Date of Award

2013

Degree Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

Department

Psychology

Abstract

The current project included a pilot and primary study with experimental designs to explore the impact that a patient's race, mental health and socioeconomic status (SES) have on impression formation, affective reactions, and communication with patients. The

medical literature shows that health disparities exist for minorities and individuals with low socioeconomic statuses (Adler & Ostrove, 1999). In addition individuals with severe mental illness receive low quality care for their physical health in comparison to those presenting only a physical illness (Lawrence & Kisely, 2010).

To explore this phenomenon, pilot study participants read one of eight descriptions of a man visiting a doctor because of unexplained weight loss. The scenarios varied by race (black/white), depression diagnosis (no/yes), and SES (not low/low). Participants answered questions about their impressions of the patient, affective reactions to the patient, and basic personal demographics. I hypothesized that the scenarios describing a black man, a man with a low SES and a man with depression would elicit more stigmatizing responses than a white man, a man without a low SES and a man without depression. While no effects were found for race, results showed that a patient with low SES or depression were seen as less warm and competent than a patient with neither condition but more warm than a patient with both conditions. The findings were largely consistent with the Stereotype Content Model, which was used along with the Behavior from Intergroup Affect and Stereotypes (BIAS) Map to formulate second study hypotheses.

Using secondary data, I analyzed physician communication with a patient whose presentation varied by SES and depression. A standardized patient, who followed a script very similar to the scenarios, played the patient. Measures of communication were

based on the Roter Interactional Analysis System (RIAS) and coded from transcripts of surreptitiously recorded medical encounters. As predicted results showed low socioeconomic status patients experienced less positive communication. However, contrary to predictions, patients with depression received less stigmatizing and more patient-centered communication. Future work should explore the implications of differential reactions to stigmatizing characteristics in physician communication and how to translate these into impacts on patient care.

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