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距至关重要。然而，沟通不仅仅是医疗专业人员的任务，患者在积极参与其护理以及获得必要的信心和能力以实施和继续治疗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，识字率以及指导患者和医生观点的文化和规范期望。拟议的调查的目的是有助于解开医生衍生和患者衍生的贡献，社会偏见，可能会加剧与提供和接受抑郁症护理和自杀风险评估在美国和英国的健康差距。为了做到这一点，我们提出了一种新的方法，其中录像带模拟被用来描绘一个抑郁症为重点的访问在初级保健中，参与者的种族和性别已被实验操纵。在共享医疗访问的背景下，模拟的重点不同;一个是旨在检查医生的认知和临床推理过程，而另一个探索患者的感知，反应和判断有关的接收护理。在第一项研究中（已经收集了数据），向128名美国和英国医生展示了访视模拟，他们被要求扮演治疗医生的角色，并提供其临床推理的叙述性说明。第二项研究显示了模拟抑郁症的访问，其中患者和医生的性别和种族是实验性操纵的，在美国和英国的640名种族多样化的男性和女性受试者。受试者在模拟中扮演抑郁症患者的角色，以了解他们对护理的认知和情感反应。通过这种方式，我们将能够探索如何科目作为模拟患者和医生的性别和种族的影响，在美国和英国的医疗保健系统和社会结构的背景下，在医疗保健的判断。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病人进行有效沟通的能力对于减少健康差距至关重要。然而，改善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。拟议的调查的目的是有助于解开医生衍生和患者衍生的贡献，社会偏见，可能会加剧与提供和接受抑郁症护理和自杀风险在美国和英国，使更有效的干预措施，可以设计和实施相关的健康差距。

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.