CoChat
Sign Up
Cited by 45Mental Health Treatment and AccessPatient-Provider Communication in HealthcareClinical Reasoning and Diagnostic Skills

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

Open access
Kales, Helen C., Neighbors, Harold W., Valenstein, Marcia, Blow, Frederic C., McCarthy, John F., Ignacio, Rosalinda V., Taylor, Kiran K.‐K., Gillon, Leah +1 more·2005·Journal of the American Geriatrics Society
DOI 10.1111/j.1532-5415.2005.53255.x
Open this paper in CoChat — free accountOpen PDF

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.

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Integrity signals

Registry

Crossref · 10.1111/j.1532-5415.2005.53255.x

Cites

5 of 5 references verified0 citation errors · 0 not checkable

Statistics

Claims the paper makes

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • In another study, international medical graduates rated the African-American male patient in the vignette as being of significantly lower SES than did US graduates.

    “In another study, international medical graduates rated the African-American male patient in the vignette as being of significantly lower SES than did US graduates [38].”

    From Implicit bias in healthcare professionals: a systematic review (2017) · cites this paper as [38]

  • The two studies that reported no evidence of bias in diagnosis of depression found that physicians' estimates of SES were influenced by race, with lower SES estimated for black patients.

    “The two studies that reported no evidence of bias in diagnosis of depression found that physicians’ estimates of SES were influenced by race (lower SES estimated for black patients); [37, 38]”

    From Implicit bias in healthcare professionals: a systematic review (2017) · cites this paper as [38]

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

The self-check needs the paper’s full text.

Cites

Flagged first, then by citations

Research works printed but not linked: 43

  1. Unutzer J. Diagnosis and treatment of older adults with depression in primary care. Biol Psychiatry 2002;52:285-292.
  2. Unutzer J, Simon G, Belin TR et al. Care for depression in HMO patients aged 65 and older. J Am Geriatr Soc 2000;48:871-878.
  3. Coyne J, Katz I. Improving the primary care treatment of late life depression. Med Care 2001;39:756-759.
  4. Gallo JJ, Rabins PV, Iliffe S. The 'research magnificent' in late-life: Psychiatric epidemiology and the primary health care of older adults. Int J Psychiatry Med 1997;27:185-204.
  5. Adebimpe VR, Hedlund JL, Cho DW et al. Symptomatology of depression in black and white patients. J Natl Med Assoc 1982;74:185-190.
  6. Strakowski SM, Lonczak HS, Sax KW et al. The effects of race on diagnosis and disposition from a psychiatric emergency service. J Clin Psychiatry 1995;56:101-107.
  7. Jones BE, Gray BA. Problems in diagnosing schizophrenia and affective dis- orders among blacks. Hosp Community Psychiatry 1986;37:61-65.
  8. Strakowski SM, Shelton RC, Kolbrener ML. The effects of race and comor- bidity on clinical diagnosis in patients with psychosis. J Clin Psychiatry 1993; 54:96-102.
  9. Bell CC, Mehta H. The misdiagnosis of black patients with manic-depressive illness. J Natl Med Assoc 1980;72:141-145.
  10. Mulsant BH, Stergiou A, Keshavan MS et al. Schizophrenia in late life: Elderly patients admitted to an acute care psychiatric hospital. Schizophr Bull 1993;19:709-721.
  11. Fabrega H, Mulsant BH, Rifai AH et al. Ethnicity and psychopathology in an aging hospital-based population. J Nerv Ment Dis 1994;182:136-144.
  12. Leo RJ, Narayan DA, Sherry C et al. Geropsychiatric consultation for African American and Caucasian patients. Gen Hosp Psychiatry 1997;19:216-222.
  13. Kales HC, Blow FC, Bingham CR et al. Race and inpatient psychiatric diag- noses among elderly veterans. Psychiatr Serv 2000;51:795-800.
  14. Blazer DG, Hybels CF, Simonsick EM et al. Marked differences in antide- pressant use by race in an elderly community sample: 1986-96. Am J Psychi- atry 2000;157:1089-1094.
  15. Pingitore D, Snowden L, Sansone RA et al. Persons with depressive symptoms and the treatments they receive: A comparison of primary care physicians and psychiatrists. Int J Psychiatry Med 2001;31:41-60.
  16. Rollman BL, Hanusa BH, Belnap BH et al. Race, quality of depression care and recovery from major depression in a primary care setting. Gen Hosp Psychiatry 2002;24:381-390.
  17. Crawford MJ, Prince M, Menezes P et al. The recognition and treatment of depression in older people in primary care. Int J Geriatr Psychiatry 1998;13: 172-176.
  18. Freund KM, Moskowitz MA, Lin TH et al. Early antidepressant therapy for elderly patients. Am J Med 2003;114:15-19.
  19. Garb HN. Race bias, social class bias, and gender bias in clinical judgment. Clin Psychol Sci Prac 1997;4:99-120.
  20. Smedley BD, Stith AY, Nelson AR. Unequal Treatment. Confronting Racial and Ethnic Disparities in Health Care. Washington, DC: National Academies Press, 2002.
  21. Coleman D, Baker FM. Misdiagnosis of schizophrenia among older black veterans. J Nerv Ment Dis 1994;182:527-528.
  22. Baker FM. Misdiagnosis among older psychiatric patients. J Natl Med Assoc 1995;87:872-876.
  23. Snowden LR. Bias in mental health assessment and intervention. Theory and evidence. Am J Public Health 2003;93:239-243.
  24. Neighbors HW, Trierweiler SJ, Ford BC et al. Racial differences in DSM diagnosis using a semi-structured instrument: The importance of clinical judgment in the diagnosis of African Americans. J Health Soc Behav 2003;44: 237-256.
  25. Glazer WM, Morgenstern H, Doucette J. Race and tardive dyskinesia among outpatients at a CMHC. Hosp Community Psychiatry 1994;45:38-42.
  26. Schulman KA, Berlin JA, Harless W et al. The effect of race and sex on phy- sicians' recommendations for cardiac catheterization. N Engl J Med 1999;340: 618-626.
  27. vanRyn M, Fu SS. Paved with good intention: Do public health and human service providers contribute to racial/ethnic disparities in health? Am J Public Health 2003;93:248-255.
  28. Cohen J. Quantitative methods in psychology: A power primer. Psychol Bull 1992;112:155-159.
  29. Husaini BA, Moore ST. Arthritis disability, depression, and life satisfaction among black elderly people. Health Soc Work 1990;25:253-260.
  30. Neighbors HW, Jackson JS. The use of informal and formal help: Four patterns of illness behavior in the black community. Am J Community Psychol 1984; 12:629-644.
  31. Neighbors HW, Musick MA, Williams DR. The African American minister as a source of help for serious personal crise: Bridge or barrier to mental health care? Health Educ Behav 1998;25:759-777.
  32. Yokopenic PA, Clark VA, Aneshensel CS. Depression, problem recognition and professional consultation. J Nerv Ment Dis 1983;171:15-23.
  33. Sleath B, Rubin RH. Gender, ethnicity and physician-patient communication about depression and anxiety in primary care. Patient Educ Couns 2002;48: 243-252.
  34. Cooper-Patrick L, Gallo J, Gonzales J et al. Race, gender, and partnership in the patient-physician relationship. JAMA 1999;282:583-589.
  35. Schwartzberg JG, Guttman R. Effect of training on physician attitudes and practices in home and community care of the elderly. Arch Fam Med 1997;6: 439-444.
  36. Arean PA, Alvidrez J, Feldman M et al. The role of provider attitudes in prescribing antidepressants to older adults: Leverage points for effective pro- vider education. Int J Psychiatry Med 2003;33:241-256.
  37. Wigton RJ, Poses RM, Collins M et al. Teaching old dogs new tricks: Using cognitive feedback to improve physicians' diagnostic judgments on simulated cases. Acad Med 1990;65:S5-S6.
  38. Jones TV, Gerrity MS, Earp JA. Written case simulation: Do they predict physician's behavior? J Clin Epidemiol 1990;43:805-815.
  39. Kirwan JR, Chaput de Saintonge DM, Joyce CRB et al. Clinical judgment in rheumatoid arthritis. I. Rheumatologists' opinion and the development of paper patients. Ann Rheum Dis 1983;42:644-647.
  40. Kirwan JR, Bellamy N, Condon H et al. Judging 'current disease activity' in rheumatoid arthritisFan international comparison. J Rheumatol 1983;10: 901-905.
  41. Peabody JW, Luck J, Glassman P et al. Comparison of vignettes, standardized patients, and chart abstraction. A prospective validation study of 3 methods for measuring quality. JAMA 2000;283:1715-1722.
  42. McNutt RA, O'Meara JJ, de Bliek R. The effect of visual information and order of patient presentation on the accuracy of physicians' estimates of acute ischemic heart disease: A pilot study. Med Decis Making 1992;12:342.
  43. Feldman HA, McKinlay JB, Potter DA et al. Nonmedical influences on medical decision making: An experimental technique using videotapes, factorial design, and survey sampling. Health Serv Res 1997;32:343-366.

Cited by

Sorted by citations

Authors
Kales, H. C., Neighbors, H. W., Valenstein, M., Blow, F. C., McCarthy, J. F., Ignacio, R. V., Taylor, K. K. ‐., Gillon, L., & Mellow, A. M.
Affiliations
University of Michigan (US)
Corresponding author
Kales, Helen C.
ORCID
Venue
Journal of the American Geriatrics Society
Publisher
Wiley
Published
2005-05
Volume
53
Issue
5
Pages
777-784
ISSN
  • 0002-8614 (ISSN-L)
  • 1532-5415
DOI
10.1111/j.1532-5415.2005.53255.x
OpenAlex
W1505963038
Cited by
45
References
5
Citations by year
2026: 1 · 2024: 1 · 2023: 4 · 2022: 3 · 2021: 1 · 2020: 2 · 2019: 2 · 2017: 3 · 2016: 1 · 2015: 1 · 2014: 3 · 2013: 2 · 2012: 2
FWCI
4.91
Type
journal article
Language
en
Open access
Licence
onlinelibrary.wiley.com/termsAndConditions#vor (vor)
Locations
  • Journal of the American Geriatrics Society (publishedVersion)
  • PubMed (publishedVersion)
  • Deep Blue (University of Michigan) (submittedVersion)
Funders
  • U.S. Department of Veterans Affairs
  • Health Services Research and Development
Topics
  • Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
  • Health Sciences › Health Professions › General Health Professions › Patient-Provider Communication in Healthcare
  • Health Sciences › Medicine › Family Practice › Clinical Reasoning and Diagnostic Skills
Keywords
geriatric depression, racial disparities, sex differences, primary care physicians, physician bias, African American older adults, depression diagnosis, depression treatment, vignette study, international medical graduates
MeSH terms
Aged, Attitude of Health Personnel, Black or African American, Decision Making, Depression, Female, Foreign Medical Graduates, Humans, Male, Physicians, Family, Sex Factors, United States, Video Recording, White People, Racial Groups

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review