Tag: bias

Reading of the Week: More Therapy, More Inequity? The New JAMA Psych Study; Also, Dr. Reimer on Living with Depression and Generative AI & Biases

January 23, 2025 /

From the Editor

What has been the most significant innovation in mental healthcare delivery in recent years? It wasn’t a new medication or therapy, but the widespread adoption of the webcam in 2020. Over the course of a handful of pandemic weeks, psychiatrists and therapists switched to virtual sessions, making it easier for people to receive care, including psychotherapy, unbound by geography, and thus addressing inequity – or, at least, that was the hope. As noted recently in The New York Times: “In the 1990s, teletherapy was championed as a way to reach disadvantaged patients living in remote locations where there were few psychiatrists. A decade later, it was presented as a more accessible alternative to face-to-face sessions, one that could radically lower barriers to care.”

So, are more people receiving psychotherapy? And has this new era of virtual care resulted in better access for all? Dr. Mark Olfson (of Columbia University) and his co-authors attempt to answer these questions in a new paper for JAMA Psychiatry. Drawing on the data of more than 90 000 Americans, they analyzed trends in outpatient psychotherapy in the US, finding more care than ever before. That said, they note greater inequity: “psychotherapy use increased significantly faster among several socioeconomically advantaged groups and that inequalities were evident in teletherapy access.” We consider the study and its implications.

As doctors, we often shy away from discussing our health, especially our mental health – even with our own physicians. This is particularly concerning because doctors have a higher suicide rate than the general population, yet fears of vulnerability, judgment, and stigma keep many of us silent. In this episode of Quick Takes, I sit down with Dr. Joss Reimer, president of the Canadian Medical Association, who openly shares her own experiences with depression, as a doctor and as a patient. “We all need help sometimes.”

And in the third selection, Matthew Flathers (of Harvard University) et al. analyze AI depictions of psychiatric diagnoses in a new paper for BMJ Mental Health. They tested two AI image models with different diagnoses and commented on the results. “Generative AI models acquire biases at every stage of their development – from societal prejudice in online training data, to the optimisation metrics and safety guidelines each developer puts in place. These layered biases persist even when their precise origins remain elusive.”

DG

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Reading of the Week: Physician Burnout – the New NEJM Review; Also, Depression in India and Dr. Ushna Shamoon on Bias

November 7, 2024 /

From the Editor

I started watching the clock, thinking about how much time is left in my day. That just started getting earlier and earlier. One day, at 8:35 am, I thought: Oh boy, it feels like I’ve been here a while already.

So comments a colleague on his burnout. 

More and more, we are discussing physician burnout. But how has the concept of burnout evolved over time? How is it distinct from depression? What are evidence-based interventions? Drs. Constance Guille (of the University of South Carolina) and Srijan Sen (of the University of Michigan) seek to answer these questions in a new review for The New England Journal of Medicine. Though they note challenges, including with the definition itself, they strike an optimistic tone. “Over the past 15 years, progress has been made in raising awareness about physician well-being and improving well-being in specific populations, including physicians in training. There is a clear pathway for investing in and implementing established interventions and developing new interventions to improve well-being for all physicians.” We consider the review and its implications.

In the second selection, Dr. Felix Teufel (of Emory University) and his co-authors explore the treatment of depression in India. In a new JAMA Psychiatry brief report, they drew on a national survey, finding limited care, particularly among those living in rural areas. “Nationwide, 97% of individuals with depression were undiagnosed, and around half of individuals with diagnosed depression were untreated.”

And, in the third selection from Academic Psychiatry, Dr. Ushna Shamoon (of the University of Texas) writes about her medical school rotation in a county jail. She discusses her biases before stepping into the correctional facility. She then describes her connection to an inmate suffering from mental illness. “Though her mind was riddled with psychosis, she was not just a victim of her illness.”

Note: there will be no Reading next week.

DG

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Reading of the Week: Ethnicity, Bias, and Alcohol – the New AJP Paper; Also, Global Mental Health & AI (JAMA Psych) and Halprin on Her Mother (Globe)

May 25, 2023 /

From the Editor

He drinks heavily, but does he have a diagnosed alcohol use disorder?

Does the answer to that question tie to ethnicity and biases? In a new American Journal of Psychiatry paper, Rachel Vickers-Smith (of the University of Kentucky) and her co-authors suggest it does. Drawing on US Veterans Affairs’ data with over 700,000 people, they analyzed the scores of a screening tool and the diagnoses with ethnicity recorded in the EMR. “We identified a large, racialized difference in AUD diagnosis, with Black and Hispanic veterans more likely than White veterans to receive the diagnosis at the same level of alcohol consumption.” We look at the paper and mull its implications.

In the second selection, Alastair C. van Heerden (of the University of the Witwatersrand) and his co-authors consider AI and its potential for global mental health services in a new JAMA Psychiatry Viewpoint. They focus on large language models (think ChatGPT) which could do several things, including helping to train and supervise humans. “Large language models and other forms of AI will fundamentally change how we treat mental disorders, allowing us to move away from the current model in which most of the world’s population does not have access to quality mental health services.”

And, in the third selection, Paula Halprin discusses her mother’s alcohol use in an essay for The Globe and Mail. In a moving piece that touches on anger, trauma, and regret, Halprin writes about her re-examination of her mother’s life. “I now understand my mother drank not because of a weak character, but to cope with a body wearing out before its time from unremitting pregnancy and as a way to swallow her anger and disappointment. It was also a way to mourn a loss of self.”

DG

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Reading of the Week: Psychiatry’s Dirty Little Secret?

November 11, 2015 /

Stigma has repeatedly been identified as a major barrier to help seeking for mental health problems across various disorders and across the lifespan. Stigma is also an obstacle to community reintegration and rehabilitation in people suffering from severe mental illness. Moreover, people with psychiatric diagnoses suffer the effects of discrimination in health care settings. Not only do people with mental illness have diminished access to primary care, there is evidence to suggest that physicians perform fewer physical examinations and laboratory investigations, provide less preventive health care, and undertake fewer therapeutic interventions in this population. Researchers are increasingly framing the problem of stigma as a public health issue.

So begins a new paper that considers stigma and mental health.

This week’s Reading: “Explicit and Implicit Attitudes of Canadian Psychiatrists Toward People With Mental Illness” by Dr. Layla Dabby et al., which was just published in The Canadian Journal of Psychiatry.

This paper shows that members of the public demonstrated relatively negative explicit attitudes towards mental illness. In fact, Canadians reported a desire for greater social distance from the patient with schizophrenia as opposed to the patient with diabetes, even though the study describes the patient with schizophrenia as well-controlled by medication. Wow.

Except here’s the twist in the tale. The paper actually didn’t look at the public. The paper looked at psychiatrists and residents of psychiatry. In other words, the relatively negative explicit attitude wasn’t from the uninformed small businessman in Edmonton or the teacher in Halifax; it reflects the biases of people like… me.

Is this psychiatry’s dirty little secret? Continue reading