Diagnosing depression in African Americans.

Since the 1970s, articles have noted the increased presence of psychotic symptoms among depressed African Americans, the presence of diagnostic bias identified when structured clinical interviews are used, and the identification of misdiagnosis of affective illness among chronically, mentally ill, African Americans. This paper reviews this literature and describes three alternative presentations of depressive illness among African Americans that differ from the DSM IV criteria for Major Depressive Disorder: "the stoic believer," "the angry, 'evil' one" with a personality change, and "the John Henry doer." Clinicians are encouraged to recall these presentations of depression when evaluating African American patients.