International medical graduates and the diagnosis and treatment of late-life depression.
International medical graduates (IMGs) constitute a significant number of physicians in the United States. Because of cultural differences in the manifestations and acceptance of mental disorders, depression may be less recognized in countries where IMGs train than in the United States. Differences in medical training may affect IMGs' recognition of depression. The authors hypothesized that the diagnosis and treatment of late-life depression would differ between United States medical graduates (USMGs) and IMGs.



Physicians, both USMGs and IMGs, at two different professional physician association meetings in 2002 were asked to view a multimedia computer program including a vignette of an elderly patient-actor with late-life depression. They completed a computerized survey, including their diagnosis and recommendations for management. Statistical analyses were performed to compare the two groups for physician characteristics and patient treatment recommendations.



Study subjects were 178 primary care physicians and 321 psychiatrists. Three hundred fifty-three (71%) respondents were USMGs and 146 (29%) were IMGs. IMGs were significantly less likely than USMGs to make the correct diagnosis of depression (p < .004) or recommend treatment with a first-line antidepressant (p < .001). When specialty, other physician characteristics, and patient race and gender were controlled for, IMGs still differed significantly in their diagnoses (p = .006) and treatment (p = .006) of depression.



The authors found significant differences between USMGs and IMGs for the diagnosis and treatment of late-life depression. This could be due to IMGs' lesser familiarity with depressive symptoms or different cultural conceptions of depression. These findings may point to the need for additional depression training initiatives for IMGs.
Kales
Helen C
HC
Psychiatry Service (116A), Veterans' Affairs Medical Service, 2215 Fuller Road, Ann Arbor, MI 48105, USA. kales@umich.edu
DiNardo
Andrew R
AR
Blow
Frederic C
FC
McCarthy
John F
JF
Ignacio
Rosalinda V
RV
Riba
Michelle B
MB
D000328:Adult; D000368:Aged; D002983:Clinical Competence; D003226:Congresses as Topic; D003625:Data Collection; D003866:Depressive Disorder / Q000175:diagnosis*; D005194:Family Practice / Q000193:education*; D005260:Female; D005550:Foreign Medical Graduates / Q000592:standards*; D005852:Geriatric Psychiatry / Q000193:education*; D006801:Humans; D007396:Internship and Residency / Q000592:standards*; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care / Q000592:standards*; D011795:Surveys and Questionnaires; D014481:United States