Webster Rebecca K, Iyer Aarti
School of Psychology, University of Sheffield, Sheffield, UK.
J Racial Ethn Health Disparities. 2025 Mar 26. doi: 10.1007/s40615-025-02403-y.
Many medication side effects are the result of negative patient expectations rather than the pharmacological action of the drugs, thus triggering a "nocebo effect." Negative expectations can be generated by contextual factors that contribute to the perceived quality of care. Research shows that perceived discrimination in healthcare settings among Black, Asian, and other Minority Ethnic (BAME) groups is associated with lower perceived quality of care. Yet, no work has considered whether perceived discrimination contributes to experiences of nocebo effects among BAME groups, leading to potentially poorer medication adherence and health outcomes. We conducted an online cross-sectional survey of 801 participants representing the four largest UK racial/ethnic groups (Asian, Black, Mixed, and White) who had been prescribed a new medication in a general practitioner (GP) consultation in the previous 6 months. Participants' perceived discrimination during their GP consultation was significantly and positively associated with their side-effect experience, and significantly and negatively associated with their adherence to the prescribed medication, with side-effect expectations significantly mediating these relationships. There was a significant interaction between ethnicity and perceived discrimination: participants who identified as mixed race were less likely to report side effects than White participants who experienced the same level of discrimination. Future longitudinal studies are needed to confirm the identified causal relationships and to explore the types of perceived discrimination BAME individuals are experiencing in health care to help develop interventions to reduce nocebo effects.
许多药物副作用是患者负面期望的结果，而非药物的药理作用，从而引发了“反安慰剂效应”。负面期望可能由影响医疗服务感知质量的背景因素产生。研究表明，黑人、亚裔和其他少数族裔（BAME）群体在医疗环境中感受到的歧视与较低的医疗服务感知质量相关。然而，尚无研究探讨感知到的歧视是否会导致BAME群体出现反安慰剂效应，进而可能导致药物依从性和健康结果更差。我们对801名参与者进行了一项在线横断面调查，这些参与者代表英国四个最大的种族/族裔群体（亚裔、黑人、混血和白人），他们在过去6个月内曾在全科医生（GP）会诊中被开了一种新药。参与者在GP会诊期间感受到的歧视与他们的副作用体验显著正相关，与他们对所开药物的依从性显著负相关，副作用期望在这些关系中起到显著的中介作用。种族和感知到的歧视之间存在显著的交互作用：与经历相同程度歧视的白人参与者相比，混血种族的参与者报告副作用的可能性更小。未来需要进行纵向研究，以确认已确定的因果关系，并探索BAME个体在医疗保健中所经历的感知歧视类型，以帮助制定减少反安慰剂效应的干预措施。
