The Perception of Physician Cultural Competency and Mental Health Outcomes

black man speaking to therapist
black man speaking to therapist
This study examines patient preferences for physicians with cultural competency among patients with depression and anxiety.

Racial and ethnic disparities exist in patients with depression, according to a recent retrospective analysis published in the Lancet Psychiatry. The authors believe the study is among the first to show patient preference for culturally competent physicians among individuals with anxiety and/or depression.

The retrospective, population-based, cross-sectional study examined how patients view the cultural competence of their providers, eg, whether the providers shared or understood their culture. The researchers used data from self-reported questionnaires given to adults who participated in the US National Health Interview Survey (NHIS; 2017 cycle). They narrowed their search to individuals who reported anxiety and/or depression and answered cultural competency questions. The search yielded 3,910 individuals, 60.9% of whom were women, with an average age of 52 years. Most (82.7%) were White, 9.1% were Black or African American, 0.8% were American Indian or Alaskan Native, 4.8% were Asian American, 2.6% were Mixed Race, and 12.5% identified with Hispanic ethnicity.

Patients who had depressive symptoms were more likely to place importance on the need for providers to share or understand their culture than those without depression and/or anxiety. Patients with depressive symptoms also more often reported that they were less likely to see providers who shared their cultural background.

Patients who were of a racial minority were more likely than Whites to report that it was important for their providers to share or understand their culture.

These groups were less likely to report the ability to see providers who shared their culture more commonly (Black or African American [59.1%] vs White [72.6%], aOR 0.56 [0.38–0.84], P =.005; Asian American [53.8%] vs White, aOR 0.38 [0.20–0.72], P =.003; Mixed Race [45.6%] vs White, aOR 0.35 [0.19–0.64], P =.001; Hispanic [56.2%] vs non-Hispanic [71.3%], aOR 0.61 [0.42–0.89], P =.010).

Of the limitations, the analysis used frequency and intensity of depression and anxiety symptoms rather than a formal diagnosis to identify, “patients with depression and anxiety.” The analysis did not factor in whether individuals had seen a mental health provider in the past year. Finally, most of the minority sample sizes were small.

“Our findings show the importance of adopting cultural competence as a framework to guide patient–provider interactions for providers from all backgrounds,” the researchers state. “Cultural competence as a concept focuses on under-represented racial and ethnic minorities, as these are the populations whose cultural contexts have been traditionally overlooked… Understanding patients’ cultural background, associated communications styles, and disease presentations will allow for improved therapeutic relationships, and improved outcomes in psychiatric care.”


Eken HN, Dee EC, Powers AR 3rd, Jordan A. Racial and ethnic differences in perception of provider cultural competence among patients with depression and anxiety symptoms: a retrospective, population-based, cross-sectional analysis. Published online September 23, 2021. Lancet Psychiatry. doi:10.1016/S2215-0366(21)00285-6