Chinese-speaking doctors in British Columbia were less likely to diagnose mental disorders in all of their patients, according to researchers who say the findings have important implications for Chinese immigrants across North America.

In Tuesday's issue of the medical journal Open Medicine, Alice Chen, a health sciences professor at Simon Fraser University in Vancouver, and her colleague at the University of British Columbia investigated whether Chinese-speaking doctors helped Chinese immigrants to receive care, based on a review of health records from more than 270,000 people in the province.

'While this study does not dispute that having doctors who speak the language will improve access, it also tells us that there are nuances in this access.'— Alice Chen, professor

The researchers found Chinese immigrants had only 10 to 20 per cent as many mental health consultations as a control group of people who were matched for age, sex and local area of residence.

"The main point is that the Chinese immigrants non-Chinese comparison subjects who receive primary care from Chinese-speaking doctors are less likely to receive diagnosis of mental disorders and have lower rate of consultations (than those who visit non-Chinese-speaking doctors)," Chen said in an email.

"The possible explanation is that Chinese-speaking primary care doctors have a different practice pattern and may be under-diagnosing mental disorders."

Chinese immigrants in the study also accessed medical services in general at a much lower rate than the comparison group: 14 per cent of immigrants had not visited a GP during the study period, compared with four per cent among the comparison group.

"Our findings have implications for access to mental health care by minority populations in metropolitan centres in Canada and North America, where immigrants rely heavily on health-care practitioners who speak their native language for their primary care."

In 2006, Citizenship and Immigration Canada reported that 19 per cent or 418,200 immigrants to Canada between 1997 and 2006 were of Chinese origin.

Research also suggests that Chinese and Asian populations are less likely than non-Asian populations to use mental health services, regardless of need.

Magnitude of effect surprising

The purpose of the latest study was to evaluate the idea that recruiting health-care practitioners who speak the same language as their immigrant patients facilitate access to mental health care.

The researchers identified a total of 866 Chinese-speaking GPs and psychiatrists for the study, based on self reports of Chinese language ability or graduation from a medical school in a Chinese-speaking region with verification of language spoken.

Chen and Arminée Kazanjian, a professor in the school of population and public health at UBC, reported that the disparity in mental health services by doctors' language skill was also found in the group of comparison subjects, which suggests that Chinese-speaking physicians may have a different practice or diagnostic pattern than non-Chinese speaking physicians, they said.

"I was surprised by the magnitude of the effect, and that the effect was evident even among the non-Chinese," Chen said. "Therefore, it could not be explained simply by the doctor being sensitive to the patient's cultural orientation and avoiding a stigmatizing diagnosis."

For example, there was a relatively higher rate of the diagnosis of anxiety-depression rather than formal psychiatric diagnoses, the study's authors found. It's also possible that recognition of serious psychiatric illnesses such as schizophrenia is less dependent on cultural interpretation so the doctor's language skills don't come into play as much in those cases, the study's authors said.

Balancing misdiagnosis, under-diagnosis

The finding of what appears to be a mental health disparity poses a dilemma for health-care policy, the researchers noted. If GPs are unable to communicate with patients in their preferred language then the risk of misdiagnosis is high, but there also implications if Chinese-speaking GPs are under-diagnosing mental health conditions.

"While this study does not dispute that having doctors who speak the language will improve access, it also tells us that there are nuances in this access and more can be done beyond recruiting providers with diverse language skills," Chen said, adding that the characteristics of health-care providers themselves are also important in evaluating the adequacy and quality of health-care systems.

The research was supported by the Canadian Institutes of Health Research, Canadian Health Services Research Foundation, and Alberta Heritage Foundation for Medical Research.