Duong Lang A, Zoupou Eirini, Boga Cathryn I, Kashden Jody, Fisher Jena, Connolly Gibbons Mary Beth, Crits-Christoph Paul
Department of Psychiatry, University of Pennsylvania - Perelman School of Medicine, Philadelphia, USA.
Princeton Behavioral Health, Moorestown and Princeton, Moorestown, NJ, USA.
Adm Policy Ment Health. 2025 Jan;52(1):59-73. doi: 10.1007/s10488-023-01335-1. Epub 2024 Jan 4.
A plethora of studies has exhibited the effectiveness of using measurement-based care feedback systems within mental health services to improve treatment outcomes; however, patient gender/race and patient-therapist matching on gender and race remain relatively unexplored as predictors/moderators in feedback studies. We conducted predictor/moderator analyses focusing on the relation of gender, race/ethnicity, and patient-therapist gender and race/ethnicity matching on two outcomes: patient self-reported levels of (1) functioning and (2) trust/respect within the therapeutic relationship. We used data from a randomized controlled trial studying the effectiveness of a feedback system comparing patient-reported levels of trust and respect towards their provider (together with symptom feedback) in comparison to symptom only feedback. We found that men improved in functioning more than women when their therapists received trust/respect feedback compared to symptom only feedback (F[1, 902] = 9.79, p = .002, d = 0.21). We also found that dyads matched on race/ethnicity but not gender, and those matched on gender but not race/ethnicity, improved in functioning over time more than dyads mismatched on both gender and race/ethnicity and those matched on both gender and race/ethnicity (F[1, 897] = 8.63, p = .0034, d = 0.20). On trust/respect outcomes, we found a gender difference over time (F[1, 759] = 6.61, p = .01, d = 0.19), a gender matching difference by feedback condition interaction (F[1, 757] = 5.25, p = .02, d = 0.17), and a racial/ethnic matching difference on trust/respect scores over time (F[1, 785] = 3.89, p = .049, d = 0.14). Male patients showed an initial decrease followed by a steady increase in trust/respect over time while female patients showed an initial increase followed by a steady decrease. Gender-matched therapeutic dyads showed higher levels of trust/respect compared to mismatched dyads when therapists received symptom only feedback, but this difference was not apparent when trust/respect feedback was provided. Dyads mismatched on race/ethnicity improved steadily in trust/respect over time, but matched dyads decreased in trust/respect after an initial increase. Future research should focus on the use of feedback systems to enhance outcomes for patients with specific gender and racial/ethnic identities.
大量研究表明，在心理健康服务中使用基于测量的护理反馈系统可有效改善治疗效果；然而，在反馈研究中，患者的性别/种族以及患者与治疗师在性别和种族上的匹配情况作为预测因素/调节因素仍相对未被充分探索。我们进行了预测因素/调节因素分析，重点关注性别、种族/族裔以及患者与治疗师在性别和种族/族裔上的匹配与两个结果之间的关系：（1）患者自我报告的功能水平，以及（2）治疗关系中的信任/尊重程度。我们使用了一项随机对照试验的数据，该试验研究了一个反馈系统的有效性，将患者报告的对其提供者的信任和尊重程度（以及症状反馈）与仅症状反馈进行比较。我们发现，与仅接受症状反馈相比，当治疗师收到信任/尊重反馈时，男性在功能改善方面比女性更明显（F[1, 902] = 9.79，p = 0.002，d = 0.21）。我们还发现，种族/族裔匹配但性别不匹配的二元组，以及性别匹配但种族/族裔不匹配的二元组，随着时间推移在功能改善方面比性别和种族/族裔都不匹配的二元组以及性别和种族/族裔都匹配的二元组更明显（F[1, 897] = 8.63，p = 0.0034，d = 0.20）。在信任/尊重结果方面，我们发现随着时间推移存在性别差异（F[1, 759] = 6.61，p = 0.01，d = 0.19），在反馈条件交互作用下存在性别匹配差异（F[1, 757] = 5.25，p = 0.02，d = 0.17），以及随着时间推移在信任/尊重得分上存在种族/族裔匹配差异（F[1, 785] = 3.89，p = 0.049，d = 0.14）。男性患者的信任/尊重程度最初下降，随后随着时间稳定上升，而女性患者则最初上升，随后稳定下降。当治疗师仅收到症状反馈时，性别匹配的治疗二元组比不匹配的二元组表现出更高的信任/尊重水平，但当提供信任/尊重反馈时，这种差异并不明显。种族/族裔不匹配的二元组在信任/尊重方面随着时间稳步改善，但匹配的二元组在最初上升后信任/尊重程度下降。未来的研究应侧重于使用反馈系统来改善具有特定性别和种族/族裔身份患者的治疗效果。
