Racial Implicit Associations in Child Psychiatry

Abstract

Objective: Racial disparities in diagnosis and treatment are prevalent in child psychiatry, including disparate diagnosis rates of internalizing and externalizing disorders in Black and White children. However, limited research has investigated mechanisms that contribute to these disparities. This study examined child racial implicit associations in psychiatric clinicians and medical students to address this gap.

Method: Psychiatrists and trainees completed an online survey including 2 race Implicit Association Tests (IATs) pairing child faces to words with either positive or negative valence, and words related to internalizing or externalizing behavioral problems. Psychiatrists and trainees' demographic predictors of implicit associations were also investigated.

Results: Data were analyzed from 235 psychiatrists and trainees (112 child and adolescent psychiatrists and fellows) who met inclusion criteria. Psychiatrists and trainees demonstrated greater moderate-to-strong association between Black child faces and "bad" (ie, negatively valenced) words (44.3%) vs "good" (ie, positively valenced) words (6.4%), and between externalizing words (41.7%) vs internalizing words (7.2%). Psychiatrists and trainees' demographic characteristics including being female (β = -0.12; 95% CI = -0.23 to -0.01; p<.05), Black (β = -0.36; 95% CI = -0.54 to -0.18; p<.001), or an attending physician (β = -0.26; 95% CI = -0.45 to -0.06; p = .01) were significant predictors of decreased association between Black child faces and negative valence words. Being female was a significant predictor of decreased association between Black child faces and externalizing words (β = -0.26; 95% CI = -0.45 to -0.06; p = .01).

Conclusion: Participating psychiatrists and trainees demonstrated bias toward associating Black rather than White child faces with negative words and externalizing behavioral problems. Future research should examine the following: racial implicit associations in a more generalizable sample; the relationship between race IATs and provider behavior; and interventions to reduce racial inequities in psychiatry, including individual and systemic solutions.

Plain language summary: Racial disparities are prevalent in child psychiatry, including disparate diagnosis rates of internalizing and externalizing disorders in Black and White children, which may be driven by provider implicit biases. In this study, 235 psychiatrists, including child and adolescent psychiatrists and trainees, completed 2 race Implicit Association Tests (IATs) pairing child faces perceived to be Black or White with words of either positive or negative valence, and words related to internalizing or externalizing behavioral problems. Psychiatrists and trainees demonstrated greater moderate-to-strong association between Black child faces and negative words (44.3%) versus positive words (6.4%), and between externalizing words (41.7%) versus internalizing words (7.2%). Identifying as female, Black, or an attending physician were predictors of a decreased association between Black child faces and negative valence words. These results have implications for clinical care, training, and future research to minimize implicit biases in child and adolescent psychiatrists.

Diversity & inclusion statement: We worked to ensure sex and gender balance in the recruitment of human participants. We worked to ensure race, ethnic, and/or other types of diversity in the recruitment of human participants. We worked to ensure that the study questionnaires were prepared in an inclusive way. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented sexual and/or gender groups in science. We actively worked to promote sex and gender balance in our author group. We actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our author group. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented racial and/or ethnic groups in science. One or more of the authors of this paper received support from a program designed to increase minority representation in science.

Keywords: equity; health disparities; pediatric; race implicit bias; racial discrimination.