pathological delusions: the DST scale measures the mildest form, the PHO falls in the middle, and the FBP scale taps the severest type of paranoia. This study will involve primary data collection using the PERI scales of paranoia (DST, PHO, FBP), an well as the Rosenberg Self-Esteem Scale and the Fenigstein Paranoia Scale, and a measure of cultural paranoia, the Cultural Mistrust Inventory (CMI). One hundred and eighty Black patients diagnosed as having major depression or schizophrenia by means of traditional unstructured clinical interview will be reassessed with the PERI paranoia scales and other self-reported measures. In addition, culturally-sensitive rediagnoses of these black patients will be done with the Structured Clinical Interview for DSM III (SCID) followed by a """"""""best estimate"""""""" of their psychiatric diagnoses by an African American psychologist or psychiatrist. It is expected that there will be disagreement between the original chart diagnoses and the culturally-sensitive rediagnoses of these Black patients. High levels of cultural paranoia, as reflected by CMI scores, controlling for other types of self-reported paranoia should predict disagreement if misinterpretation of cultural paranoia as a clinical symptom contributes to misdiagnosis. The results of this study have implications for understanding black cultural experiences that may explain observed race differences in the psychiatric epidemiologic literature.
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