Date of Award
January 2020
Document Type
Open Access Thesis
Degree Name
Medical Doctor (MD)
Department
Medicine
First Advisor
Michael H. Bloch
Abstract
Objective: In the past decade there has been increased interest in understanding racial
disparities throughout the world. In doing so, racial associations and biases have been
found to be one potential etiology of these disparities. Particularly in the medical field,
trainings and institutions often have providers rely on self-reported racial associations as
a means to understanding their biases. However, there is little known on how
explicit/self-reported associations relate to implicit associations and clinical behavior,
specifically within mental healthcare. This study aims to understand the relationship
between explicit/self-reported statements and psychiatric providers’ implicit racial
associations.
Methods: Psychiatric providers were asked to provide explicit/self-reported statements
reflecting their views on racial associations regarding (1) compliance, (2) diagnosis, and
(3) treatment. They were also asked to complete 3 race Implicit Association Tests (IATs)
on the same outcomes. Demographic predictors of self-reported statements were
examined. Linear regression models were used to estimate the association between
explicit/self-reported associations and results of IATs, which served as indicators of
implicit racial associations.
Results: We analyzed data from 294 providers who completed IATs. Training level was
the only demographic predictor of explicit/self-reported associations—Board-certified
psychiatrists had stronger explicit/self-reported associations of Black patients with noncompliance,
compared to medical students (βΔD= 0.03, P <0.01) but not for the other
assessed categories. Explicit/self-reported and implicit associations linking noncompliance
with Black patients were significantly but weakly correlated (βΔD=0.11; P
0.01, R2=0.03). Otherwise, explicit/self-reported statements were NOT significantly
correlated with implicit associations.
Conclusions: Overall, these results suggest a dissociation between psychiatry providers’
explicit/self-reported vs. implicit racial associations. This may imply that racial
associations and biases often operate outside conscious awareness. Future studies may
benefit from including both implicit and explicit association assessments in order to
better understand their relationship and how these (1) affect clinical behavior and (2)
whether interventions can change both self-reported and implicit racial associations. This
is vital to better understand conscious and unconscious processes within individuals,
particularly psychiatrists, to reduce racial disparities within healthcare. It is also essential
in our efforts to create a world with justice, liberty, and meaning for all.
Recommended Citation
Cunningham, Dervin Junior, "Exploring The Role Of Racial Associations Within Life And Psychiatry: The Dissociation Of Explicit And Implicit" (2020). Yale Medicine Thesis Digital Library. 3892.
https://elischolar.library.yale.edu/ymtdl/3892
Comments
This is an Open Access Thesis.