Original Article

Journal of General Internal Medicine

, Volume 23, Issue 5, pp 600-606

Patient–Physician Communication in the Primary Care Visits of African Americans and Whites with Depression

  • Bri K. GhodsAffiliated withDivision of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine
  • , Debra L. RoterAffiliated withDepartment of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health
  • , Daniel E. FordAffiliated withDivision of General Internal Medicine, Department of Medicine, Johns Hopkins University School of MedicineDepartments of Epidemiology and Health Policy & Management, Johns Hopkins Bloomberg School of Public HealthJohns Hopkins Medical Institutions, Welch Center for Prevention, Epidemiology, and Clinical Research
  • , Susan LarsonAffiliated withDepartment of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health
  • , Jose J. ArbelaezAffiliated withDivision of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine
  • , Lisa A. CooperAffiliated withDivision of General Internal Medicine, Department of Medicine, Johns Hopkins University School of MedicineDepartments of Epidemiology and Health Policy & Management, Johns Hopkins Bloomberg School of Public HealthJohns Hopkins Medical Institutions, Welch Center for Prevention, Epidemiology, and Clinical Research Email author 

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Abstract

Background

Little research investigates the role of patient–physician communication in understanding racial disparities in depression treatment.

Objective

The objective of this study was to compare patient–physician communication patterns for African-American and white patients who have high levels of depressive symptoms.

Design, Setting, and Participants

This is a cross-sectional study of primary care visits of 108 adult patients (46 white, 62 African American) who had depressive symptoms measured by the Medical Outcomes Study–Short Form (SF-12) Mental Component Summary Score and were receiving care from one of 54 physicians in urban community-based practices.

Main Outcomes

Communication behaviors, obtained from coding of audiotapes, and physician perceptions of patients’ physical and emotional health status and stress levels were measured by post-visit surveys.

Results

African-American patients had fewer years of education and reported poorer physical health than whites. There were no racial differences in the level of depressive symptoms. Depression communication occurred in only 34% of visits. The average number of depression-related statements was much lower in the visits of African-American than white patients (10.8 vs. 38.4 statements, p = .02). African-American patients also experienced visits with less rapport building (20.7 vs. 29.7 statements, p = .009). Physicians rated a higher percentage of African-American than white patients as being in poor or fair physical health (69% vs. 40%, p = .006), and even in visits where depression communication occurred, a lower percentage of African-American than white patients were considered by their physicians to have significant emotional distress (67% vs. 93%, p = .07).

Conclusions

This study reveals racial disparities in communication among primary care patients with high levels of depressive symptoms. Physician communication skills training programs that emphasize recognition and rapport building may help reduce racial disparities in depression care.

KEY WORDS

depression African Americans healthcare disparities patient–physician communication