Date of Award

January 2020

Document Type

Open Access Thesis

Degree Name

Medical Doctor (MD)



First Advisor

Michael H. Bloch


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


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.


This is an Open Access Thesis.

Open Access

This Article is Open Access