Abstract
ObjectiveTo determine the impact of doctors’ communication style and doctor–patient race concordance on UK African–Caribbeans’ comfort in disclosing depression. Methods160 African–Caribbean and 160 white British subjects, stratified by gender and history of depression, participated in simulated depression consultations with video-recorded doctors. Doctors were stratified by black or white race, gender and a high (HPC) or low patient-centred (LPC) communication style, giving a full 2×2×2 factorial design. Afterwards, participants rated aspects of doctors’ communication style, their comfort in disclosing depression and treatment preferences ResultsRace concordance had no impact on African–Caribbeans’ comfort in disclosing depression. However a HPC versus LPC communication style made them significantly more positive about their interactions with doctors (p=0.000), their overall comfort (p=0.003), their comfort in disclosing their emotional state (p=0.001), and about considering talking therapy (p=0.01); but less positive about considering antidepressant medication (p=0.01). ConclusionDoctors’ communication style was shown to be more important than patient race or race concordance in influencing African Caribbeans’ depression consultation experiences. Changing doctors’ communication style may help reduce disparities in depression care. Practice ImplicationsPractitioners should cultivate a HPC style to make African–Caribbeans more comfortable when disclosing depression, so that it is less likely to be missed.
Highlights
This paper aims to shed light on aspects of primary care practice which can improve the experiences of UK African–Caribbeans presenting with depression, and help reduce racial disparities in care
We achieved our target of recruiting 320 White British and African–Caribbean male and female analogue patients (160 of each), as described above, with a response rate of 20.7% for those recruited via clinical services
To test Hypotheses 1 and 2, that black compared with white patients will find it more difficult to disclose depression to primary care doctors and feel less comfortable with doctors overall, we examined analogue patients (APs)’ responses to the questions: “To what extent did you feel COMFORTABLE disclosing your emotional state to this doctor?” and “To what extent did you feel COMFORTABLE, overall, with this doctor?” Table 3 shows there are no statistically significant differences between the two races; so Hypotheses 1 and 2 are rejected
Summary
This paper aims to shed light on aspects of primary care practice which can improve the experiences of UK African–Caribbeans presenting with depression, and help reduce racial disparities in care. It explores the impact of different consultation conditions on African–Caribbeans' ability to disclose symptoms of depression. Depression is acknowledged to be difficult to diagnose, and is missed in about 50% of primary care consultations [1] Reasons for this are due to a complex mix of patient and doctor factors, a key one of which is patients’ difficulty in disclosing their symptoms [2]
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