Abstract
We examined the influences of demographic factors on diagnostic assignment among youth served in California public mental health systems after adjusting for the effects of county characteristics and standardized symptom and functioning indices. The sample consisted of 12,106 youth with severe emotional disturbance being served in integrated and coordinated service systems in 13 counties of California. African Americans were overrepresented in the sample relative to the ethnic characteristics of the counties and Asian Americans were under-represented. Results from logistic regression analyses showed that gender, age, and ethnicity affected the assignment of eight categories of clinical diagnosis at admission. However, standardized measurement of clinical status and functioning had little relationship to clinicians' assignment of diagnosis. Whereas no significant gender and age differences were found on broadband CBCL syndromes, ethnically diverse youth differed on CBCL internalizing and externalizing scores. Youth's role functioning as assessed by the CAFAS also significantly differed by gender, age, and ethnicity.
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REFERENCES
Achenbach, T. M. (1991). Manual for the Child Behavior Checklist/4-18 and 1991 Profile. Burlington: University of Vermont Department of Psychiatry.
American Psychiatric Association. (1994). DSM-IV: Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author.
Atkins, D. L., Pumariega, A. J., Rogers, K., Montgomery, L., Nybro, C., Jeffers, G., & Sease, F. (1999). Mental health and incarcerated youth. I: Prevalence and nature of psychopathology. Journal of Child and Family Studies, 8, 193–204.
Bui, K. T., & Takeuchi, D. T. (1992). Ethnic minority adolescents and the use of community mental health care services. American Journal of Community Psychology, 20, 403–417.
Cheung, F. K., & Snowden L. R. (1990). Community mental health and ethnic minority populations. Community Mental Health Journal, 26, 277–291.
Cohen, R., Parmelee, D. X., Irwin, L., & Weisz, J. R. (1990). Characteristics of children and adolescents in a psychiatric hospital and a corrections facility. Journal of the American Academy of Child & Adolescent Psychiatry, 29, 909–913.
Costello, E. J., Angold, A., Burns, B. J., Stangl, D. K., Tweed, D. L., Erkanli, A., & Worthman, C. M. (1996). The Great Smoky Mountains study of youth: Goals, design, methods, and the prevalence of DSM-III-R disorders. Archives of General Psychiatry, 53, 1129–1136.
Cross, T. L., Bazron, B. J., Dennis, K. W., & Isaacs, M. R. (1989). Towards a culturally competent system of care, Volume I: A monograph on effective services for minority children who are severely emotionally disturbed. Washington, DC: National Technical Assistance Center for Children's Mental Health, Georgetown University Child Development Center.
Fabrega, H., Ulrich, R., & Mezzich, J. E. (1993). Do Caucasian and Black adolescents differ at psychiatric intake? Journal of the American Academy of Child and Adolescent Psychiatry, 32, 407–413.
Good, B. (1993). Culture, diagnosis and comorbidity. Culture, Medicine and Psychiatry, 16, 427–446.
Hoberman, H. M. (1992). Ethnic minority status and adolescent mental health services utilization. Journal of Mental Health Administration, 19, 246–267.
Hodges, K. (1990). CAFAS Training Manual: A self training manual which contains example scoring and vignettes for establishing interrater reliability. Author.
Hodges, K., & Wong, M. M. (1996). Psychometric characteristics of a multidimensional measure to assess impairment: The Child and Adolescent Functional Assessment Scale. Journal of Child and Family Studies, 5, 445–467.
Kaplan, S. L., & Busner, J. (1992). A note on racial bias in the admission of children and adolescents to state mental health facilities versus correctional facilities in New York. American Journal of Psychiatry, 149, 768–772.
Kilgus, M. D., Pumariega, A. J., & Cuffee, S. P. (1995). Influence of race on diagnosis in adolescent psychiatric inpatients. Journal of the American Academy of Child and Adolescent Psychiatry, 34, 67–72.
Lin, K-M., Inui, T. S., Kleinman, A. M., & Womack, W. M. (1982). Sociocultural determinants of the help-seeking behavior of patients with mental illness. Journal of Nervous & Mental Disease, 170, 78–85.
Malgady, R. G. (1996). The question of cultural bias in assessment and diagnosis of ethnic minority clients: Let's reject the null hypothesis. Professional Psychology: Research and Practice, 27, 73–77.
Markus, H. R., & Kityama, S. (1991). Culture and the self: Implications for cognition, emotion, and motivation. Psychological Review, 98, 224–253.
Matsuoka, J. K., Breaux, C., & Ryujin, D. H. (1997). National utilization of mental health services by Asian Americans/Pacific Islanders. Journal of Community Psychology, 25, 141–145.
Proctor, E. K., Vosler, N. R.,& Murty, S. (1992). Child demographics and DSM diagnosis: A multi-axis study. Child Psychiatry and Human Development, 22, 165–183.
Ramirez, S. Z., Wassef, A., Paniagua, F. A., Linskey, A. O., & O'Boyle, M. (1994). Perceptions of mental health providers concerning cultural factors in the evaluation of Hispanic children and adolescents. Hispanic Journal of Behavioral Sciences, 16, 28–42.
Roberts, R. E., Attkisson, C. C., & Rosenblatt, A. (1998). Prevalence of psychopathology among children and adolescents. American Journal of Psychiatry, 155, 715–725.
Roberts, R. E., Chen, Y. W., & Solovitz, B. L. (1995). Symptoms of DSM-III-R major depression among Anglo, African and Mexican American adolescents. Journal of Affective Disorders, 36, 1–9.
Solomon, A. (1992). Clinical diagnosis among diverse populations: A multicultural perspective. Families in Society: The Journal of Contemporary Human Services, 73, 371–377.
Sue, D.W., Bingham, R. P., Porché-Burke, L., & Vasquez, M. (1999). The diversification of psychology: A multicultural revolution. American Psychologist, 54, 1061–1069.
Sue, S. (1999). Asian American mental health: What we know and what we don't know. In W. J. Lonner, D. L. Dinnel, D. K. Forgays, & S. A. Hayes (Eds), Merging past, present, and future in cross-cultural psychology (pp. 82–89). Lisse, Netherlands: Swets & Zeitlinger.
U.S. Bureau of the Census. (2001). State and County Quickfacts. Retrieved September 20, 2001, from http://quickfacts.census.gov/qfd/states/06000.html
U.S. Department of Health and Human Services. (2001). Mental health: Culture, race, and ethnicity—A supplement to mental health: A report of the surgeon general. Rockville, MD: U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Mental Health Services.
Westendorp, F., Brink, K. L., Roberson, M. K., & Ortiz, I. E. (1986). Variables which differentiate placement of adolescents into juvenile justice or mental health systems. Adolescence, 21, 23–37.
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Mak, W., Rosenblatt, A. Demographic Influences on Psychiatric Diagnoses Among Youth Served in California Systems of Care. Journal of Child and Family Studies 11, 165–178 (2002). https://doi.org/10.1023/A:1015173508474
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DOI: https://doi.org/10.1023/A:1015173508474