Researchers: Ilana Kremer¹, Douglas Levinson², Alon Reshef³, Kamal Farhat⁴

Background: Effective treatment depends on accurate diagnoses. Reasons for misdiagnosis include cultural and language differences between clinicians and patients, and culturally-insensitive diagnostic tools and criteria. Many Israeli psychiatric patients speak only Arabic. The possibility of frequent misdiagnoses (suggested by anecdotal observations) has not been systematically studied.

Objectives: To determine how often Arabic-speaking patients with major depression, bipolar disorder or schizophrenia are misdiagnosed in clinical settings, and to make recommendations for improved practice.

Method: The project team includes Jewish, Arab and an American advisor. The team has developed the first Arabic version of the Structured Clinical Interview for DSM-IV (SCID), with culture-specific expressions of symptoms and distress. An interviewer highly trained for cultural sensitivity diagnosis using the SCID, with the team as supervisors, has blindly examined 94 Arab patients and 67 Jewish patients from psychiatric clinics of Mazor, Haemek and The MMS Nazareth Hospital, and these diagnoses were compared with the Clinic diagnoses by Cohen’s kappa statistics and significance of difference between kappas for the two language groups, to assess concordance of Team and Clinical diagnoses, as well as other analyses to study the contributing factors.

Findings: The diagnostic agreement of Schizophrenia vs. Mood Disorders between the clinic and the research team was significant lower for Arabs (0.285) than for Jewish (0.575). Analysis for contributing factors revealed that for Bipolar disorder (BIP) kappas were 0.095 (Arab) vs. 0.541 (Jewish). Of the 21 Arab patients with BIP diagnoses by the research team, 17 (81%) received SCZ diagnoses from the clinic (p=1.4x10-7), the most highly significant source of mis-diagnoses observed in the study.

Conclusions: The primary hypothesis was confirmed.

Recommendations: The primary hypothesis was confirmed.
Policy implications: Mis-diagnoses of Bipolar or other Mood Disorders for Schizophrenia have major implications on treatment and prognosis and must be eliminated. Further development of cultural sensitive diagnostic tools and training are needed.

Research end date: 12/2016