Race, gender, and psychiatrists' diagnosis and treatment of major depression among elderly patients
Race, gender, and psychiatrists' diagnosis and treatment of major depression among elderly patients
复制标题
DOI：
10.1176/appi.ps.56.6.721
复制
发表时间：
2005-06-01
影响因子：
3.8
通讯作者：
Mellow, AM
中科院分区：
文献类型：
--
作者：
Kales, HC;Neighbors, HW;Mellow, AM
目的：本研究探讨精神科医师对老年人诊断和治疗中种族和性别差异的贡献。研究方法：志愿参加这项研究的精神科医生被随机分配到四个视频片段中的一个，视频片段描述了一位患有晚年抑郁症的老年患者。这些小插曲的不同之处只在于描绘病人的演员的种族（白色或非洲裔美国人）和性别。研究对象是参加2002年美国精神病学协会年会的329名精神病医生。结果：81%的精神科医生将老年患者诊断为重度抑郁症。患者的种族和性别与重性抑郁症的诊断、大多数患者特征的评估或管理该疾病的建议的显著差异无关。然而，精神科医生的特征，特别是精神科医生接受培训的医学院的位置（美国与国际），与许多变量显著相关。结论：鉴于标准化的症状图片，精神科医生在非裔美国老年患者中诊断或治疗抑郁症的可能性并不低于其他患者，这表明单纯基于种族的偏见并不是早期临床研究中发现的诊断和治疗种族差异的可能解释。在国际医学院校接受过诊断、治疗和判断患者属性培训的精神科医生的影响可能表明需要针对衰老和文化能力的有针对性的教育举措。
Objective: This study examined psychiatrists' contributions to racial and gender disparities in diagnosis and treatment among elderly persons. Methods: Psychiatrists who volunteered to participate in the study were randomly assigned to one of four video vignettes depicting an elderly patient with late-life depression. The vignettes differed only in terms of the race of the actor portraying the patient ( white or African American) and gender. The study participants were 329 psychiatrists who attended the 2002 annual meeting of the American Psychiatric Association. Results: Eighty-one percent of the psychiatrists assigned the elderly patient a diagnosis of major depression. Patients' race and gender was not associated with significant differences in the diagnoses of major depression, assessment of most patient characteristics, or recommendations for managing the disorder. However, psychiatrists' characteristics, particularly the location of the medical school at which the psychiatrist was trained ( United States versus international), were significantly associated with a number of variables. Conclusions: Given standardized symptom pictures, psychiatrists are no less likely to diagnose or treat depression among African-American elderly patients than among other patients, which suggests that bias based simply on race is not a likely explanation for racial differences in diagnosis and treatments found in earlier clinical studies. The impact of psychiatrists' having trained at international medical schools on diagnosis, treatment, and judgment of several patient attributes may indicate the need for targeted educational initiatives for aging and cultural competency.