Assessing Provider Bias in General Practitioners’ Assessment and Referral of Depressive Patients with Different Migration Backgrounds: Methodological Insights on the Use of a Video-Vignette Study

Ceuterick, Melissa; Bracke, Piet; Canegem, Timo Van; Buffel, Veerle

doi:10.1007/s10597-020-00590-y

Cited by 11 publications

(6 citation statements)

References 57 publications

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“…The higher frequency of PTSD diagnoses for the Somali characters is in line with findings from a previous vignette study. 22 According to the DSM-5, 55 symptoms that are indicative of PTSD include negative alterations in cognitions and mood, negative emotional states, diminished interest in activities and detachment from others. These symptoms have substantial overlap with depressive symptoms and could, in combination with the belief that refugees are likely to have been exposed to actual or threatened death, injury or sexual violence, have led GPs to choose the PTSD diagnosis for the Somali refugee versus the Norwegian vignette characters.…”

Section: Discussionmentioning

confidence: 99%

“…21 Additionally, lower contact rates to specialist MH services may reflect lower referrals from GPs. 22 A United Nations High Commissioner for Refugees (UNHCR) report on the culture, context, and MH of Somali refugees has suggested that health professionals find it challenging to provide healthcare to Somalis with a refugee background suffering from MH problems, due to their psychosocial problems and distinct cultural and religious conceptualisations of MH, 19 which may include the belief that mental illness is the result of spiritual possession or of being a bad Muslim. 20 21 While the knowledge that a patient has undergone forced migration may increase empathy towards refugees among host country residents, it may also increase anxiety and feelings of threat.…”

Section: Strengths and Limitations Of This Studymentioning

confidence: 99%

“… 21 Additionally, lower contact rates to specialist MH services may reflect lower referrals from GPs. 22 …”

Section: Introductionmentioning

confidence: 99%

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General practitioners’ management of depression symptoms in Somali refugee and Norwegian patients: a film vignette experiment

et al. 2021

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ObjectivesRefugees in comparison with non-refugee patients may face higher unmet mental healthcare needs. The mechanisms underlying these disparities are still poorly understood. The general practitioner (GP) plays a vital role in refugees’ mental health (MH), managing complaints within primary care and acting as gatekeeper to specialist services. However, GPs have reported feeling uncertain about working with refugee patients. Somalis make up one of the largest refugee groups in Norway and use primary care services more than the majority population for physical health, although not for MH. The current study examines GPs’ management of MH complaints in Somali refugee versus Norwegian vignette characters and the role of GP clinical uncertainty.DesignWe distributed an online experimental survey to GPs in Norway (n=133), who were randomised to watch a simulated consultation with a female Norwegian, female Somali, male Norwegian or male Somali vignette character, presenting the same symptoms of depression. GPs indicated which diagnoses, assessments and treatments they would endorse for the patient and their level of certainty.Outcome measuresWe calculated Simpson indices to measure inter-rater reliability and 2×2 analysis of variances as well as Bayesian estimation to examine clinical certainty based on patient background and gender.ResultsGPs’ clinical decisions about Somali and Norwegian vignette characters were similar, with a few exceptions. There was less consensus regarding the first prioritised diagnosis for Somali characters (Simpson index=0.129) versus Norwegian characters (Simpson index=0.208), (p=0.011, one-tailed). Somalis more frequently received diagnoses of post-traumatic stress disorder (PTSD), while Norwegians received diagnoses of feeling depressed. GPs endorsed sick leave more often for Norwegian characters and medication for physical complaints for Somali characters. There were no substantial differences in GPs’ self-reported certainty.ConclusionsWe found few and relatively small effects of patient background and gender on GPs’ clinical decisions. Nevertheless, the validity of certain diagnoses and prescription of sick leave need to be considered by clinicians and in future research.

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Section: Discussionmentioning

confidence: 99%

Section: Strengths and Limitations Of This Studymentioning

confidence: 99%

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General practitioners’ management of depression symptoms in Somali refugee and Norwegian patients: a film vignette experiment

et al. 2021

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“…The general practitioners expected that the patients gave a complete and clear description of what they want. The study also noted that general practitioners tend to be reluctant to refer their patients to psychologists, social works and specialized nurses [21]. Moreover, the study noted that the general practitioner's attitude towards the cancer patients' survivors was not a proactive approach as long as they were cancer-free.…”

Section: General Practitioners' Perspective Towards Cancer Survivor Return To Workmentioning

confidence: 95%

Primary Health Care Physician’s Role in Return to Work after Cancer: A Systematic Review

Murad

Almuhaysin²,

Alkhatem

et al. 2021

JPRI

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Cancer is considered one of the most debilitating diseases as it affects all aspects of patients' life. One of the most neglected aspects is the ability to return to work during or after cancer treatment. General practitioners were considered the most common visited physicians after cancer treatment. However, their role in this critical problem to cancer patients is not well established. That is why we have done this review to investigate the role of general practitioners and primary health care in cancer care and how it should be reinforced. Six databases were searched using specific search terms. We included any study that assessed the role of general practitioners to help cancer patients return to work. In addition, we included studies that assessed the difficulties towards the integration of general physicians into the plan of care of cancer patients. The studies were assessed for the quality of evidence using the NIH quality assessment tool before being included for the review. Seven studies fulfilled our inclusion criteria and had passed the quality assessment to be included for the qualitative evidence synthesis. Based on these studies, the patients reported the lack of support from the general practitioners in the primary health care, and they found the attitude of the general practitioners not encouraging to ask for support from them. For general practitioners, they acknowledged their lack of support towards cancer patients and they needed more resources so they can counsel the patient regarding their work environment. General practitioners lacked the necessary knowledge and resources required to help patients to get back to their workplace. More plans are required to help them understand the problems of cancer survivors so they can counsel them properly.

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“…The methodological quality and clinical realism of the vignettes were validated by an academic expert in experimental psychology Delaruelle et al ( 2021 ). For more details on the design, see Ceuterick et al ( 2020 ) and Delaruelle et al ( 2021 ). The script of the vignettes was developed and validated by an academic expert in experimental psychology and an advisory committee composed of two psychiatrists, two GPs, a psychiatric nurse, a psychologist, and an expert in culturally sensitive care.…”

Section: Appendix 1: Video Vignettes In French and In Dutch With The ...mentioning

confidence: 99%

Unintentional Discrimination Against Patients with a Migration Background by General Practitioners in Mental Health Management: An Experimental Study

Duveau

Wets

Delaruelle

et al. 2023

Adm Policy Ment Health

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Populations with a migration background have a higher prevalence of mental health problems than their native counterparts. They are also more likely to have unmet medical needs and are less frequently referred to mental health services. One potential explanation for this is that physicians, such as general practitioners (GPs), may unintentionally discriminate against migrant patients, particularly when they lack humanization. To date, no experimental study has investigated this hypothesis. This paper assesses the influence of humanization on GPs’ discriminatory decisions regarding migrant patients with depression. A balanced 2 × 2 factorial experiment was carried out with Belgian GPs (N = 797) who received video-vignettes depicting either a native patient or a migrant patient with depression. Half of the respondents were exposed to a text that humanized the patient by providing more details about the patient’s life story. Decisions related to diagnosis, treatment and referral were collected, as well as the time spent on each video and text, and were analysed using ANOVA. Migrant patients’ symptoms were judged to be less severe than those of native patients (F = 7.71, p < 0.05). For almost all treatments, the decision was less favourable for the migrant patient. Humanization had little effect on medical decisions. We observed that GPs spent significantly more time on the vignette with the humanization intervention, especially for the migrant patients. The results indicate that ethnic differences in the management of depression persist in primary care. Humanization, however, does not mitigate those differences in medical decisions.

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Assessing Provider Bias in General Practitioners’ Assessment and Referral of Depressive Patients with Different Migration Backgrounds: Methodological Insights on the Use of a Video-Vignette Study

Cited by 11 publications

References 57 publications

General practitioners’ management of depression symptoms in Somali refugee and Norwegian patients: a film vignette experiment

General practitioners’ management of depression symptoms in Somali refugee and Norwegian patients: a film vignette experiment

Primary Health Care Physician’s Role in Return to Work after Cancer: A Systematic Review

Unintentional Discrimination Against Patients with a Migration Background by General Practitioners in Mental Health Management: An Experimental Study

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