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

摘要 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是 对减少健康差距至关重要。然而，沟通不仅仅是医疗的任务， 除了专业人员外，患者在积极参与护理和获得必要的 实施和继续治疗的信心和能力。内部明显的差异 医疗保健反映了社会因素的相互作用，包括种族、性别、年龄、文化和 规范的期望，指导病人和医生的观点。拟议的调查 旨在有助于理清医生和患者对社会的贡献， 偏见可能会加剧与提供和接受抑郁症护理相关的健康差异， 自杀风险评估在美国和英国。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，种族和性别的 参与者被实验性地操纵了。在分享医疗访问的背景时， 模拟的重点各不相同;一个是为了检查医生的认知和临床推理过程 另一个是探讨病人对接受护理的感受，反应和判断。在 第一项研究（已经收集了数据），向128名美国和英国医生展示了访问模拟 他们被要求扮演治疗医生的角色， 推理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 在美国和英国，对640名不同种族的男性和女性受试者进行了实验操作。 受试者在模拟中扮演抑郁症患者的角色， 对护理的认知和情感反应。通过这种方式，我们将能够探索受试者如何作为 模拟患者和医生在做出医疗护理判断时受到性别和种族的影响， 美国和英国的医疗体系和社会结构。研究3将测试 通过分析来自不同种族的医生的实际患者数据， 背景在匿名数据库中评估了患者的抑郁和自杀风险。

Abstract 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.