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.

How doctors' communication style and race concordance influence African-Caribbean patients when disclosing depression

Objective: To determine the impact of doctors' communication style and doctor-patient race concordance on UK African-Caribbeans' comfort in disclosing depression. Methods: 160 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. Results: Race 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). Conclusion: Doctors' 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 Implications: Practitioners should cultivate a HPC style to make African-Caribbeans more comfortable when disclosing depression, so that it is less likely to be missed.

Reflections on race in contemporary Ireland

Any reflection on the category "race" in the contemporary world is inevitably framed by the cumulative layers of meanings and practices attached to bodies and cultures over the previous centuries. If the idea of race resembles anything, it is a palimpsest,1with past interpretations leaking through to make the ink of the present run. Accordingly, I present some historical notes not as a distinct prelude to the "real" story, positing a rupture of past and present, but as the beginning of the story proper.

Big city days: Race and labor in early Miami, 1914--1925

The purpose of this study was to recast Miami's social history during the first three decades of the twentieth century through an examination of working class life. The thesis attempts to fill a gap in the literature while also expanding on the advances made in race and class studies of the United States. Through an analysis of local newspapers, minutes of a carpenter's union, and other archival sources, the thesis demonstrates how white workers obtained a virtual monopoly in skilled jobs over black workers, particularly in the construction industry, and exacted economic pressure on business through the threat of work stoppages. Driven by the concern to maintain smooth and steady growth amidst a vibrant tourist economy, business reluctantly worked with labor to maintain harmonious market conditions. Blacks, however, were able to gain certain privileges in the labor market through challenging the rigid system of segregation and notions of what constituted skilled labor. The findings demonstrate that Miami's labor unions shaped the city's social, cultural, and political landscape but the extent of their power was limited by booster discourse and the city's dependence on tourism. ^

The absence of race in democratic politics: The case of the Dominican Republic

This dissertation explores the relationship between race and democratization. Through the examination of the case of the Dominican Republic, this study challenges mainstream explanations of democratic transitions. At its core, this dissertation aims at calling attention to the absence of race and ethnic allegiances as explanatory variables of the democratic processes and debates in the region. By focusing on structural variables, the analysis shies away from elite and actor-centered explanations that fall short in predicting the developments and outcomes of transitions. The central research questions of this study are: Why is there an absence of the treatment of race and ethnic allegiances during the democratic transitions in Latin America and the Caribbean? How has the absence of ethnic identities affected the nature and depth of democratic transitions? Unlike previous explanations of democratic transitions, this dissertation argues that the absence of race in democratic transitions has been a deliberate attempt to perpetuate limited citizenship by political and economic elites. Findings reveal a difficulty to overcome nationalist discourses where limited citizenship has affected the quality of democracy. Original field research data for the study has been gathered through semi-structured interviews and focus groups conducted from October 2008 to December 2009 in the Dominican Republic.

Navigating racial boundaries: The one-drop rule and mixed-race Jamaicans in South Florida

Like many West Indians, mixed-race Jamaican immigrants enter the United States with fluid notions about race and racial identifications that reflect socio-political events in their home country and that conflict with the more rigid constructions of race they encounter in the U.S. This dissertation explores the experiences of racially mixed Jamaicans in South Florida and the impact of those experiences on their racial self-characterizations through the boundary-work theoretical framework. Specifically, the study examines the impact of participants’ exposure to the one-drop rule in the U.S., by which racial identification has been historically determined by the existence or non-existence of black forebears. Employing qualitative data collected through both focus group and face-to-face semi-structured interviews, the study analyzes mixed-race Jamaicans’ encounters in the U.S. with racial boundaries, and the boundary-work that reinforces them, as well their response to these encounters. Through their stories, the dissertation examines participants’ efforts to navigate racial boundaries through choices of various racial identifications. Further, it discusses the ways in which structural forces and individual agency have interacted in the formation of these identifications. The study finds that in spite of participants’ expressed preference for non-racialism, and despite their objections to rigid racial categories, in seeking to carve out alternative identities, they are participating in the boundary-making of which they are so critical.^

The influence of spirituality, race/ethnicity and religion on parent grief and mental health at one and three months after their infant's/child's death in the neonatal or pediatric intensive care unit

The death of an infant/child is one of the most devastating experiences for parents and immediately throws them into crisis. Spiritual and religious coping strategies may help parents with their loss. The purposes of this longitudinal study were to: (1) describe differences in bereaved parents' use of spiritual coping strategies across racial/ethnic and religious groups, mother/father dyads, and time—one (T1) and three (T2) months after the infant's/child's death in the neonatal (NICU) or pediatric intensive care unit (PICU), and (2) test the relationship between spiritual coping strategies and grief, mental health, and personal growth for mothers and fathers at T1 and T2. A sample of 126 Hispanic, Black/African American, and White parents of 119 deceased children completed the Spiritual Coping Strategies scale, Beck Depression Inventory-II, Impact of Events-Revised, Hogan Grief Reaction Checklist, and a demographic form at T1 and T2. Controlling for race and religion, spiritual coping was a strong predictor of lower grief, better mental health, and greater personal growth for mothers at T1 and T2 and lower grief for fathers at T1. The findings of this study will guide bereaved parents to effective strategies to help them cope with their early grief.

Critical Race Theory: Focusing the Lens on Human Resource Development

The challenge that continues to face HRD is how to integrate real concerns for diversity into programs, practices, and research. Critical race theory was used as a lens to examine work on diversity published in Human Resource Development Quarterly (HRDQ). Eight publications were selected and analyzed.

Using Critical Race Theory: An Analysis of Cultural Differences in Healthcare Education

This paper is a literature review of articles published from 1992 to 2002 in the American Journal of Health Education using critical race theory as a lens of analysis of culture differences in healthcare.

Critical Race Theory and Adult Education: Critique of the Literature in Adult Education Quarterly

This paper examines the assumptions and paradigms used to discuss diversity and equity in adult education literature using critical race theory as a lens. Five themes emerged from the critique that may initiate an innovative dialogue about the realities and subjectivities singling out racial and ethnic minorities in the USA.

The Exclusion of Race From Mandated Continuing Legal Education Requirements: A Critical Race Theory Analysis

The purpose of this paper is to critique the system of CLE using Critical Race Theory as an analytical lens in an effort to reveal possible reasons for the exclusion of bias and discrimination from CLE offerings in the legal profession.

Race, Gender, & Leadership: Perspectives of Female Secondary Leaders

Female secondary principals not only have to deal with internal and external pressures to lead successfully but are scrutinized because of their gender (Shakeshaft, 1993; Skrla & Young, 2003; Thurman, 2004). The purpose of this study was to investigate how female secondary principals from one southwestern state teased out complex views of leadership, gender, and race.

Investigating Race and Ethnicity on Data Collection and Analysis

This paper details the research methods an introductory qualitative research class used to both study an issue related to race and identity, and to familiarize themselves with data collection strategies. Throughout the paper the authors attempt to capture the challenges, disagreements, and consensus building that marked this unusual research endeavor.

Race, Class and the Promise of the Public University

Commencement address by Professor Thomas Breslin at Florida International University dissects in a few words both the promise of a public university system and the threats to that system embedded in racial and class privilege.