Ethnic and racial differences in decision-making by healthcare professionals for individuals with mental health conditions. What does experimental research tell us?

Objective: We sought to understand how manipulations of ethnicity or race in experimental research might lead healthcare professionals to make different decisions or judgements about people with mental health conditions. Method: We systematically reviewed experimental studies where ethnicity or race was manipulated in a vignette depicting an individual with a mental health condition. Healthcare professionals were required to have made a clinical decision or judgement about the vignette. Thirty-one studies were included and narratively synthesised both in relation to main findings and methodological quality. Results: Overall, the evidence for an impact of vignette ethnicity or race on decision-making was mixed. Around half of the studies showed no between group differences. Of the others, there was limited evidence suggesting that, compared to people depicted or described as having an ethnic minority status, people depicted or described as 'white' or 'European' ethnicity were somewhat more likely to receive diagnoses of schizophrenia or personality disorder, be prescribed medication, and have their symptoms considered to be more serious. There was stronger evidence for a lack of difference by vignette ethnicity in depression diagnoses, and a more consistent pattern of differences by vignette ethnicity in relation to judgements made in the context of psychological therapies. Discussion: Future research needs to improve methodologically to increase confidence in the obtained findings. There is also a need to consider interaction effects more systematically. Better understanding of ethnicity or race biases in relation to judgements about psychological therapies, particularly outside the USA, is a research priority.