GPs’ clinical decisions about Somali vs Norwegian patients with depression

Refugees in comparison with non-refugee patients may face higher unmet mental healthcare needs. The mechanisms underlying these disparities are still poorly understood. The general practitioner (GP) plays an important role in refugees’ mental health, managing complaints within primary care and acting as gatekeeper to specialist services. However, GPs have reported feeling unprepared for working with refugee patients. The current study examines GPs’ management of mental health complaints in fictitious Somali refugee versus Norwegian patients We distributed an online experimental survey to GPs in Norway, who watched either a simulated consultation with a female Norwegian, female Somali, male Norwegian or male Somali patient, presenting the same symptoms of depression. GPs indicated which diagnoses, assessments, and treatments they would endorse for the patient and their level of certainty in that decision. GPs’ clinical decisions about Somali and Norwegian vignette characters were similar, with a few exceptions. GPs more often chose a diagnosis of post-traumatic stress disorder (PTSD) for the Somali patients, while they more often chose a diagnosis of feeling depression for the Norwegian patients. There were no substantial differences in GPs’ self-reported certainty.

We found few and relatively small effects of patient background and gender on GPs’ clinical decisions. Nevertheless, the validity of certain diagnoses and prescription of sick leave need to be considered by clinicians and in future research.