Psychiatric diagnoses of Cuban refugees in the United States: findings of medical review boards

To assess the reproducibility of psychiatric diagnoses made in immigration proceedings, the authors examined cases of 109 Cuban refugees who had appealed psychiatric diagnoses that precluded their admission to the United States according to the Immigration and Nationality Act. Medical review boards upheld only 23 (42%) of 55 initial diagnoses of antisocial personality disorder but affirmed exclusionary certifications in 39 (72%) of the 54 other cases. Failure to sustain a high proportion of diagnoses of antisocial personality disorder may reflect interviewer biases, cross-cultural inappropriateness of diagnostic criteria, or other deficiencies in the current system of psychiatric evaluation of potential refugees.