Two Key Studies of Clinical Biases (HL IB Psychology)
Revision Note
Exam Tip
You can use either/both of these studies to answer a question on validity/reliability of diagnosis as each study addresses the central questions as to a) whether diagnosis is impartial and is based on the actual symptoms presented and b) the consistency with which the same symptoms across genders and cultures achieve the same diagnosis across clinicians.
Key Study One: Longnecker et al. (2010)
Aim: To investigate the gender ratios (i.e. how many males, how many females took part per study) present in research studies on schizophrenia.
Participants: A total of 252,578 participants (147,725 male; 104, 853 female = 66% male; 34% female) amassed from 220 articles taken from a range of psychological journals.
Procedure: A review article in which a range of studies were analysed by the researchers to look for inconsistencies in terms of the number of males and females who featured as participants.
Results: The findings included the following observations:
One meta-analysis that the researchers reviewed showed that the number of males used in schizophrenia is almost double that of the number of females used (1.94 males for every female participant)
Males outnumbered females across all of the studies reviewed
Males develop schizophrenia at an earlier age than females so this may be one reason for the gender imbalance in research
Females who developed schizophrenia after the age of 45 were excluded from some early research which has resulted in this diagnostic bias towards males
Females may be under-used as participants in studies of schizophrenia which means that the findings and conclusions of schizophrenia research may over-represent the male experience and under-represent the female experience
Conclusion: Females presenting with schizophrenic symptoms may be misdiagnosed due to clinicians operating a gender bias based on under-representation of females in research studies.
Evaluation of Longnecker et al. (2010)
Strengths
A total sample size of 252,578 participants provides robust quantitative data that should withstand statistical analysis making the research reliable
The findings of this research have good application and could be used to inform clinicians to treat males and females equally when they present with schizophrenia-type symptoms
Limitations
The findings cannot determine why this gender imbalance in schizophrenia research happens, it can only suggest reasons which means that it lacks explanatory power
The research studies in this review article were taken from seven different psychological journals which means that there could be inconsistencies to do with control, precision and procedure across the studies which would affect the reliability of the findings
Everyone should be treated with respect by their clinician - regardless of gender, ethnicity, age etc.
Key Study Two: Jenkins-Hall & Sacco (1991)
Aim: To investigate culture bias in the diagnosis of depression.
Participants: 62 White psychotherapists from the USA (39 female: 23 male with a mean age of 36 years) who were in possession of a Master’s degree and who had been practising as a psychotherapist for at least three years.
Procedure:
The participants watched a 3-minute video of a (fake) consultation between a client and a therapist
The independent variable comprised four conditions:
A White female client acting ‘depressed’
A Black female client acting ‘depressed’
A White female client acting ‘nondepressed’
A Black female client acting ‘nondepressed’
This was an independent measures design which meant that each therapist viewed only one of the above four conditions
The fake consultations between client and therapist were developed using a script of questions taken from a standardised depression inventory
The answers to the questions were written so as to highlight the presence or absence of the major symptoms of depression e.g. low mood; lack of interest in usual pastimes; difficulty sleeping
The participants thought that they were viewing a real client/therapist interaction; they had no idea that the consultations were fake
Once the participants had watched the video they filled in a questionnaire which used different rating scales measuring a range of variables linked to the ‘client’ viewed in the video including her depressive symptoms, social skills and psychological state
Results:
The participants were able to correctly diagnose each woman in the ‘depressed’ condition, giving them high ratings on the depressive symptoms scale
The Black non-depressed and the White non-depressed clients were rated similarly overall
The participants gave lower ratings for social skills and likeability to the Black depressed clients, scoring them significantly more negatively on these dimensions than they did for the White depressed clients
A combination of being both Black and depressed resulted in a more negative overall rating than for any other condition.
Conclusion:
The therapists showed a racial bias against Black clients in that they evaluated depressed Black clients more negatively than they did depressed White clients
Negative evaluations based on ethnicity, race or skin colour could bias the diagnostic process and may result in a depressed client receiving adverse, negative and ultimately harmful treatment
Evaluation of Jenkins-Hall and Sacco (1991)
Strengths:
This findings of this study support previous research which showed that Black people may be discriminated against by White professionals if they are judged according to their culture/ethnicity rather than according to their symptoms
The use of several different standardised rating scales is an example of data triangulation which increases both the validity and reliability of the study
Limitations
Some of the participants may have realised that the consultations were fake, giving rise to demand characteristics which would lower the ecological validity of the study
This is socially sensitive research which should be handled carefully as, once published, it could be used to perpetuate stereotypes about minority groups
Worked Example
The question is, ‘Discuss the role of clinical bias in diagnosis’. [22]
This essay question is asking you to offer a considered and balanced review of the role of clinical bias in diagnosis that includes a range of arguments, factors or hypotheses. Here is an exemplar paragraph for guidance:
Research in non-Western, collectivist cultures has found that there is more than one way of presenting with abnormal behaviour. Many non-Western cultures have identifiable mental disorders which cannot easily be categorised through the use of the ICD 11 or DSM-5 classification systems. These culture-specific mental disorders are referred to as culture-bound syndromes. The indigenous name is used in their description and they remain closely or even exclusively associated with the culture or population in which they were first identified e.g. hsieh-ping: (Taiwan) a brief trance state during which one is possessed by an ancestral ghost, who often attempts to communicate to other family members. Symptoms include tremors, disorientation and delirium, and visual or auditory hallucinations. Not understanding the cultural context of these symptoms would mean that the sufferer is at the mercy of a diagnosis which ignores their cultural significance and which could result in misdiagnosis leading to incorrect, even harmful, treatment.
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