People are going to be willing to stay in a treatment study if they view their provider as more culturally competent, which means to me they understand and can trust that that provider knows how to take care of them. That they’re competent to understand their illness through the lens of what cultural background they have, that it might be different.

We found in the bipolar study, the STEP-BD, the first study we’d done on ethnic differences, that African Americans tended to have a higher rate of history of psychosis and even current psychotic symptoms. They were reported to have more psychosis, which has been found in other studies as well. Does that mean that they actually do have more psychosis or that the person doing the ratings and interpretation viewed them as more psychotic?

And there seems to be evidence that that does happen at times. There’s an overdiagnosis of psychosis. So you can imagine how if you have a sense of that interacting with a provider who you may fear is not culturally aware or competent to treat you that you’re not going to want to go be in a study or get treatment.

So I would say cultural competence is: one person has described it, or several people, as using an etic and emic approach where you look not only from the outside, using DSM and using norms to understand a particular disorder, but also looking within the culture to understand somebody’s presentation.