Date of Award


Document Type

Campus Access Dissertation

Degree Name

Doctor of Philosophy (PhD)


Clinical Psychology

First Advisor

Tahirah Abdullah

Second Advisor

Karen Suyemoto

Third Advisor

Kristen Woodberry


There is established support for the disproportionate rate at which clinicians diagnose Black Americans with schizophrenia and other psychotic disorders rather than affective disorders (e.g., depression; Neighbors et al., 2003; Olbert et al., 2018; Schwartz & Blankenship, 2014; Trierweiler et al., 2006). Clinician biases have been investigated as probable causes of the longstanding trend of disproportionate rates of psychosis diagnoses among Black populations. However, the influence of racial biases, specifically, have not yet been explored. Researchers have identified that adopting a colorblind racial ideology may introduce bias and limits clinicians’ ability to engage with elements of multiculturalism in their assessment and treatment of racial minority clients (Neville et al., 2013). This association warrants further exploration, given that White clinicians’ lower cultural awareness and multicultural responsiveness have been linked with uncomprehensive assessment and inappropriate approaches to therapeutic interventions (Constantine & Gushue, 2003; Constantine & Sue, 2007). Furthermore, multicultural insensitivity may increase clinicians’ susceptibility to clinical interpretations based on racial stereotypes, which may, in turn, contribute to psychosis misdiagnoses in Black populations (Miserocchi, 2014). Limited multicultural awareness and responsiveness was found to correlate with more negative racial attitudes towards persons of color (Chao, 2012; Gushue & Constantine, 2003; Miserocchi, 2014; Neville et al., 2006; Spanierman et al., 2008), higher levels of racist beliefs and/or negative racial biases, defensiveness, and denial/distortion of racial topics/discrimination in general (e.g., colorblind racial attitudes; Neville et al., 2000, Neville et al., 2013). Conversely, clinicians’ higher endorsement of self-perceived multicultural counseling responsiveness has been linked with better mental health treatment outcomes and reductions in CBRA (Miserocchi, 2014; Neville et al., 2013; Spanierman et al., 2008). In sum, there is a need to further understand the role of colorblind racial attitudes (CBRA) and less self-perceived multicultural responsiveness as possible forms of racial bias in the diagnostic decision-making process for clinicians working with racial minority clients, as findings from studies investigating the race of clients and/or clinicians have yielded limited and inconclusive information. This study examined whether a client’s race, depicted in a set of clinical vignettes as White or Black, influenced clinicians’ interpretation of psychiatric symptoms or likelihood of diagnosing psychosis. I then considered if and how colorblind racial attitudes and self-perceived multicultural responsiveness related to clinicians’ diagnostic decision-making processes, when making distinctions between depressive and psychotic symptoms.


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