Patient race and gender may affect physician diagnosis of mental health problems

The race and gender of a patient may influence whether his or her mental health problems are recognized by a primary care physician, suggest the results of a study.

Mental health problems like depression are common in primary care populations and can severely impair functioning. These problems can also be costly since such conditions tend to increase primary care visits.

"A significant finding was that patient race/ethnicity and gender influenced physician recognition of mental health problems," said lead author Steven J. Borowsky, MD, MPH, of the Minneapolis VA Center for Chronic Disease Outcomes Research in Minneapolis, MN.

This study is based on data from the late 1980s and focused on a large group of patients in the general population who received an independent screening for mental health problems. The researchers surveyed physicians to determine whether mental health problems were recognized.

Physicians were less likely to detect mental health problems in African Americans and Hispanics compared to whites and were less likely to detect such problems in men compared to women, the researchers found. The study results appear in the June 2000 issue of the Journal of General Internal Medicine.

Other findings included that physicians were generally more effective at recognizing severe depression--they detected nearly 60 percent of patients with major depression--than mild depression. "These absolute rates of detection are consistent with many other studies that indicate the need for better depression recognition," said Borowsky.

Also, depression in patients with common medical illnesses like hypertension and diabetes was more likely to be recognized. Such patients may visit their doctors more frequently and may feel comfortable discussing mental health issues, the researchers speculated.

"Poor detection of depression by primary care providers could be a major barrier to appropriate care for African-American and Hispanic patients because they are even more unlikely than nonminority populations to access care for this illness from nonprimary care providers," said Borowsky.

The lower rate of detection among minorities may relate in part to their receiving care from physicians who are less oriented toward depression counseling. Borowsky and colleagues based this assertion on results from another facet of their study: a survey of physician characteristics.

The scientists called for more research into how physician characteristics affect the detection of mental health problems, particularly in minority populations. "Strategies to improve detection of mental health problems in specific populations, such as African Americans, Hispanics, and men, should be explored and evaluated," said Borowsky.

The Journal of General Internal Medicine, a monthly peer-reviewed journal of the Society of General Internal Medicine, publishes original articles on research and education in primary care. For information about the journal, contact Renee F. Wilson at (410) 955-9868.

Posted by the Center for the Advancement of Health (http://www.cfah.org). For information about the Center, call Petrina Chong, pchong@cfah.org (202) 387-2829.