Understanding Social Contributions to Disparities in Depression Care: US and UK

描述（由申请人提供）：医生与来自不同种族和社会背景的患者进行有效沟通的能力对于减少健康差异至关重要。然而，沟通不仅仅是医疗专业人员的任务，患者在积极参与他们的护理和获得实施和继续治疗所需的信心和能力方面也发挥着关键作用。医疗保健中明显的差异反映了社会因素的相互作用，包括种族、性别、年龄、文化水平以及指导患者和医生观点的文化和规范期望。拟议的调查旨在有助于理清医生和患者对社会偏见的贡献，这种社会偏见可能会加剧与美国和英国提供和接受抑郁症治疗和自杀风险评估相关的健康差异。为了做到这一点，我们提出了一种新颖的方法，在这种方法中，使用录像带模拟来描绘初级保健中以抑郁症为重点的访问，其中参与者的种族和性别已被实验操纵。虽然共享医疗访问的背景，但模拟的重点不同；其中一个旨在检查医生的认知和临床推理过程，而另一个则探索患者的感知、反应和与接受护理相关的判断。在第一项研究中（数据已经收集），对128名美国和英国医生进行了访问模拟，他们被要求扮演治疗医生的角色，并提供他们临床推理的叙述。第二项研究模拟了美国和英国的640名不同种族的男性和女性抑郁症患者的就诊情况，其中患者和医生的性别和种族被实验性地操纵。受试者在模拟中扮演抑郁症患者的角色，以深入了解他们对护理的认知和情感反应。通过这种方式，我们将能够探索在美国和英国医疗保健系统和社会结构的背景下，作为模拟患者和医生的受试者在做出医疗保健判断时如何受到性别和种族的影响。研究3将通过分析来自不同种族背景的医生在匿名数据库中评估患者抑郁和自杀风险的实际患者数据来测试模拟结果的生态有效性。公共卫生相关性：与来自不同种族和社会背景的患者进行有效沟通的能力对于减少健康差异至关重要。然而，缩小差距不仅仅是医疗专业人员的任务：患者在积极参与护理和获得实施和继续治疗所需的信心和能力方面也发挥着关键作用。拟议的调查旨在有助于理清医生和患者对社会偏见的贡献，这种偏见可能会加剧与美国和英国提供和接受抑郁症治疗和自杀风险相关的健康差异，以便设计和实施更有效的干预措施。

DESCRIPTION (provided by applicant): Physicians' ability to communicate effectively with patients from ethnically and socially diverse backgrounds is essential to reducing health disparities. However, communication is not solely the task of medical professionals, patients also play a critical role in active participation in their care and in gaining the necessary confidence and competence to implement and continue treatment. The disparities that are evident within medical care reflect the interplay of social factors, including race, gender, age, literacy, and the cultural and normative expectations that guide the perspectives of both patients and physicians. The proposed investigation is designed to contribute to the disentangling of physician-derived and patient-derived contributions to social bias that may exacerbate health disparities associated with the provision and receipt of depression care and suicide risk assessment in the US and UK. In order to do so, we propose a novel approach in which videotape simulations are used to portray a depression -focused visit in primary care in which the ethnicity and gender of the participants have been experimentally manipulated. While sharing the context of a medical visit, the simulations differ in focus; one is designed to examine physicians' cognitive and clinical reasoning processes while the other explores patients' perceptions, responses and judgments related to the receipt of care. In the first study (for which data are already collected), visit simulations were shown to 128 US and UK physicians who were asked to take the role of the treating physician and provide a narrative account of their clinical reasoning. The second study shows simulated depression visits, in which patient and physician gender and ethnicity is experimentally manipulated, to 640 ethnically diverse male and female subjects in the US and UK. Subjects vicariously take the role of the depressed patient in the simulations to provide insights into their cognitive and affective reactions to care. In this way, we will be able to explore how subjects acting as analogue patients and physicians are influenced by gender and ethnicity in making medical care judgments in the context of the US and UK health care system and social structure. Study 3 will test the ecological validity of the analogue findings through the analysis of actual patient data in which physicians from different ethnic backgrounds have assessed patients' depression and suicide risk in an anonymised database. PUBLIC HEALTH RELEVANCE: ability to communicate effectively with patients from ethnically and socially diverse backgrounds is essential to reducing health disparities. However amelioration of disparities is not solely the task of medical professionals: patients also play a critical role in active participation in care and acquisition of the confidence and competence necessary to implement and continue treatment. The proposed investigation is designed to contribute to the disentangling of physician-derived and patient-derived contributions to social bias that may exacerbate health disparities associated with the provision and receipt of depression care and suicide risk in the US and UK so that more effective interventions may be designed and implemented.