Understanding the Role of Past Health Care Discrimination in Help-Seeking and Shared Decision-Making for Depression Treatment Preferences

Abstract

As a part of a larger, mixed-methods research study, we conducted semi-structured interviews with 21 adults with depressive symptoms to understand the role that past health care discrimination plays in shaping help-seeking for depression treatment and receiving preferred treatment modalities. We recruited to achieve heterogeneity of racial/ethnic backgrounds and history of health care discrimination in our participant sample. Participants were Hispanic/Latino ( n = 4), non-Hispanic/Latino Black ( n = 8), or non-Hispanic/Latino White ( n = 9). Twelve reported health care discrimination due to race/ethnicity, language, perceived social class, and/or mental health diagnosis. Health care discrimination exacerbated barriers to initiating and continuing depression treatment among patients from diverse backgrounds or with stigmatized mental health conditions. Treatment preferences emerged as fluid and shaped by shared decisions made within a trustworthy patient–provider relationship. However, patients who had experienced health care discrimination faced greater challenges to forming trusting relationships with providers and thus engaging in shared decision-making processes.

Racism in healthcare: a scoping review

“…Other articles examine experiences of racism within specific illnesses or healthcare contexts. These include qualitative articles looking at hypertension care in the USA [ 66 ], decision making processes in diabetes care in the USA [ 67 ], depression care in USA [ 68 ], HIV-care in USA [ 69 – 72 ], mental care in USA [ 73 ], cardiovascular disease care in USA [ 74 ], reproductive, maternal and perinatal healthcare in USA [ 75 – 78 ], and chronic renal failure care in Brazil [ 79 ]. Quantitative articles examine how experiences of racism in HIV-care [ 80 , 81 ], sickle cell disease management in the USA [ 82 ] mental healthcare in UK [ 83 ] and in USA [ 8 , 84 ], diabetes care in USA [ 85 – 89 ], dental care in the USA [ 90 , 91 ] and maternal care in USA [ 92 ].…”

“…Qualitative studies show that experiences of racism by various racialized minority healthcare users are linked with feelings of frustration, sorrow, dismay and feeling insignificant as reported by e.g. Aboriginals in Australia [ 116 ] and African Americans [ 33 , 68 ]. The qualitative studies also show that racialized minority healthcare users avoid seeking healthcare due to experiences of racism in healthcare services.…”

Perceived healthcare discrimination and well-being among older adults in the United States and Brazil

“…Perceiving discrimination may contribute to decreased provider visits ( Facione & Facione, 2007 ) and reduced utilization of preventive healthcare services ( Trivedi & Ayanian, 2006 ). Moreover, patient experiences of discrimination are associated with delays in filling prescriptions, treatment nonadherence, and varied treatment preference ( Burgess et al, 2007 ; Casagrande et al, 2007 ; Progovac et al, 2020 ; Sonik et al, 2020 ). For example, Alcalá and Cook (2018) found that perceived racial or ethnic discrimination in healthcare in the US was associated with higher odds of delaying or forgoing medical care or prescriptions in the past 12 months.…”

Developing new ways to listen: the value of narrative approaches in empirical (bio)ethics

“…In a similar way, patients' stories seem to take a specific shape in their encounters with clinicians; they can be disjointed, focusing on medical-technical aspects, and leaving out clues to social and cultural contexts [18,20,24]. Furthermore, factors such as age, gender, cultural and mental health background, expectations and powerimbalances in the doctor-patient relationship, and organizational factors have shown to profoundly influence what is being told by patients and how clinicians respond to it [25][26][27][28]. And even when a person-centered care approach is deliberately applied, some patients' stories are taken more seriously than others [29].…”