Effects of patient gender, ethnicity, and socioeconomic status on psychiatric assessments: A vignette-based experimental study.

OBJECTIVE: To investigate whether information about the gender, ethnicity, and socioeconomic status of the patient affects psychiatric assessments in a sample of practicing clinicians in Swedish adult psychiatry. METHOD: The study used an experimental design in which vignettes describing patients were identical except for information regarding their gender, ethnicity, and socioeconomic status. The outcome variables included assessments of the severity of the patient's clinical condition, how dangerous the patient was to themselves and others, the likelihood of reporting to social services (due to concern for the welfare of children), and whether the patient was recommended psychotherapy or psychopharmaceutical treatment. RESULTS: A series of ANOVAs were performed to investigate main and interaction effects of the studied variables. The performed analyses identified several instances in which the clinicians' assessments varied as a function of the social categories under investigation. For example, male patients and "Arab Swedish" patients were perceived as more dangerous, "Arab Swedish" patients, male patients, and patients with low socioeconomic status were less likely to be recommended psychotherapy, and "Arab Swedish" patients were more likely to be reported to social services. The effect sizes were generally small. CONCLUSIONS: The study provides support for the suggestion that information regarding patient gender, ethnicity, and socioeconomic status affects central aspects of psychiatric assessments. The results are interpreted and discussed in relation to other studies on the influence of social stereotypes on psychiatric assessments and the practice of clinical psychiatric assessments.

Suicidal behaviour in over-indebted individuals: a cross-sectional study in Sweden.

OBJECTIVE: Associations between debt and suicidal behaviour have been identified, but the research is sparse. Thus, more research is needed to understand the association between economic vulnerability and suicide. The study aimed to generate further knowledge about over-indebted individuals who have attempted suicide at least once. METHOD: Participants were a Swedish sample comprising 641 over-indebted individuals. The inclusion criteria were that the participants should be indebted and have been subjected to debt collection measures and/or seizure orders by the Swedish Enforcement Authority. Participants answered questionnaires regarding socio-demographic variables, debt size, history of suicide attempt, critical life events, and social contacts, and filled the Hospital Anxiety and Depression Scale (HADS). In the statistical analyses, Chi2 test for independence and t-test was used, and binary logistic regression to adjust for the confounding effects of the variables on each other. RESULTS: The analysis revealed that nearly one in five (19.3%, N = 123) had attempted suicide at least once. A larger part of the respondents who had a history of suicide attempts reported that they were living alone (OR 2.30 (95% CI 1.34-3.89, p = .002). Many of those living alone were women (χ2 (1, n = 121) = 4.88, p = 0.03, ɸ = 0.22). CONCLUSIONS: The results of the current study point to the fact that economic vulnerability is an important psychosocial aspect to take into serious consideration concerning mental health and suicide prevention. Longitudinal research is needed to explain, predict and prevent suicide due to over-indebtedness.

Coping and financial strain as predictors of mental illness in over- indebted individuals in Sweden.

This cross-sectional study examined psychological mechanisms in order to increase knowledge regarding mental illness amongst 561 over-indebted individuals in Sweden. Differences were explored between individuals with probable clinical depression and/or anxiety and individuals without probable clinical depression and/or anxiety, considering objective measures of the debt, financial strain, coping strategies as well as sociodemographic variables. Furthermore, binary logistic regression analyses were performed in order to construct a model of predictors of mental illness. In order to collect the data, Hospital Anxiety and Depression Scale (HADS), Brief Coping Orientation to Problems Experienced (COPE_, as well as questions formulated by the research team, were used as measures. Prominent results showed that over-indebted individuals with probable clinical depression and/or anxiety were younger, showed greater levels of financial strain, used adaptive coping strategies to a lesser extent, and maladaptive coping strategies to a greater extent. Additionally, financial strain, use of maladaptive and emotion-focused coping, age and employment status were significant predictors of mental illness. These results put emphasis on the importance of adaptive coping as well as the psychological exposure of over-indebted individuals.