Adams, Ann, Vail, Laura, Buckingham, Christopher D., Kidd, Jane M., Weich, Scott and Roter, Debra (2014) Investigating the influence of African American and African Caribbean race on primary care doctors' decision making about depression. Social Science & Medicine, Volume 116 . pp. 161-168. doi:10.1016/j.socscimed.2014.07.004

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Abstract

This paper explores differences in how primary care doctors process the clinical presentation of depression by African American and African-Caribbean patients compared with white patients in the US and the UK. The aim is to gain a better understanding of possible pathways by which racial disparities arise in depression care. One hundred and eight doctors described their thought processes after viewing video recorded simulated patients presenting with identical symptoms strongly suggestive of depression. These descriptions were analysed using the CliniClass system, which captures information about micro-components of clinical decision making and permits a systematic, structured and detailed analysis of how doctors arrive at diagnostic, intervention and management decisions. Video recordings of actors portraying black (both African American and African-Caribbean) and white (both White American and White British) male and female patients (aged 55 years and 75 years) were presented to doctors randomly selected from the Massachusetts Medical Society list and from Surrey/South West London and West Midlands National Health Service lists, stratified by country (US v.UK), gender, and years of clinical experience (less v. very experienced). Findings demonstrated little evidence of bias affecting doctors' decision making processes, with the exception of less attention being paid to the potential outcomes associated with different treatment options for African American compared with White American patients in the US. Instead, findings suggest greater clinical uncertainty in diagnosing depression amongst black compared with white patients, particularly in the UK. This was evident in more potential diagnoses. There was also a tendency for doctors in both countries to focus more on black patients' physical rather than psychological symptoms and to identify endocrine problems, most often diabetes, as a presenting complaint for them. This suggests that doctors in both countries have a less well developed mental model of depression for black compared with white patients.

Item Type:	Journal Article
Subjects:	R Medicine > R Medicine (General)
Divisions:	Faculty of Medicine > Warwick Medical School > Health Sciences > Mental Health and Wellbeing Faculty of Medicine > Warwick Medical School
Library of Congress Subject Headings (LCSH):	Depression, Mental, African Americans -- Health and hygiene, Discrimination in medical care, Primary care (Medicine) -- Great Britain, Primary care (Medicine) -- United States
Journal or Publication Title:	Social Science & Medicine
Publisher:	Elsevier
ISSN:	0277-9536
Official Date:	September 2014
Dates:	Date Event September 2014 Published 3 July 2014 Available 3 July 2014 Accepted 30 April 2014 Submitted
Volume:	Volume 116
Page Range:	pp. 161-168
DOI:	10.1016/j.socscimed.2014.07.004
Status:	Peer Reviewed
Publication Status:	Published
Access rights to Published version:	Open Access
Funder:	Economic and Social Research Council (Great Britain) (ESRC), National Institute on Aging (NIA)
Grant number:	RES-177-25-0014 (ESRC), AG16747 (NIA)

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