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OP44 Unintentional discrimination against patients with a migration Background by general practitioners in mental health management: an experimental study
  1. Camille Duveau1,
  2. Camille Wets2,
  3. Katrijn Delaruelle2,
  4. Stéphanie Demoulin3,
  5. Marie Dauvrin1,
  6. Brice Lepièce1,
  7. Melissa Ceuterick2,
  8. Piet Bracke2,
  9. Vincent Lorant1
  1. 1Institute of Research Health and Society, University Catholic of Louvain, Brussels, Belgium
  2. 2Health and Demographic Research, Ghent University, Ghent, Belgium
  3. 3Psychological Sciences Research Institute, University Catholic of Louvain, Louvain-la-Neuve, Belgium


Background Generally, there is a higher prevalence of mental health problems among people with a migration background, hereinafter “migrant patients”, than among their native counterparts. They are also more likely to have unmet medical needs and are less frequently referred to mental health services. One potential explanation is that general practitioners (GPs) may unintentionally discriminate against patients in this group, particularly when they dehumanize those patients. Humanization is a care model whereby medical doctors consider the patient’s life story, show empathy, and practice active listening with patients. To date, no experimental study has empirically investigated this hypothesis. This paper, therefore, sought to assess the influence of humanization on GPs’ discriminatory attitudes towards diagnosis, assessment of severity of symptoms, treatment, and referral decisions regarding depressed patients with and without a migration background.

Methods A balanced 2X2 factorial experiment was carried out with Belgian GPs (N = 797). It used four video vignettes depicting either a native patient or a migrant patient with depressive symptoms. Half of the respondents were exposed to an intervention that aimed to humanize the patient by providing more details about the patient’s life story. The randomly assigned vignette was followed by an online questionnaire about diagnosis, assessment of severity of symptoms, treatment, and referral decisions. Chi-square, two-way ANOVA, and MANOVA were used for the analysis.

Results GPs systematically judged the migrant patients’ symptoms to be less severe than those of the native patients (F = 7.71, p < 0.05). GPs also prescribed benzodiazepines less often to migrants (F = 8.79, p < 0.01), and this result was not explained by adjusting the model for the assessment of the severity of symptoms (F =9.94, p < 0.01). We observed, however, that the humanization intervention had little effect on the diagnosis, treatment, and referral of depressed patients, regardless of their migration status.

Conclusion In summary, the results indicate that ethnic differences in the management of depression persist in Belgian primary care, for example, in the assessment of severity of symptoms and in treatment prescription. We cannot, however, assert that humanization interventions are a factor that mitigates those differences in medical decisions and disparities in the use of mental health care services.

  • General practitioners
  • mental health
  • migrant

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