Exploring The Role Of Racial Associations Within Life And Psychiatry: The Dissociation Of Explicit And Implicit

EXPLORING THE ROLE OF RACIAL ASSOCIATIONS WITHIN LIFE AND PSYCHIATRY: THE DISSOCIATION OF EXPLICIT AND IMPLICIT Dervin Cunningham, BSA1; Victor J. Avila-Quintero, MD1; Kathleen Malison1; Pedro Macul Ferreira de Barros, MD3; José M. Flores, MPH, MD, PhD1,2; Michael H. Bloch, MD, MS 1,2; Amalia Londono-Tobón, MD1* 1 Yale Child Study Center, Yale University School of Medicine, New Haven, CT 2 Yale Department of Psychiatry, Yale University School of Medicine, New Haven, CT 3 Institute of Psychiatry, University of Sao Paulo, Sao Paulo, SP, Brazil Objective: In the past decade there has been increased interest in understanding racial disparities throughout the world. In doing so, racial associations and biases have been found to be one potential etiology of these disparities. Particularly in the medical field, trainings and institutions often have providers rely on self-reported racial associations as a means to understanding their biases. However, there is little known on how explicit/self-reported associations relate to implicit associations and clinical behavior, specifically within mental healthcare. This study aims to understand the relationship between explicit/self-reported statements and psychiatric providers’ implicit racial associations. Methods: Psychiatric providers were asked to provide explicit/self-reported statements reflecting their views on racial associations regarding (1) compliance, (2) diagnosis, and (3) treatment. They were also asked to complete 3 race Implicit Association Tests (IATs) on the same outcomes. Demographic predictors of self-reported statements were examined. Linear regression models were used to estimate the association between explicit/self-reported associations and results of IATs, which served as indicators of implicit racial associations. Results: We analyzed data from 294 providers who completed IATs. Training level was the only demographic predictor of explicit/self-reported associations—Board-certified psychiatrists had stronger explicit/self-reported associations of Black patients with noncompliance, compared to medical students (βΔD= 0.03, P <0.01) but not for the other assessed categories. Explicit/self-reported and implicit associations linking noncompliance with Black patients were significantly but weakly correlated (βΔD=0.11; P < 0.01, R2=0.03). Otherwise, explicit/self-reported statements were NOT significantly correlated with implicit associations. Conclusions: Overall, these results suggest a dissociation between psychiatry providers’ explicit/self-reported vs. implicit racial associations. This may imply that racial associations and biases often operate outside conscious awareness. Future studies may benefit from including both implicit and explicit association assessments in order to better understand their relationship and how these (1) affect clinical behavior and (2) whether interventions can change both self-reported and implicit racial associations. This is vital to better understand conscious and unconscious processes within individuals, particularly psychiatrists, to reduce racial disparities within healthcare. It is also essential in our efforts to create a world with justice, liberty, and meaning for all.