Factors associated with discrimination in GPs’ decisions towards migrants with mental health problems

BACKGROUND: Although people with a migration background (MB) have more unmet mental health needs than the general population, patients with a MB are still underrepresented in mental health care services. Provider bias towards these patients has been evidenced repeatedly but its driving factors remain elusive. We assessed the moderating effect of individual (e.g. age and ethnicity), interpersonal (e.g. provider trust), and organizational (e.g. perceived workload) factors on general practitioners’ (GPs) differential decision-making regarding diagnosis, treatment, and referral for a depressed patient with a MB and for a depressed patient without a MB. METHODS: An experimental study was carried out in which GPs were shown one of two video-vignettes featuring adult male depressed patients, one with a MB and the other without. Belgian GPs (n = 797) had to decide on their diagnosis, treatment, and referral. ANOVA and logistic regression were used to analyse the effect of a MB, adding interaction terms for the explanatory variables. RESULTS: Overall, we found that there were ethnic differences in GPs’ decisions regarding diagnosis and treatment recommendations (F = 3.56, p < 0.001). GPs also considered the symptoms of the patient with a MB less severe (F = 7.68, p < 0.01) and were less likely to prescribe a combination of medical and non-medical treatment to patients with a MB (F = 11.55, p < 0.001). Those differences increased in accordance with the GP's age and perceived workload; at an interpersonal level, we found that differences increased when the GP thought the patient was malingering or exaggerating his distress. CONCLUSIONS: This paper showed that GPs’ trust in their patients and GPs’ workload affect ethnic bias in medical decisions. This may perpetuate ethnic inequalities in mental health care. Future researchers should develop an intervention to decrease the ethnic inequities in mental health care by addressing GPs’ trust in their migrant patients. KEY MESSAGES: • This research provides an insight into the discriminatory decisions made by GPs in mental healthcare. • Future research should take interpersonal and organizational factors into account when developing new interventions to improve quality of care for migrants with mental health problems.