Mind the Gate: General Practitioner’s Attitudes Towards Depressed Patients with Diverse Migration Backgrounds

Delaruelle, Katrijn; Buffel, Veerle; Canegem, Timo Van; Bracke, Piet; Ceuterick, Melissa

doi:10.1007/s10597-021-00844-3

Cited by 6 publications

(9 citation statements)

References 68 publications

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“…The lower severity of symptoms attributed to the migrant patient is in line with the findings of a recent study, which are also consistent with those of an experimental study in which physicians concluded that North-African patients were less likely to overreport their symptoms than Western-European patients (Delaruelle et al, 2021;Schulman et al, 1999). Potential explanations for this result may also be related to GPs' racial prejudice, their dehumanization of migrant patients, a lack of empathy, or even an assumption that Black patients feel less pain than White patients (Trawalter & Hoffman, 2015).…”

Section: Diagnosis Assessment Of Symptom Severity Treatment and Referralsupporting

confidence: 90%

Section: Appendix 1: Video Vignettes In French and In Dutch With The ...mentioning

confidence: 99%

“…The methodological quality and clinical realism of the vignettes were validated by an academic expert in experimental psychology Delaruelle et al ( 2021 ). For more details on the design, see Ceuterick et al ( 2020 ) and Delaruelle et al ( 2021 ). The script of the vignettes was developed and validated by an academic expert in experimental psychology and an advisory committee composed of two psychiatrists, two GPs, a psychiatric nurse, a psychologist, and an expert in culturally sensitive care.…”

Section: Appendix 1: Video Vignettes In French and In Dutch With The ...mentioning

confidence: 99%

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Unintentional Discrimination Against Patients with a Migration Background by General Practitioners in Mental Health Management: An Experimental Study

Duveau

Wets

Delaruelle

et al. 2023

Adm Policy Ment Health

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Populations with a migration background have a higher prevalence of mental health problems than their native counterparts. They are also more likely to have unmet medical needs and are less frequently referred to mental health services. One potential explanation for this is that physicians, such as general practitioners (GPs), may unintentionally discriminate against migrant patients, particularly when they lack humanization. To date, no experimental study has investigated this hypothesis. This paper assesses the influence of humanization on GPs’ discriminatory decisions regarding migrant patients with depression. A balanced 2 × 2 factorial experiment was carried out with Belgian GPs (N = 797) who received video-vignettes depicting either a native patient or a migrant patient with depression. Half of the respondents were exposed to a text that humanized the patient by providing more details about the patient’s life story. Decisions related to diagnosis, treatment and referral were collected, as well as the time spent on each video and text, and were analysed using ANOVA. Migrant patients’ symptoms were judged to be less severe than those of native patients (F = 7.71, p < 0.05). For almost all treatments, the decision was less favourable for the migrant patient. Humanization had little effect on medical decisions. We observed that GPs spent significantly more time on the vignette with the humanization intervention, especially for the migrant patients. The results indicate that ethnic differences in the management of depression persist in primary care. Humanization, however, does not mitigate those differences in medical decisions.

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Section: Diagnosis Assessment Of Symptom Severity Treatment and Referralsupporting

confidence: 90%

Section: Appendix 1: Video Vignettes In French and In Dutch With The ...mentioning

confidence: 99%

Section: Appendix 1: Video Vignettes In French and In Dutch With The ...mentioning

confidence: 99%

See 1 more Smart Citation

Unintentional Discrimination Against Patients with a Migration Background by General Practitioners in Mental Health Management: An Experimental Study

Duveau

Wets

Delaruelle

et al. 2023

Adm Policy Ment Health

Self Cite

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“…23 GPs may, therefore, experience distinctly different psychological responses to refugee patients in comparison with nonrefugee patients. This is supported by findings indicating that health professionals evaluate forcibly displaced patients differently from majority population and other patients with foreign descent, for example being less optimistic about their recovery 24 and feeling less confident about providing care to them. [25][26][27][28] Similarly, Somali women with a refugee background may be perceived as being more at risk for violence, 29 such as female genital mutilation, 30 which may influence GPs' clinical decisions about this patient group.…”

Section: Strengths and Limitations Of This Studymentioning

confidence: 82%

“… 37 Furthermore, cultural competence contributes to health professionals attributing more trustworthiness to asylum-seeking patients. 24 Feeling a lack of cultural competence, for example through lacking training or courses, may therefore play a role in the experience of clinical uncertainty in inter-cultural consultations.…”

Section: Introductionmentioning

confidence: 99%

General practitioners’ management of depression symptoms in Somali refugee and Norwegian patients: a film vignette experiment

et al. 2021

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ObjectivesRefugees in comparison with non-refugee patients may face higher unmet mental healthcare needs. The mechanisms underlying these disparities are still poorly understood. The general practitioner (GP) plays a vital role in refugees’ mental health (MH), managing complaints within primary care and acting as gatekeeper to specialist services. However, GPs have reported feeling uncertain about working with refugee patients. Somalis make up one of the largest refugee groups in Norway and use primary care services more than the majority population for physical health, although not for MH. The current study examines GPs’ management of MH complaints in Somali refugee versus Norwegian vignette characters and the role of GP clinical uncertainty.DesignWe distributed an online experimental survey to GPs in Norway (n=133), who were randomised to watch a simulated consultation with a female Norwegian, female Somali, male Norwegian or male Somali vignette character, presenting the same symptoms of depression. GPs indicated which diagnoses, assessments and treatments they would endorse for the patient and their level of certainty.Outcome measuresWe calculated Simpson indices to measure inter-rater reliability and 2×2 analysis of variances as well as Bayesian estimation to examine clinical certainty based on patient background and gender.ResultsGPs’ clinical decisions about Somali and Norwegian vignette characters were similar, with a few exceptions. There was less consensus regarding the first prioritised diagnosis for Somali characters (Simpson index=0.129) versus Norwegian characters (Simpson index=0.208), (p=0.011, one-tailed). Somalis more frequently received diagnoses of post-traumatic stress disorder (PTSD), while Norwegians received diagnoses of feeling depressed. GPs endorsed sick leave more often for Norwegian characters and medication for physical complaints for Somali characters. There were no substantial differences in GPs’ self-reported certainty.ConclusionsWe found few and relatively small effects of patient background and gender on GPs’ clinical decisions. Nevertheless, the validity of certain diagnoses and prescription of sick leave need to be considered by clinicians and in future research.

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Individual, interpersonal, and organisational factors associated with discrimination in medical decisions affecting people with a migration background with mental health problems: the case of general practice

Duveau,

Wets,

Delaruelle

et al. 2023

Ethnicity & Health

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Mind the Gate: General Practitioner’s Attitudes Towards Depressed Patients with Diverse Migration Backgrounds

Cited by 6 publications

References 68 publications

Unintentional Discrimination Against Patients with a Migration Background by General Practitioners in Mental Health Management: An Experimental Study

Unintentional Discrimination Against Patients with a Migration Background by General Practitioners in Mental Health Management: An Experimental Study

General practitioners’ management of depression symptoms in Somali refugee and Norwegian patients: a film vignette experiment

Individual, interpersonal, and organisational factors associated with discrimination in medical decisions affecting people with a migration background with mental health problems: the case of general practice

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