Background

Racial and ethnic minorities face disparities in access to health care. Culturally competent care might lessen these disparities. Few studies have studied the patients' view of providers' cultural competence, especially in psychiatric care. We aimed to examine the associations of race, ethnicity, and mental health status with patient-reported importance of provider cultural competence.

Methods

Our retrospective, population-based, cross-sectional study used data extracted from self-reported questionnaires of adults aged at least 18 years who participated in the US National Health Interview Survey (NHIS; 2017 cycle). We included data on all respondents who answered supplementary cultural competence questions and the Adult Functioning and Disability survey within the NHIS. We classified participants as having anxiety or depression if they reported symptoms at least once a week or more often, and responded that the last time they had symptoms the intensity was “somewhere between a little and a lot” or “a lot.” Participant answers to cultural competency survey questions (participant desire for providers to understand or share their culture, and frequency of access to providers who share their culture) were the outcome variables. Multivariable ordinal logistic regressions were used to estimate adjusted odds ratios (aORs) for the outcome variables in relation to sociodemographic characteristics (including race and ethnicity), self-reported health status, and presence of symptoms of depression, anxiety, or both.

Findings

3910 people had available data for analysis. Mean age was 52 years (IQR 36–64). 1422 (39·2%, sample weight adjusted) of the participants were men and 2488 (60·9%) were women. 3290 (82·7%) were White, 346 (9·1%) were Black or African American, 31 (0·8%) were American Indian or Alaskan Native, 144 (4·8%) were Asian American, and 99 (2·6%) were Mixed Race. 380 (12·5%) identified as Hispanic ethnicity and 3530 (87·5%) as non-Hispanic. Groups who were more likely to express a desire for their providers to share or understand their culture included participants who had depression symptoms (vs those without depression or anxiety symptoms, aOR 1·57 [95% CI 1·13–2·19], p=0·008) and participants who were of a racial minority group (Black vs White, aOR 2·54 [1·86–3·48], p=0·008; Asian American vs White, aOR 2·57 [1·66–3·99], p<0·001; and Mixed Race vs White, aOR 1·69 [1·01–2·82], p=0·045) or ethnic minority group (Hispanic vs non-Hispanic, aOR 2·69 [2·02–3·60], p<0·001); these groups were less likely to report frequently being able to see providers who shared their culture (patients with depression symptoms vs those without depression or anxiety symptoms, aOR 0·63 (0·41–0·96); p=0·030; Black vs White, aOR 0·56 [0·38–0·84], p=0·005; Asian American vs White, aOR 0·38 [0·20–0·72], p=0·003; Mixed Race vs White, aOR 0·35 [0·19–0·64], p=0·001; Hispanic vs non-Hispanic, aOR 0·61 [0·42–0·89], p=0·010). On subgroup analysis of participants reporting depression symptoms, patients who identified their race as Black or African American, or American Indian or Alaskan Native, and those who identified as Hispanic ethnicity, were more likely to report a desire for provider cultural competence.

Interpretation

Racial and ethnic disparities exist in how patients perceive their providers' cultural competence, and disparities are pronounced in patients with depression. Developing a culturally competent and humble approach to care is crucial for mental health providers.

Funding

None.

中文翻译：

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患有抑郁和焦虑症状的患者对医疗服务提供者文化能力的看法存在种族和民族差异：基于人群的回顾性横断面分析

背景

种族和族裔少数群体在获得医疗保健方面面临着不平等。具有文化能力的护理可能会减少这些差异。很少有研究研究患者对医疗服务提供者文化能力的看法，尤其是在精神科护理方面。我们的目的是研究种族、民族和心理健康状况与患者报告的提供者文化能力的重要性之间的关系。

方法

我们的回顾性、基于人群的横断面研究使用了从参加美国国家健康访谈调查（NHIS；2017 年周期）的至少 18 岁成年人的自我报告问卷中提取的数据。我们纳入了所有回答补充文化能力问题以及 NHIS 内成人功能和残疾调查的受访者的数据。如果参与者每周至少报告一次或更频繁地报告症状，我们将其归类为患有焦虑或抑郁，并回答说，他们上次出现症状时的强度是“介于一点和很多之间”或“很多”。参与者对文化能力调查问题的回答（参与者希望提供者了解或分享其文化，以及访问分享其文化的提供者的频率）是结果变量。使用多变量序数逻辑回归来估计与社会人口特征（包括种族和民族）、自我报告的健康状况以及是否存在抑郁、焦虑或两者症状相关的结果变量的调整优势比（aOR）。

发现

3910 人拥有可用于分析的数据。平均年龄为 52 岁（IQR 36-64）。1422 名（39·2%，样本权重调整）参与者为男性，2488 名（60·9%）为女性。3290 名 (82·7%) 为白人，346 名 (9·1%) 为黑人或非裔美国人，31 名 (0·8%) 为美洲印第安人或阿拉斯加原住民，144 名 (4·8%) 为亚裔美国人，99 名(2·6%) 是混血儿。380 名 (12·5%) 被认定为西班牙裔，3530 名 (87·5%) 被认定为非西班牙裔。更有可能表达希望其提供者分享或理解其文化的群体包括有抑郁症状的参与者（与没有抑郁或焦虑症状的参与者相比，aOR 1·57 [95% CI 1·13–2·19]， p=0·008）以及属于少数种族群体的参与者（黑人与白人，aOR 2·54 [1·86–3·48]，p=0·008；亚裔美国人与白人，aOR 2·57 [ 1·66–3·99]，p<0·001；混血与白人，aOR 1·69 [1·01–2·82]，p=0·045）或少数族裔群体（西班牙裔与非裔）西班牙裔，aOR 2·69 [2·02–3·60]，p<0·001)；这些群体不太可能经常报告能够见到与其文化相同的提供者（有抑郁症状的患者与没有抑郁或焦虑症状的患者，aOR 0·63（0·41–0·96）；p=0·030；黑人与白人，aOR 0·56 [0·38–0·84]，p=0·005；亚裔美国人与白人，aOR 0·38 [0·20–0·72]，p=0·003；混合种族与白人，aOR 0·35 [0·19–0·64]，p=0·001；西班牙裔与非西班牙裔，aOR 0·61 [0·42–0·89]，p=0·010） 。在对报告抑郁症状的参与者进行亚组分析时，自认为种族为黑人或非裔美国人、美洲印第安人或阿拉斯加原住民的患者以及西班牙裔患者更有可能报告对提供者文化能力的渴望。

解释

患者如何看待其提供者的文化能力存在种族和民族差异，抑郁症患者的差异尤为明显。对于心理健康服务提供者来说，制定一种文化上合格且谦虚的护理方法至关重要。

资金

没有任何。