Showing papers by "Harold W. Neighbors published in 2005"

Race, Gender, and Psychiatrists' Diagnosis and Treatment of Major Depression Among Elderly Patients

Abstract: 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 Sta

Effect of Race and Sex on Primary Care Physicians' Diagnosis and Treatment of Late-Life Depression

Abstract: Objectives: To examine primary care physician (PCP) contributions toward racial and sex differences in the diagnosis and treatment of late-life depression. Design: Survey using a computerized instrument incorporating video interviews and text, with volunteer PCPs randomly assigned to one of four standardized video vignettes of an elderly patient depicting late-life depression. Vignettes differed only in the patient/actor's race (white/African-American) or sex. Setting: American Academy of Family Physicians meeting, San Diego, California, 2002. Participants: One hundred seventy-eight U.S.-practicing postresidency PCPs who were asked to participate in a clinical decision-making study. Measurements: The computerized survey instrument assessed PCPs' diagnoses, first-line treatment and management recommendations, and judgment of personal characteristics/behaviors for the patients in the vignettes. Results: Eighty-five percent of all PCPs correctly diagnosed the elderly patient(s) with major depression. There were no significant differences in the diagnosis of depression, treatment recommendations, or PCP assessment of most patient characteristics by the race or sex of the patient/actor in the vignette, but PCP characteristics, most notably the location of medical school training (U.S. vs international), affected the likelihood of a depression diagnosis and treatment recommendations. Conclusion: Given standardized symptom-pictures, PCPs are just as likely to diagnose and treat depression in African-American as in white older people, suggesting that bias based simply on apparent patient race is not a likely explanation for the lower rates of depression diagnosis and treatment in older African Americans. PCPs who have trained at international medical schools may benefit from targeted training initiatives on the diagnosis and treatment of late-life depression.

Clinician race, situational attributions, and diagnoses of mood versus schizophrenia disorders.

Abstract: This research examined clinicians' consideration of situational factors in diagnostic decisions of mood vs. schizophrenia disorders among psychiatric inpatients from a low-income, African American community. Clinicians completed questionnaires describing their diagnostic decisions. Responses reflecting the usage of situational information were investigated. African American clinicians used situational information more than non-African American clinicians. However, this increased attention to situational information was not uniquely associated with a particular diagnostic decision for African American clinicians. In contrast, consideration of situational attributions by non-African American clinicians did increase the probability of a mood diagnosis. Logistic regression analyses suggested differential application of a diagnostic standard among African American and non-African American clinicians. Implications for enhancing the cultural sensitivity of diagnosis practices are discussed.