Abstract
Objective
Racial and ethnic disparities are well documented in psychiatry, yet suboptimal understanding of underlying mechanisms of these disparities undermines diversity, inclusion, and education efforts. Prior research suggests that implicit associations can affect human behavior, which may ultimately influence healthcare disparities. This study investigated whether racial implicit associations exist among medical students and psychiatric physicians and whether race/ethnicity, training level, age, and gender predicted racial implicit associations.
Methods
Participants completed online demographic questions and 3 race Implicit Association Tests (IATs) related to psychiatric diagnosis (psychosis vs. mood disorders), patient compliance (compliance vs. non-compliance), and psychiatric medications (antipsychotics vs. antidepressants). Linear and logistic regression models were used to identify demographic predictors of racial implicit associations.
Results
The authors analyzed data from 294 medical students and psychiatric physicians. Participants were more likely to pair faces of Black individuals with words related to psychotic disorders (as opposed to mood disorders), non-compliance (as opposed to compliance), and antipsychotic medications (as opposed to antidepressant medications). Among participants, self-reported White race and higher level of training were the strongest predictors of associating faces of Black individuals with psychotic disorders, even after adjusting for participant’s age.
Conclusions
Racial implicit associations were measurable among medical students and psychiatric physicians. Future research should examine (1) the relationship between implicit associations and clinician behavior and (2) the ability of interventions to reduce racial implicit associations in mental healthcare.
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Change history
05 April 2021
A Correction to this paper has been published: https://doi.org/10.1007/s40596-021-01435-w
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Acknowledgments
We would like to thank the following faculty and trainees who reviewed the pilots for this project: Dr. Robert Rohrbaugh, Dr. Kali Cyrus, Dr. Esperanza Diaz, and Dr. Laine Taylor. We would also like to thank Dr. Nix Zelin, Caroline Scott, and Dr. Roberto Montenegro for their support in recruitment. Preliminary data was presented as a poster at the American Psychiatric Association Meeting on May 5–9, 2018 in New York, NY, and the American College of Neuropsychopharmacology on December 10, 2018 in Hollywood, FL, and as an oral presentation at the American Academy of Child and Adolescent Psychiatry on October 22, 2018 in Seattle, WA.
Funding
Financial support for this project was provided by the American Psychiatric Association Minority Fellowship Program sponsored by SAMHSA that was awarded to A.L.T and J.H.T.
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A.LT. is supported by NIMH (5T32MH018268-34), the Ariella Ritvo grant. M.H.B. receives research support from Therapix Biosciences, Neurocrine Biosciences, Janssen Pharmaceuticals and Biohaven Pharmaceuticals, but received no support from these sources for the current manuscript. M.H.B. gratefully acknowledges additional research support from NIH. J.H.T is supported by the National Center for Advancing Translational Sciences at the NIH (KL2TR001879) and the Brain and Behavior Research Foundation. Mr. Johnson is supported by the Yale School of Medicine Medical Student Research Fellowship. Dr. Flores receives financial support for his research from NIH training grant T32MH018268. Dr. Landeros-Wisenberger, Dr. Avila-Quintero, Mr. Johnson, and Mr. Aboiralor report no financial relationships with commercial interests.
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Londono Tobon, A., Flores, J.M., Taylor, J.H. et al. Racial Implicit Associations in Psychiatric Diagnosis, Treatment, and Compliance Expectations. Acad Psychiatry 45, 23–33 (2021). https://doi.org/10.1007/s40596-020-01370-2
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DOI: https://doi.org/10.1007/s40596-020-01370-2