Investigating the influence of African American and African Caribbean race on primary care doctors' decision making about depression

This paper explores differences in how primary care doctors process the clinical presentation of depression by African American and African-Caribbean patients compared with white patients in the US and the UK. The aim is to gain a better understanding of possible pathways by which racial disparities arise in depression care. One hundred and eight doctors described their thought processes after viewing video recorded simulated patients presenting with identical symptoms strongly suggestive of depression. These descriptions were analysed using the CliniClass system, which captures information about micro-components of clinical decision making and permits a systematic, structured and detailed analysis of how doctors arrive at diagnostic, intervention and management decisions. Video recordings of actors portraying black (both African American and African-Caribbean) and white (both White American and White British) male and female patients (aged 55 years and 75 years) were presented to doctors randomly selected from the Massachusetts Medical Society list and from Surrey/South West London and West Midlands National Health Service lists, stratified by country (US v.UK), gender, and years of clinical experience (less v. very experienced). Findings demonstrated little evidence of bias affecting doctors' decision making processes, with the exception of less attention being paid to the potential outcomes associated with different treatment options for African American compared with White American patients in the US. Instead, findings suggest greater clinical uncertainty in diagnosing depression amongst black compared with white patients, particularly in the UK. This was evident in more potential diagnoses. There was also a tendency for doctors in both countries to focus more on black patients' physical rather than psychological symptoms and to identify endocrine problems, most often diabetes, as a presenting complaint for them. This suggests that doctors in both countries have a less well developed mental model of depression for black compared with white patients. © 2014 The Authors.

Talking about depression:an analogue study of physician gender and communication style on patient disclosures

Objectives: To disentangle the effects of physician gender and patient-centered communication style on patients' oral engagement in depression care. Methods: Physician gender, physician race and communication style (high patient-centered (HPC) and low patient-centered (LPC)) were manipulated and presented as videotaped actors within a computer simulated medical visit to assess effects on analogue patient (AP) verbal responsiveness and care ratings. 307 APs (56% female; 70% African American) were randomly assigned to conditions and instructed to verbally respond to depression-related questions and indicate willingness to continue care. Disclosures were coded using Roter Interaction Analysis System (RIAS). Results: Both male and female APs talked more overall and conveyed more psychosocial and emotional talk to HPC gender discordant doctors (all p <.05). APs were more willing to continue treatment with gender-discordant HPC physicians (p <.05). No effects were evident in the LPC condition. Conclusions: Findings highlight a role for physician gender when considering active patient engagement in patient-centered depression care. This pattern suggests that there may be largely under-appreciated and consequential effects associated with patient expectations in regard to physician gender that these differ by patient gender. Practice implications: High patient-centeredness increases active patient engagement in depression care especially in gender discordant dyads. © 2014.

From apartheid to unity: white capital and black power in the racial integration of South African football, 1976-1992

This article analyses the complex process that deracialised and democratised South African football between the early 1970s and 1990s. Based mainly on archival documents, it argues that growing isolation from world sport, exemplified by South Africa's expulsion from the Olympic movement in 1970 and FIFA in 1976, and the reinvigoration of the liberation struggle with the Soweto youth uprising triggered a process of gradual desegregation in the South African professional game. While Pretoria viewed such changes as a potential bulwark against rising black militancy, white football and big business had their own reasons for eventually supporting racial integration, as seen in the founding of the National Soccer League. As negotiations for a new democratic South Africa began in earnest between the African National Congress (ANC) and the National Party (NP) in the latter half of the 1980s, transformations in football and politics paralleled and informed each other. Previously antagonistic football associations began a series of 'unity talks' between 1985 and 1986 that eventually culminated in the formation of a single, non-racial South African Football Association in December 1991, just a few days before the Convention for a Democratic South Africa (CODESA) opened the process of writing a new post-apartheid constitution. Finally, three decades of isolation came to an end as FIFA welcomed South Africa back into world football in 1992 - a powerful example of the seemingly boundless potential of a liberated and united South Africa ahead of the first democratic elections in 1994.