Race, gender, and psychiatrists' diagnosis and treatment of major depression among elderly patients.
OBJECTIVE
This study examined psychiatrists' contributions to racial and gender disparities in diagnosis and treatment among elderly persons.


METHODS
Psychiatrists who volunteered to participate in the study were randomly assigned to one of four video vignettes depicting an elderly patient with late-life depression. The vignettes differed only in terms of the race of the actor portraying the patient (white or African American) and gender. The study participants were 329 psychiatrists who attended the 2002 annual meeting of the American Psychiatric Association.


RESULTS
Eighty-one percent of the psychiatrists assigned the elderly patient a diagnosis of major depression. Patients' race and gender was not associated with significant differences in the diagnoses of major depression, assessment of most patient characteristics, or recommendations for managing the disorder. However, psychiatrists' characteristics, particularly the location of the medical school at which the psychiatrist was trained (United States versus international), were significantly associated with a number of variables.


CONCLUSIONS
Given standardized symptom pictures, psychiatrists are no less likely to diagnose or treat depression among African-American elderly patients than among other patients, which suggests that bias based simply on race is not a likely explanation for racial differences in diagnosis and treatments found in earlier clinical studies. The impact of psychiatrists' having trained at international medical schools on diagnosis, treatment, and judgment of several patient attributes may indicate the need for targeted educational initiatives for aging and cultural competency.
Kales
Helen C
HC
University of Michigan School of Public Health, Ann Arbor, MI 48105, USA. kales@umich.edu
Neighbors
Harold W
HW
Blow
Frederic C
FC
Taylor
Kiran K K
KK
Gillon
Leah
L
Welsh
Deborah E
DE
Maixner
Susan M
SM
Mellow
Alan M
AM
D000328:Adult; D000368:Aged; D000928:Antidepressive Agents / Q000008:administration & dosage; D044383:Black People / Q000523:psychology; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000188:drug therapy / Q000208:ethnology*; D005006:Ethnicity / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016544:Patient Simulation; D010552:Personality Assessment / Q000706:statistics & numerical data; D011570:Psychiatry; D011594:Psychometrics; D012737:Sex Factors; D013240:Stereotyping; D044465:White People / Q000523:psychology; D001741:Black or African American
D000928:Antidepressive Agents