Title: ESRC/NIH Health Disparities - Understanding Social Contributions to Disparities in Depression Care: US and UK
Funder: Economic and Social Research Council

Abstract: Making sure that all patients receive good, equitable care is the responsibility of both clinicians and patients. Inequity in clinical care can be due to the same factors that contribute to inequity in other areas of social life, including race, gender, age, and literacy. These factors can shape both patients' and clinicians' expectations of care provision. Understanding how they do this will enable us to explain and improve the communication and interpersonal dynamics between clinicians and patients. We have designed this study to help disentangle how both clinicians' and patients' social characteristics contribute to inequitable care. The study setting is depression care in the US and UK. We will use video-taped scenarios in which actors portray patients presenting in primary care with symptoms of depression. An equal mix of male and female actors portraying patients from different ethnic backgrounds will be filmed, to help us understand how patients' gender and ethnicity can change what happens in consultations. We aim to understand both patients' and clinicians' perspectives on this. The first part of the study examines how clinicians think and reason about patients' problems, while the second part explores patients' perspectives on what happens. Study 1 involves analysing information already collected as part of another study. Here, primary care doctors in the US and UK viewed a videotape of a simulated depression visit (i.e. one involving actors). Doctors were then asked to imagine themselves in the shoes of the videotape doctor, and to tell us their thoughts about the videotape 'patient'. Study 2 involves filming new simulated depression visits. This time we will ask real US and UK patients to put themselves in the shoes of the videotape (actor) patients, and tell us how they would feel and what they would be thinking during the consultation, if they were that patient. Findings will be compared with those related to real patients presenting with symptoms of depression and suicide risk, available in a real database (Study 3). This will tell us about the accuracy of our findings. Together, the three studies will help us understand how clinicians' and patients' social and racial characteristics influence clinical care. The specific aims are: (1) to investigate how US and UK primary care doctors think and reason about patients presenting with depression symptoms and potential suicide risk. This will be achieved using information already collected; (2) Develop a new US/UK study to parallel this from the patients' perspective, to gauge real patients' responses to watching video-tapes of depression simulations. This includes: (a) getting them to voice their thoughts while watching; (b) asking how comfortable they would be sharing sensitive or embarrassing information with the video-tape clinician; (c) how they feel about any medication, lifestyle, or referral recommendations made; (d) their likelihood of returning to this clinician; (e) their ratings of the clinician's interpersonal skills; (f) their ratings of trust, liking, confidence, and satisfaction with information given and rapport with the clinician; and (g) their willingness to continue in treatment. Finally, findings will be compared with actual patient data (in anonymous form). Findings will shed light on how the mental health needs of patients from different ethnic backgrounds may best be met in US and UK primary care. They will also guide the design of a skills training programme to help clinicians communicate better with patients from these backgrounds, while at the same time helping these patients to communicate better with clinicians.


Research activity codes: 8.1 ORGANISATION AND DELIVERY OF SERVICES;7.3 MANAGEMENT AND DECISION MAKING
Health categories: MENTAL HEALTH