Ethnic differences in DSM-classifications in youth mental health care practice

In community youth mental health care (YMHC), patients are mostly diagnosed according to the clinical judgment of professionals. Because validated instruments are hardly used, this process may be influenced by other factors than the diagnostic criteria, such as the ethnic background of the patient. The goal of our study was to assess differences between ethnic groups in the received clinical diagnoses. The sample consisted of children (n=1940) and adolescents (n=2484) admitted to a Dutch YMHC center. Ethnic background was specified based on the country of birth of the parents. Odds ratios on clinical diagnoses for non-native patients were calculated with the native patients as reference. The results showed that native patients more often received specific psychiatric disorders and co-morbid diagnoses on Axis I, while ethnic minority children more often received V-codes only, indicating that there was insufficient information to determine a psychiatric disorder. We therefore assume that it is harder to recognise psychiatric disorders when non-native patients are diagnosed. This could imply that immigrant children and adolescents are not adequately treated for their disorders in YMHC. We recommend that YMHC professionals should reflect on the potential biasing effect of the patient's ethnic background in diagnostic procedures.