National Origin and Behavioural Problems of Toddlers: The Role of Family Risk Factors and Maternal Immigration Characteristics

In many societies the prevalence of behavioural problems in school-aged children varies by national origin. We examined the association between national origin and behavioural problems in 1½-year-old children. Data on maternal national origin and the Child Behavior Checklist for toddlers (n = 4943) from a population-based cohort in the Netherlands were used. Children from various non-Dutch backgrounds all had a significantly higher mean behavioural problem score. After adjustment for family risk factors, like family income and maternal psychopathology, the differences attenuated, but remained statistically significant. Non-Dutch mothers with immigration risk factors, such as older age at immigration or no good Dutch language skills, reported significantly more behavioural problems in their offspring. In conclusion, the present study indicated more behavioural problems in immigrant toddlers from various backgrounds. Researchers and policymakers aiming to tackle disparities in behavioural problems should take into account that risks associated with national origin are intertwined with unfavourable family and immigration characteristics

Racial and Ethnic Diagnostic Patterns in Schizophrenia Spectrum Disorders

The literature on racial and ethnic diagnostic patterns (as these pertain to schizophrenia spectrum disorders) is reviewed in this chapter. The chapter begins with a review of the literature on the diagnostic patterns among racial and ethnic minorities in the USA and abroad, followed by a review of racial/ethnic differences in symptom severity, symptom expression, and prevalence rates. This is then followed by a review of the empirical literature that offers explanations about why differential diagnostic patterns are observed. This review explores the question of whether differential patterns are due to inherent differences between racial/ethnic groups or if clinician biases and/or decision-making processes are contributing to differential diagnostic practices. Finally, literature that points to cultural mistrust, paranoia, and other environmental factors (e.g., stress) as potential variables that may contribute to the differential diagnostic patterns among racial/ethnic groups is reviewed. These reviews suggest that Black patients are three to four times more likely to receive a schizophrenia spectrum diagnosis. Findings also suggest that racial/ethnic variations may exist on a symptom level, with greater differences observed among positive symptom profiles. This review suggests that unawareness of cultural differences in symptom expression, cultural mistrust, and environmental factors (e.g., low SES) may be related to greater likelihood of receiving a schizophrenia spectrum diagnosis but do not fully account for the diagnostic discrepancies observed among racial/ethnic groups. To better understand these relationships, we conclude with recommendations to improve diagnostic accuracy and cultural competence (e.g., greater reliance on the Cultural Formulation Interview) and suggestions for future research that may further clarify the racial/ethnic diagnostic conundrum (e.g., using analog research studies)