title: Does Patient Race/Ethnicity Influence Physician Decision-Making for Diagnosis and Treatment of Childhood Disruptive Behavior Problems?
abstract: Race/ethnic disparities in utilization of children's mental health care have been well documented and are particularly concerning given the long-term risks of untreated mental health problems (Institute of Medicine, 2003; Kessler et al. Am J Psychiatry 152:10026-1032, 1995). Research investigating the higher rates of unmet need among race/ethnic minority youths has focused primarily on policy, fiscal, and individual child or family factors that can influence service access and use. Alternatively, this study examines provider behavior as a potential influence on race/ethnic disparities in mental health care. The goal of the study was to examine whether patient (family) race/ethnicity influences physician diagnostic and treatment decision-making for childhood disruptive behavior problems. The study utilized an internet-based video vignette with corresponding survey of 371 randomly selected physicians from across the USA representing specialties likely to treat these patients (pediatricians, family physicians, general and child psychiatrists). Participants viewed a video vignette in which only race/ethnicity of the mother randomly varied (non-Hispanic White, Hispanic, and African American) and then responded to questions about diagnosis and recommended treatments. Physicians assigned diagnoses such as oppositional defiant disorder (48 %) and attention deficit disorder (63 %) to the child, but there were no differences in diagnosis based on race/ethnicity. The majority of respondents recommended psychosocial treatment (98 %) and/or psychoactive medication treatment (60 %), but there were no significant differences based on race/ethnicity. Thus, in this study using mock patient stimuli and controlling for other factors, such as insurance coverage, we did not find major differences in physician diagnostic or treatment decision-making based on patient race/ethnicity.
authors: Child and Adolescent Services Research Center (CASRC), San Diego, CA, USA. agarland@sandiego.edu.|Department of School, Family & Mental Health Professions, School of Leadership and Education Sciences, University of San Diego, 5998 Alcalá Park, San Diego, CA, 92110, USA. agarland@sandiego.edu.
authors: Ann F
authors: AF
authors: Garland
authors: Child and Adolescent Services Research Center (CASRC), San Diego, CA, USA. robinmcfarlandtaylor@gmail.com.
authors: Robin
authors: R
authors: Taylor
authors: Child and Adolescent Services Research Center (CASRC), San Diego, CA, USA. lbrookman@ucsd.edu.|Department of Psychiatry, University of California, San Diego, CA, USA. lbrookman@ucsd.edu.
authors: Lauren
authors: L
authors: Brookman-Frazee
authors: Child and Adolescent Services Research Center (CASRC), San Diego, CA, USA. mjbaker@rchsd.org.|Rady Children's Hospital and Health Center, San Diego, CA, USA. mjbaker@rchsd.org.
authors: Mary
authors: M
authors: Baker-Ericzen
authors: Child and Adolescent Services Research Center (CASRC), San Diego, CA, USA. rhaine@mail.sdsu.edu.|Department of Psychology, San Diego State University, San Diego, CA, USA. rhaine@mail.sdsu.edu.
authors: Rachel
authors: R
authors: Haine-Schlagel
authors: Department of Pediatrics, University of California, San Diego, CA, USA. yiliu@ucsd.edu.
authors: Yi Hui
authors: YH
authors: Liu
authors: Department of School, Family & Mental Health Professions, School of Leadership and Education Sciences, University of San Diego, 5998 Alcalá Park, San Diego, CA, 92110, USA. sarinaw@sandiego.edu.
authors: Sarina
authors: S
authors: Wong
mesh_terms: D001741:Black or African American / Q000706:statistics & numerical data*; D019958:Attention Deficit and Disruptive Behavior Disorders / Q000175:diagnosis / Q000208:ethnology* / Q000628:therapy; D002648:Child; D005260:Female; D054625:Healthcare Disparities / Q000208:ethnology; D006630:Hispanic or Latino / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D010817:Physician-Patient Relations; D010820:Physicians / Q000523:psychology* / Q000706:statistics & numerical data; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D014743:Videotape Recording; D044465:White People / Q000706:statistics & numerical data*
keywords: Childhood disruptive behavior problems; Patient race/ethnicity; Physician decision-making; Psychoactive medications