Clinicans diagnosis, prognosis and treatment: the influence of sex and socioeconomic status

Abstract

ABSTRACT Studies about the traditional psychiratric facilities have revealed that factors such as social class, sex and education may be powerful determinants of the diagnosis, type of treatment and prognostic decisions of the clinicians. The differential prevelance of the several mental disorders among the sex and socioeconomic status -of the patients has been attributed either to clinical biases or to actual variation in disorder base rates. Medical model or psychiatric perspective sees mental illness as a disease manifesting the some properties as most physical illnesses. For this perspective various symptoms of mental illness can be grouped into entities like schizophrenia, affective disorders or hysteria. The classification of individuals into a particular diagnostic category leads to a search for common background factors associated with the development of their symptoms like genetic, biochemical, psychological or social environmental. On the otherhand, labeling perspective takes a different and opponent stand regarding the nature of the mental illness. This theory is concerned with why certain individuals but not others are selected to take on the social role of the mentally ill. They suggested that mental illness is a label which is applied more according to the relative social resources of individxials to resist its imposition than according to the severity of their symptoms. VThe aim of the present study was to investigate the effects of patient's sex and socioeconomic status as social variables on mental health professionals' diagnosis, prognosis and recommendations for treatment. Studies on soei odemographic variables as related to psychiatric decisions demonstrated that some of the personality disorders such as antisocial, histrionic, dependent personality disorders are among the disorders that have shown different rates of diagnosis for men and women, Similiarly, the patients with low socioeconomic status are more apt to receive pharmacologic or other somatic therapies with poor prognosis than patients with high socioeconomic status. Therefore, in this study it was hypothesized that females would more likely to be diagnosed as having histrionic and dependent personality disorders, whereas males would more likely to be diagnosed as having antisocial personality disorder. For patients with low socioeconomic status it was expected that they would be assigned a diagnosis of psychotic disorder more, would receive drug and somatic treatment more, and would receive a poor prognosis more than the patients described as having a high socioeconomic status. Fourty-eight psychiatrists and twelve psychologists from two hospitals in Izmir and three hospitals in Ankara have answered four questions for each of five vignettes that varied sex and socioeconomic status of the patient. Three of VIthe vignettes described antisocial, histrionic, and dependent personility disorders and two of them portrayed neurotic depression and bipolar disorder with manic type. The results indicated that there were no significant differences in terms of sex and socioeconomic stattis of the patient on the diagnostic decisions However, significant differences were found in terms of the socioeconomic statiis of the patient on the prognostic and treatment suggestions of the clinicians. Unfavorable prognosis and somatic treatment were recommended more for patients with a low socioeconomic status than those with a high socioeconomic s tatus. The findings were evaluated in the light oF methodological issues and the results were discussed with suggestions for future research. VII