Abstract

Decades of research show that Black Americans are diagnosed with psychotic disorders, such as schizophrenia, far more often than white Americans. In addition, Black Americans are less likely to be offered medication, and, when treated, are more likely to receive older medications. Despite this evidence, the specific mechanisms, clinical elements, causal pathways, and cultural misconceptions/biases that drive these disparities in individual clinical encounters remain poorly understood.

This project examines how race and gender influence clinicians' interpretation of mental health symptoms, particularly their interpretation of reasonable mistrust or skepticism expressed by Black patients. My research focuses on whether clinicians are more likely to interpret that distrust as a symptom of psychosis, especially in cases of diagnostic ambiguity, creating a possible pathway to diagnostic differences.

To investigate this, the study will use a computerized, case-based survey with realistic video vignettes featuring standardized patients. The videos systematically vary patient race and gender while holding clinical symptoms constant. Clinicians will be randomly assigned to view one vignette and then provide diagnostic impressions and treatment recommendations. Through my research, I hope to inform future medical training that helps clinicians move toward more equitable diagnoses.

Research Objectives

My primary objective is to identify the clinical decision-making factors that produce diagnostic bias when clinicians evaluate mental health symptoms in minoritized patients. Specifically, I will investigate whether clinicians interpret reasonable mistrust or skepticism in Black patients as a sign of psychosis. My secondary objective is to determine whether a patient's gender, alongside their race, contributes to clinician bias in how that mistrust is interpreted.

Background

Psychiatric diagnosis is one of the most consequential acts in medicine because its effects ripple across generations of vulnerable populations. Clinician bias is often implicit and difficult to intercept because it is rooted in centuries of stereotypes. Since the 1960s, established literature has consistently shown that Black patients are diagnosed with psychotic disorders at much higher rates than white patients, yet receive treatment at far lower rates. Part of this gap lies in how patient behavior is interpreted. When a Black patient appears guarded toward a healthcare provider, clinicians may misread that behavior as psychopathology rather than what it often is: a protective and historical response to discrimination.

Bias is critical to address because it becomes a question of justice. Clinical labels are powerful social identifiers that interfere with employment and educational opportunities, and can escalate encounters with the legal system. Misdiagnosis can lead to inappropriate medications that worsen an individual’s behavioral stability, reinforcing harmful perceptions of them as dangerous to society. In this way, clinician bias strengthens systemic barriers and treatment disparities, discouraging future help-seeking across entire communities.

While disparities are well documented, fewer studies have examined the mechanisms driving these inequities at the level of individual clinical encounters. Case-based clinical vignettes have been widely used in other medical fields to isolate and test the effects of patient characteristics on clinician decision-making, yet comparable studies in psychiatry remain limited. This project builds on prior work using standardized patient scenarios to directly examine how race and gender shape psychiatric diagnostic judgments. 

Methodology

The study uses a computer-based survey built around realistic clinical vignettes. Each participant will watch a video of a standardized patient then answer questions about their diagnosis and recommended treatment. I will create four videos of the same scripted encounter that vary only by the patient's race and gender, and each participant will be randomly assigned to watch one of the four. By keeping the script identical across all versions, any differences in clinicians' responses will reflect a bias toward the patient's race or gender rather than their symptoms. The project will run in two stages: a preliminary pilot to test and refine the survey instrument, followed by wider dissemination to clinicians across the US.

Potential Impact

Most existing research documents that racial disparities in psychiatric diagnosis exist, but not why they happen inside a given clinical encounter. By identifying the specific cognitive and structural mechanisms behind this bias, this project takes the necessary first step toward correcting it. These findings can inform the design and evaluation of anti-racism and bias-reduction educational training, support more equitable diagnostic practices, and ultimately improve mental health outcomes for marginalized populations.

Thank you for reading! I would value any feedback, questions, or suggestions on this outline.