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Disentangling bias in the provision and receipt of depression care and screening for suicide risk in the US and the UK

We conducted a five-year research project which explored the effect of doctor and patient characteristics such as gender, ethnicity, age and socio-economic status on the provision and receipt of depression care within the UK and the USA. We were particularly interested in exploring the effect of ethnicity and gender, as previous research had shown that they can lead to differences in care. The project was funded by the Economic and Social Research Council (ESRC) as part of a joint ESRC and US national institutes of health initiative on disparities in health and was a collaboration between Warwick, Aston and Johns Hopkins universities.

The research investigated what actually happened between doctors and patients during depression consultations and identified where communication could go wrong, and how diagnostic decisions are affected by the social characteristics of doctors and patients. By doing this we were able to develop guidance for both doctors and patients about how to improve depression care. In order to explore the impact of doctor and patient characteristics on care for depression, we undertook three separate studies:

Phase One

Phase one of the project involved exploring doctors’ clinical decision-making and thinking processes associated with diagnosing depression. We were applying an enhanced version of the CliniClass system to analyse interviews with 128 doctors collected as part of a previous US/UK study, within which they explained their thoughts about a patient portrayed by an actor who displayed symptoms strongly suggestive of depression. We were exploring how patients' gender and ethnicity (white versus Afro-Caribbean and African American) influenced doctors' thought processes.

Phase Two

Phase two involved investigating participants’ thoughts about simulated depression care visits. Participants were invited to think back to a difficult time in their lives and to interact with an analogue doctor on a video screen, responding as they would in a real-life consultation. To explore the effect of patient and doctor characteristics on participants’ views of depression care visits, we needed to recruit 320 participants to the study, to include both men and women and also Afro-Caribbean and White British participants.

Phase Three

Phase three involved analysing real consultation data, which was gained via the Galatean Risk and Safety Tool (GRiST, see database. GRiST is a web-based decision support system for assessing risks associated with mental health problems. These included the risks of suicide, self-harm, harm to others and self-neglect. By analysing the anonymised data within the GRiST database, we were able to compare if data gained via interviews with doctors and participants was in accordance with what actually happened in clinical practice.

The research team was:

Dr Ann Adams (Principal Investigator)

Dr Veronica Nanton

Mrs Laura Vail