Referral patterns and recognition of depression among African-American and Caucasian patients

A retrospective review of psychiatric consultations was conducted for African-American and Caucasian patients for a 2-year period. Reasons for referral, assigned diagnoses, accuracy rates, and discordance and concordance rates were assessed. Referrals for depression comprised 24.6% of all consults for Caucasian and African-American inpatients. Only 40.3% of patients referred for depression were diagnosed with a depressive disorder; 54.4% of patients diagnosed with depressive disorders were referred for other reasons. African-American patients were referred for evaluation of depression and diagnosed with depressive disorders significantly less often than Caucasian patients. No significant differences were obtained between African-Americans and Caucasians in the accuracy rates of patients referred for depression. Discordance and concordance rates for the two groups were comparable. Diagnoses assigned to African-Americans and Caucasians incorrectly referred for depression did not differ significantly. For depressed African-Americans and Caucasians referred for reasons other than depression, the only difference noted was in the referral rates for adjustment of psychotropics. The nonpsychiatric staff fails to recognize depression and often refer depressed patients inappropriately. Depressed patients are primarily referred for suicide assessment and disruptive behaviors. Referrals for depression may be a secondary concern to nonpsychiatric staff. In addition, cultural variables and racial differences between hospital staff and patients may account for the differences in referral patterns. Awareness of the needs of African-American patients is required.