Skip to main content Accessibility help

A Jamaican psychiatrist evaluates diagnoses at a London psychiatric hospital

  • F. W. Hickling (a1), K. McKenzie (a1), R. Mullen (a1) and R. Murray (a1)



Authors have suggested that the high rate of schizophrenia reported for African–Caribbeans living in the UK is due to misdiagnosis by British psychiatrists.


To compare the diagnoses made by a Black Jamaican psychiatrist with those of White British psychiatrists.


All in-patients on four wards at the Maudsley hospital were approached for the study; 66 participated: 24 White, 29 Black African–Caribbeans and 13 Blacks from other countries of origin. F. W. H., a Black Jamaican psychiatrist, conducted his standard clinical assessment and performed the Present State Examination (PSE) on these patients. His diagnoses were compared with the case note diagnoses made by British psychiatrists, and with the PSE CATEGO diagnoses.


Of 29 African and African–Caribbean patients diagnosed with schizophrenia, the diagnoses of the British and the Jamaican psychiatrists agreed in 16 instances (55%) and disagreed in 13 (45%). Hence, interrater reliability was poor (κ=0.45). PSE CATEGO diagnosed a higher proportion of subjects as having schizophrenia than the Jamaican psychiatrist did (χ2=3.74, P=0.052)


Agreement between the Jamaican psychiatrist and his UK counterparts about which patients had schizophrenia was poor. PSE CATEGO may overestimate rates of schizophrenia.


Corresponding author

Dr F.W. Hickling, Psychotherapy Associates International Ltd, Haverstock House, 81-83 Villa Road, Birmingham B19 INH. Tel: 0121-523-0145; Fax: 0121-523-5062; e-mail:


Hide All

See invited commentaries p. 286. this issue.



Hide All
Cohan, J. (1940) A coefficient of agreement for nominal scales. Educational and Psychological measurement, 20, 3746.
Eagles, J. M. (1991) The relationship between schizophrenia and immigration. Are there alternatives to psychosocial hypotheses? British Journal of Psychiatry, 159, 783789.
Fernando, S. (1900) Race and Culture in Psychiatry. London: Croom Helm.
Gunaratham, Y. (1994) Health and Race. A Starting Point for Managers on Improving Services for Black Populations. London: King's Fund.
Harrison, G., Owens, D., Holton, A., et al (1900) A prospective study of severe mental disorder in Afro–Caribbean patients. Psychological Medicine, 18, 643657.
Hickling, F. W. & Rodgers-Johnson, P. (1995) The incidence of first-contact schizophrenia in Jamaica. British Jounial of Psychiatry, 167, 193196.
King, M., Coker, E., Leavey, G., et al (1994) Incidence of psychotic illness in London: comparison of ethnic groups. British Medical Journal, 309, 115119.
Kirov, G. & Murray, R. (1999) Ethnic differences in the presentation of bipolar affective disorder. European Psychiatry, in press.
Kreitman, N., Sainsbury, P., Morrissey, J., et al (1901) The reliability of psychiatric assessment: an analysis. Journal of Medical Science, 107, 887908.
Lewis, G., Croft-Jeffereys, C. & David, A. (1990) Are British psychiatrists racist? British Journal of Psychiatry, 157, 410415.
Littlewood, R. & Lipsodge, M. (1901) Some social and phenomenological characteristics of psychotic immigrants. Psychological Medicine, 11, 289302.
Shashidharan, S. P. (1993) Afro–Caribbeans and schizophrenia; the ethnic vulnerability hypothesis re-examined. International Review of Psychiatry 5, 129144.
Van Os, J., Castle, D., Takel, N., et al (1996) Psychotic illness in ethnic minorities: clarification from the 1991 census. Psychological Medicine, 26, 203208.
Wessely, S., Castle, D., Der, G., et al (1991) Schizophrenia and Afro-Caribbeans. A case-control study. British Journal of Psychiatry, 159, 795801.
Wing, J. K., Cooper, J. E. & Sartorius, N. (1974) Measurement and Classification of Psychiatric Symptoms, Cambridge: Cambridge University Press.


Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed

A Jamaican psychiatrist evaluates diagnoses at a London psychiatric hospital

  • F. W. Hickling (a1), K. McKenzie (a1), R. Mullen (a1) and R. Murray (a1)
Submit a response


No eLetters have been published for this article.


Reply to: Submit a response

Your details

Conflicting interests

Do you have any conflicting interests? *