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

Abstract

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.

Trends in the use of benzodiazepine receptor agonists among working-age adults in Belgium from 2004 to 2018

“…In contrast, in the Netherlands there is a high rate of referral and non-medical mental health care use. For individuals from non-neighboring countries, this may be due to their underrepresentation in ambulatory health care, which could be caused by cultural-specific barriers such as language barriers or differences in preferences and health care seeking behavior (62)(63)(64). Barriers can also occur at the level of health care providers, where patients from non-neighboring countries are treated differently, which is described as provider bias (65, 66).…”

Explanatory models of mental health : a qualitative study among East-African migrants and Belgian healthcare professionals

“…Yet, it can be debated if these GPs have sufficient knowledge on potential cultural influences to diagnose and refer migrant patients. Research has provided evidence that GPs may make suboptimal diagnostic, treatment, and referral decisions with migrant patients (Centola et al 2021;Duveau et al 2023). Amongst other reasons such as language barriers, this was also due to the influence of practitioners' behaviours and beliefs on their decisionmaking process.…”

“…Amongst other reasons such as language barriers, this was also due to the influence of practitioners' behaviours and beliefs on their decisionmaking process. In specific Belgian studies (Delaruelle et al 2022;Duveau et al 2023;Lepièce et al 2014), it was found that Belgian GPs displayed less favourable and discriminatory decision-making regarding mental health for migrant patients. GPs (unintentionally) perceived the symptoms of migrant patients as less severe compared to those of native patients, dedicated less time to examine the sociorelational history of their migrant patients, and prescribed more drugs.…”