A retrospective review of psychiatric consultations was conducted for
African-American and Caucasian patients for a 2-year period. Reasons f
or referral, assigned diagnoses, accuracy rates, and discordance and c
oncordance 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 depre
ssive disorder; 54.4% of patients diagnosed with depressive disorders
were referred for other reasons. African-American patients were referr
ed for evaluation of depression and diagnosed with depressive disorder
s significantly less often than Caucasian patients. No significant dif
ferences were obtained between African-Americans and Caucasians in the
accuracy rates of patients referred for depression. Discordance and c
oncordance rates for the two groups were comparable. Diagnoses assigne
d to African-Americans and Caucasians incorrectly referred for depress
ion did not differ significantly. For depressed African-Americans and
Caucasians referred for reasons other than depression, the only differ
ence 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 fo
r depression may be a secondary concern to nonpsychiatric staff. In ad
dition, cultural variables and racial differences between hospital sta
ff and patients may account for the differences irt referral patterns.
Awareness of the needs of African-American patients is required. (C)
1998 Elsevier Science Inc.