Addressing Cultural Mistrust: Strategies for Alliance Building

  • Nhi-Ha T. TrinhEmail author
  • Chun-Yi Joey Cheung
  • Esther E. Velasquez
  • Kiara Alvarez
  • Christine Crawford
  • Margarita Alegría
Part of the Current Clinical Psychiatry book series (CCPSY)


Trust is a crucial element in the provider–patient relationship. However, trust is eroded when specific racial and ethnic groups systematically experience substandard levels of health care as a consequence of racism, leading to cultural mistrust. This chapter aims to outline potential cultural barriers to mental health utilization among racial and ethnic minorities as a result of cultural mistrust. Strategies are suggested for building a strong therapeutic alliance in spite of differences in provider–patient backgrounds.


Racial–ethnic disparities Treatment-seeking behaviors Cultural mistrust Therapeutic alliance 


  1. 1.
    Petersen LA. Racial differences in trust: reaping what we have sown? Med Care. 2002;40(2):81–4.CrossRefGoogle Scholar
  2. 2.
    Nelson AR, Stith AY, Smedley BD, editors. Unequal treatment: confronting racial and ethnic disparities in health care. Washington DC: National Academies Press; 2003.Google Scholar
  3. 3.
    Satcher D. Mental health: culture, race, and ethnicity—a supplement to mental health: a report of the surgeon general. Rockville: Department of Health and Human Services; 2001.Google Scholar
  4. 4.
    McFarland MR, Wehbe-Alamah HB. The theory of culture care and the ethnonursing research method. In: Leininger M, McFarland MR, editors. Transcultural nursing: concepts, theories, research, and practice. 3rd ed. New York: McGraw Hill; 2002. p. 71–98.Google Scholar
  5. 5.
    Washington HA. Medical apartheid: the dark history of medical experimentation on black Americans from colonial times to the present. New York: Harlem Moon; 2006.Google Scholar
  6. 6.
    Harris Y, Gorelick PB, Samuels P, Bempong I. Why African Americans may not be participating in clinical trials. J Natl Med Assoc. 1996;88(10):630.PubMedPubMedCentralGoogle Scholar
  7. 7.
    Poussaint AF, Alexander A. Lay my burden down: suicide and the mental health crisis among African-Americans. Boston: Beacon Press; 2001.Google Scholar
  8. 8.
    Adams D. Minority mistrust still haunts medical care. American Medical News; Chicago. 2003. Accessed 26 Jan 2004.
  9. 9.
    White RM. Unraveling the Tuskegee study of untreated syphilis. Arch Intern Med. 2000;160(5):585–98.CrossRefGoogle Scholar
  10. 10.
    Corbie-Smith G, Thomas SB, George DM. Distrust, race, and research. Arch Intern Med. 2002;162(21):2458–63.CrossRefGoogle Scholar
  11. 11.
    Daniels R. Incarcerating Japanese Americans: an atrocity revisited. J Peace Res. 1998;23(2):117–34.Google Scholar
  12. 12.
    Borchert J. Asian Americans: an interpretive history. Int Migr Rev. 1992;26(4):1465–7.Google Scholar
  13. 13.
    Chavez-Dueñas NY, Adames HY, Organista KC. Skin-color prejudice and within-group racial discrimination: historical and current impact on Latino/a populations. Hisp J Behav Sci. 2014;36(1):3–26.CrossRefGoogle Scholar
  14. 14.
    Frank R, Akresh IR, Lu B. Latino immigrants and the US racial order how and where do they fit in? Am Sociol Rev. 2010;75(3):378–401.CrossRefGoogle Scholar
  15. 15.
    Cuevas AG, Dawson BA, Williams DR. Race and skin color in Latino health: an analytic review. Am J Public Health. 2016;106(12):2131–6.CrossRefGoogle Scholar
  16. 16.
    Barrington C, Messias DK, Weber L. Implications of racial and ethnic relations for health and well-being in new Latino communities: a case study of West Columbia, South Carolina. Lat Stud. 2012;10(1–2):155–78.CrossRefGoogle Scholar
  17. 17.
    López-Cevallos DF, Harvey SM, Warren JT. Medical mistrust, perceived discrimination, and satisfaction with health care among young-adult rural Latinos. J Rural Health. 2014;30(4):344–51.CrossRefGoogle Scholar
  18. 18.
    Hatzenbuehler ML, Prins SJ, Flake M, Philbin M, Frazer MS, Hagen D, Hirsch J. Immigration policies and mental health morbidity among Latinos: a state-level analysis. Soc Sci Med. 2017;174:169–78.CrossRefGoogle Scholar
  19. 19.
    Philbin MM, Flake M, Hatzenbuehler ML, Hirsch JS. State-level immigration and immigrant-focused policies as drivers of Latino health disparities in the United States. Soc Sci Med. 2017;199:29–38.CrossRefGoogle Scholar
  20. 20.
    Goodkind JR, Ross-Toledo K, John S, Hall JL, Ross L, Freeland L, Coletta E, Becenti-Fundark T, Poola C, Roanhorse R, Lee C. Rebuilding trust: a community, multiagency, state, and university partnership to improve behavioral health care for American Indian youth, their families, and communities. J Community Psychol. 2011;39(4):452–77.CrossRefGoogle Scholar
  21. 21.
    Belcourt-Dittloff A, Stewart J. Historical racism: implications for native Americans. Am Psychol. 2000;55(10):1166–7.CrossRefGoogle Scholar
  22. 22.
    Jones DS. The persistence of American Indian health disparities. Am J Public Health. 2006;96(12):2122–34.CrossRefGoogle Scholar
  23. 23.
    Berger BR. Red: racism and the American Indian. UCLA L Rev. 2008;56:591.Google Scholar
  24. 24.
    Regan S. 5 ways the Government keeps native Americans in poverty. Forbes. 2013. Accessed 19 Jun 2017.
  25. 25.
    Mohatt NV, Thompson AB, Thai ND, Tebes JK. Historical trauma as public narrative: a conceptual review of how history impacts present-day health. Soc Sci Med. 2014;106:128–36.CrossRefGoogle Scholar
  26. 26.
    Warne D, Frizzell LB. American Indian health policy: historical trends and contemporary issues. Am J Public Health. 2014;104(S3):S263–7.CrossRefGoogle Scholar
  27. 27.
    Hartmann WE, Gone JP. American Indian historical trauma: community perspectives from two Great Plains medicine men. Am J Community Psychol. 2014;54(3–4):274–88.CrossRefGoogle Scholar
  28. 28.
    NPR. Trump’s executive order on immigration, annotated. 2017. Accessed 19 Jun 2017.
  29. 29.
    Domonoske C. These changes to tighten visa waiver program are now in effect. NPR; Washington, DC. 2016. Accessed 19 Jun 2017.
  30. 30.
    Masri A, Senussi MH. Trump’s executive order on immigration—detrimental effects on medical training and health care. N Engl J Med. 2017;376(19):e39.CrossRefGoogle Scholar
  31. 31.
    Samari G. Islamophobia and public health in the United States. Am J Public Health. 2016;106(11):1920–5.CrossRefGoogle Scholar
  32. 32.
    Terrell F, Terrell S. An inventory to measure cultural mistrust among blacks. West J Black Stud. 1981;5(3):180.Google Scholar
  33. 33.
    Ackerman SJ, Hilsenroth MJ. A review of therapist characteristics and techniques positively impacting the therapeutic alliance. Clin Psychol Rev. 2003;23(1):1–33.CrossRefGoogle Scholar
  34. 34.
    Thompson CE, Neville H, Weathers PL, Poston WC. Cultural mistrust and racism reaction among African-American students. J Coll Stud Dev. 1990;31(2):162–8.Google Scholar
  35. 35.
    Grier WH, Cobbs PM. Black rage. New York: Basic Books; 1968.Google Scholar
  36. 36.
    Whaley AL. Cultural mistrust: an important psychological construct for diagnosis and treatment of African Americans. Prof Psychol Res Pr. 2001;32(6):555–62.CrossRefGoogle Scholar
  37. 37.
    Taylor SE, Brown JD. Illusion and well-being: a social psychological perspective on mental health. Psychol Bull. 1988;103(2):193.CrossRefGoogle Scholar
  38. 38.
    Nickerson KJ, Helms JE, Terrell F. Cultural mistrust, opinions about mental illness, and black students’ attitudes toward seeking psychological help from white counselors. J Couns Psychol. 1994;41(3):378.CrossRefGoogle Scholar
  39. 39.
    Neville HA, Mobley M. Social identities in contexts: an ecological model of multicultural counseling psychology processes. Couns Psychol. 2001;29(4):471–86.CrossRefGoogle Scholar
  40. 40.
    Neighbors HW, Caldwell CH, Thompson E, Jackson JS. Help-seeking behavior and unmet need. In: Friedman S, editor. Anxiety disorders in African American. New York: Springer; 1994. p. 26–39.Google Scholar
  41. 41.
    Spector R. Is there racial bias in clinicians’ perceptions of the dangerousness of psychiatric patients? A review of the literature. J Ment Health. 2001;10(1):5–15.CrossRefGoogle Scholar
  42. 42.
    Snowden LR. Bias in mental health assessment and intervention: theory and evidence. Am J Public Health. 2003;93(2):239–43.CrossRefGoogle Scholar
  43. 43.
    Blair IV, Steiner JF, Havranek EP. Unconscious (implicit) bias and health disparities: where do we go from here? Perm J. 2011;15(2):71.PubMedPubMedCentralGoogle Scholar
  44. 44.
    Santiago CD, Miranda J. Progress in improving mental health services for racial–ethnic minority groups: a ten-year perspective. Psychiatr Serv. 2014;65(2):180–5.CrossRefGoogle Scholar
  45. 45.
    Geiger HJ. Racial and ethnic disparities in diagnosis and treatment: a review of the evidence and a consideration of causes. In: Smedly BD, Stith AY, Nelson AR, editors. Unequal treatment: confronting racial and ethnic disparities in health care. Washington, DC: National Academies Press; 2003. p. 415–54.Google Scholar
  46. 46.
    Dovidio JF, Penner LA, Albrecht TL, Norton WE, Gaertner SL, Shelton JN. Disparities and distrust: the implications of psychological processes for understanding racial disparities in health and health care. Soc Sci Med. 2008;67(3):478–86.CrossRefGoogle Scholar
  47. 47.
    Schnittker J, Pescosolido BA, Croghan TW. Are African Americans really less willing to use health care? Soc Probl. 2005;52(2):255–71.CrossRefGoogle Scholar
  48. 48.
    Alegría M, Chatterji P, Wells K, Cao Z, Chen CN, Takeuchi D, Jackson J, Meng XL. Disparity in depression treatment among racial and ethnic minority populations in the United States. Psychiatr Serv. 2008;59(11):1264–72.CrossRefGoogle Scholar
  49. 49.
    Cook BL, McGuire TG, Zaslavsky AM. Measuring racial/ethnic disparities in health care: methods and practical issues. Health Serv Res. 2012;47(3 Pt 2):1232–54.CrossRefGoogle Scholar
  50. 50.
    Chow JC, Jaffee K, Snowden L. Racial/ethnic disparities in the use of mental health services in poverty areas. Am J Public Health. 2003;93(5):792–7.CrossRefGoogle Scholar
  51. 51.
    Miranda J, Cooper LA. Disparities in care for depression among primary care patients. J Gen Intern Med. 2004;19(2):120–6.CrossRefGoogle Scholar
  52. 52.
    Campbell JL, Ramsay J, Green J. Age, gender, socioeconomic, and ethnic differences in patients’ assessments of primary health care. Qual Health Care. 2001;10(2):90–5.CrossRefGoogle Scholar
  53. 53.
    Earl TR, Fortuna LR, Gao S, Williams DR, Neighbors H, Takeuchi D, Alegría M. An exploration of how psychotic-like symptoms are experienced, endorsed, and understood from the National Latino and Asian American Study and National Survey of American Life. Ethn Health. 2015;20(3):273–92.CrossRefGoogle Scholar
  54. 54.
    Müller E, Zill JM, Dirmaier J, Härter M, Scholl I. Assessment of Trust in Physician: a systematic review of measures. PLoS One. 2014;9(9):e106844.CrossRefGoogle Scholar
  55. 55.
    Anderson LA, Dedrick RF. Development of the Trust in Physician scale: a measure to assess interpersonal trust in patient–physician relationships. Psychol Rep. 1990;67(3 Pt 2):1091–100.PubMedGoogle Scholar
  56. 56.
    LaVeist TA, Nickerson KJ, Bowie JV. Attitudes about racism, medical mistrust, and satisfaction with care among African American and white cardiac patients. Med Care Res Rev. 2000;57(1 Suppl):146–61.CrossRefGoogle Scholar
  57. 57.
    Bova C, Route PS, Fennie K, Ettinger W, Manchester GW, Weinstein B. Measuring patient–provider trust in a primary care population: refinement of the health care relationship trust scale. Res Nurs Health. 2012;35(4):397–408.CrossRefGoogle Scholar
  58. 58.
    Thompson HS, Valdimarsdottir HB, Winkel G, Jandorf L, Redd W. The Group-Based Medical Mistrust Scale: psychometric properties and association with breast cancer screening. Prev Med. 2004;38(2):209–18.CrossRefGoogle Scholar
  59. 59.
    Hall MA, Camacho F, Dugan E, Balkrishnan R. Trust in the medical profession: conceptual and measurement issues. Health Serv Res. 2002;37(5):1419–39.CrossRefGoogle Scholar
  60. 60.
    Kao AC, Green DC, Zaslavsky AM, Koplan JP, Cleary PD. The relationship between method of physician payment and patient trust. JAMA. 1998;280(19):1708–14.CrossRefGoogle Scholar
  61. 61.
    Leisen B, Hyman MR. An improved scale for assessing patients’ trust in their physician. Health Mark Q. 2001;19(1):23–42.CrossRefGoogle Scholar
  62. 62.
    Mainous AG, Smith DW, Geesey ME, Tilley BC. Development of a measure to assess patient trust in medical researchers. Ann Fam Med. 2006;4(3):247–52.CrossRefGoogle Scholar
  63. 63.
    Hall MA, Zheng B, Dugan E, Camacho F, Kidd KE, Mishra A, Balkrishnan R. Measuring patients’ trust in their primary care providers. Med Care Res Rev. 2002;59(3):293–318.CrossRefGoogle Scholar
  64. 64.
    Whaley AL. Cultural mistrust and mental health services for African Americans: a review and meta-analysis. Couns Psychol. 2001;29(4):513–31.CrossRefGoogle Scholar
  65. 65.
    Guadagnolo BA, Cina K, Koop D, Brunette D, Petereit DG. A pre–post survey analysis of satisfaction with health care and medical mistrust after patient navigation for American Indian cancer patients. J Health Care Poor Underserved. 2011;22(4):1331–43.CrossRefGoogle Scholar
  66. 66.
    David EJR. Cultural mistrust and mental health help–seeking attitudes among Filipino Americans. Asian Am J Psychol. 2010;1(1):57–66.CrossRefGoogle Scholar
  67. 67.
    Scott LD, McCoy H, Munson MR, Snowden LR, McMillen JC. Cultural mistrust of mental health professionals among black males transitioning from foster care. J Child Fam Stud. 2011;20(5):605–13.CrossRefGoogle Scholar
  68. 68.
    Kim PY, Kendall DL, Cheon HS. Racial microaggressions, cultural mistrust, and mental health outcomes among Asian American college students. Am J Orthopsychiatry. 2016;87(6):663–70.CrossRefGoogle Scholar
  69. 69.
    Fischer EH, Farina A. Attitudes toward seeking professional psychological help: a shortened form and considerations for research. J Coll Stud Dev. 1995;36(4):368–73.Google Scholar
  70. 70.
    Cabral RR, Smith TB. Racial/ethnic matching of clients and therapists in mental health services: a meta-analytic review of preferences, perceptions, and outcomes. J Couns Psychol. 2011;58(4):537–54.CrossRefGoogle Scholar
  71. 71.
    Good MJ, Hannah SD. “Shattering culture”: perspectives on cultural competence and evidence-based practice in mental health services. Transcult Psychiatry. 2015;52(2):198–221.CrossRefGoogle Scholar
  72. 72.
    Alegría M, Roter DL, Valentine A, Chen CN, Li X, Lin J, Rosen D, Lapatin S, Normand SL, Larson S, Shrout PE. Patient–clinician ethnic concordance and communication in mental health intake visits. Patient Educ Couns. 2013;93(2):188–96.CrossRefGoogle Scholar
  73. 73.
    Green AR, Ngo-Metzger Q, Legedza AT, Massagli MP, Phillips RS, Iezzoni LI. Interpreter services, language concordance, and health care quality. J Gen Intern Med. 2005;20(11):1050–6.CrossRefGoogle Scholar
  74. 74.
    Gonçalves M, Cook B, Mulvaney-Day N, Alegría M, Kinrys G. Retention in mental health care of Portuguese-speaking patients. Transcult Psychiatry. 2013;50(1):92–107.CrossRefGoogle Scholar
  75. 75.
    Villalobos BT, Bridges AJ, Anastasia EA, Ojeda CA, Hernandez Rodriguez J, Gomez D. Effects of language concordance and interpreter use on therapeutic alliance in Spanish-speaking integrated behavioral health care patients. Psychol Sci. 2016;13(1):49.Google Scholar
  76. 76.
    Pérez-Stable EJ, Karliner LS. What do we know about patient–clinician interactions with interpreters? J Gen Intern Med. 2013;28(3):339.CrossRefGoogle Scholar
  77. 77.
    Bauer AM, Alegría M. Impact of patient language proficiency and interpreter service use on the quality of psychiatric care: a systematic review. Psychiatr Serv. 2010;61(8):765–73.CrossRefGoogle Scholar
  78. 78.
    Alegria I, Aranberri N, Comas PR, Fresno V, Gamallo P, Padró L, San Vicente I, Turmo J, Zubiaga A. TweetNorm: a benchmark for lexical normalization of Spanish tweets. Lang Resour Eval. 2015;49(4):883–905.CrossRefGoogle Scholar
  79. 79.
    Rodriguez F, Cohen A, Betancourt JR, Green AR. Evaluation of medical student self-rated preparedness to care for limited English proficiency patients. BMC Med Educ. 2011;11(1):26.CrossRefGoogle Scholar
  80. 80.
    Greer JA, Park ER, Green AR, Betancourt JR, Weissman JS. Primary care resident perceived preparedness to deliver cross-cultural care: an examination of training and specialty differences. J Gen Intern Med. 2007;22(8):1107–13.CrossRefGoogle Scholar
  81. 81.
    Huey SJ Jr, Tilley JL, Jones EO, Smith CA. The contribution of cultural competence to evidence-based care for ethnically diverse populations. Annu Rev Clin Psychol. 2014;10:305–38.CrossRefGoogle Scholar
  82. 82.
    Maxie AC, Arnold DH, Stephenson M. Do therapists address ethnic and racial differences in cross-cultural psychotherapy? Psychotherapy. 2006;43(1):85.CrossRefGoogle Scholar
  83. 83.
    Vasquez MJT. Cultural difference and the therapeutic alliance: an evidence-based analysis. Am Psychol. 2007;62(8):875–85.CrossRefGoogle Scholar
  84. 84.
    Betancourt JR, Green AR, Carrillo JE, Owusu Ananeh-Firempong II. Defining cultural competence: a practical framework for addressing racial/ethnic disparities in health and health care. Public Health Rep. 2016;118(4):293–302.CrossRefGoogle Scholar
  85. 85.
    Bhui K, Warfa N, Edonya P, McKenzie K, Bhugra D. Cultural competence in mental health care: a review of model evaluations. BMC Health Serv Res. 2007;7(1):15.CrossRefGoogle Scholar
  86. 86.
    Renzaho AM, Romios P, Crock C, Sønderlund AL. The effectiveness of cultural competence programs in ethnic minority patient–centered health care—a systematic review of the literature. Int J Qual Health Care. 2013;25(3):261–9.CrossRefGoogle Scholar
  87. 87.
    Sue DW. Asian-American mental health and help-seeking behavior: comment on Solberg et al. (1994), Tata and Leong (1994), and Lin (1994). J Couns Psychol. 1994;41(3):292–5.CrossRefGoogle Scholar
  88. 88.
    Qureshi A, Collazos F, Ramos M, Casas M. Cultural competency training in psychiatry. Eur Psychiatry. 2008;23:49–58.CrossRefGoogle Scholar
  89. 89.
    Chang DF, Berk A. Making cross-racial therapy work: a phenomenological study of clients’ experiences of cross-racial therapy. J Couns Psychol. 2009;56(4):521–36.CrossRefGoogle Scholar
  90. 90.
    Mulvaney-Day NE, Earl TR, Diaz-Linhart Y, Alegría M. Preferences for relational style with mental health clinicians: a qualitative comparison of African American, Latino and non-Latino white patients. J Clin Psychol. 2011;67(1):31–44.CrossRefGoogle Scholar
  91. 91.
    Aggarwal NK, Desilva R, Nicasio AV, Boiler M, Lewis-Fernández R. Does the Cultural Formulation Interview for the fifth revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) affect medical communication? A qualitative exploratory study from the New York site. Ethn Health. 2015;20(1):1–28.CrossRefGoogle Scholar
  92. 92.
    Lewis-Fernández R, Aggarwal NK, Bäärnhielm S, Rohlof H, Kirmayer LJ, Weiss MG, Jadhav S, Hinton L, Alarcón RD, Bhugra D, Groen S. Culture and psychiatric evaluation: operationalizing cultural formulation for DSM-5. Psychiatry. 2014;77(2):130–54.CrossRefGoogle Scholar
  93. 93.
    American Psychiatric Association. Diagnostic and statistical manual, 4th edition, text revision (DSM-IV-TR). Washington, DC: American Psychiatric Association; 2000.Google Scholar
  94. 94.
    Aggarwal NK, Nicasio AV, DeSilva R, Boiler M, Lewis-Fernández R. Barriers to implementing the DSM-5 Cultural Formulation Interview: a qualitative study. Cult Med Psychiatry. 2013;37(3):505–33.CrossRefGoogle Scholar
  95. 95.
    American Psychiatric Association. Diagnostic and statistical manual, 5th edition (DSM-5). Washington, DC: American Psychiatric Association; 2013.Google Scholar
  96. 96.
    Aggarwal NK, Glass A, Tirado A, Boiler M, Nicasio A, Alegría M, Wall M, Lewis-Fernández R. The development of the DSM-5 Cultural Formulation Interview-Fidelity Instrument (CFI-FI): a pilot study. J Health Care Poor Undeserved. 2014;25(3):1397–417.CrossRefGoogle Scholar
  97. 97.
    La Roche MJ, Fuentes MA, Hinton D. A cultural examination of the DSM-5: research and clinical implications for cultural minorities. Prof Psychol Res Pr. 2015;46(3):183.CrossRefGoogle Scholar
  98. 98.
    Dwight-Johnson M, Aisenberg E, Golinelli D, Hong S, O’Brien M, Ludman E. Telephone-based cognitive–behavioral therapy for Latino patients living in rural areas: a randomized pilot study. Psychiatr Serv. 2011;62(8):936–42.CrossRefGoogle Scholar
  99. 99.
    Ye J, Shim R, Lukaszewski T, Yun K, Kim SH, Rust G. Telepsychiatry services for Korean immigrants. Telemed J E Health. 2012;18(10):797–802.CrossRefGoogle Scholar
  100. 100.
    Yeung A, Johnson DP, Trinh NH, Weng WC, Kvedar J, Fava M. Feasibility and effectiveness of telepsychiatry services for Chinese immigrants in a nursing home. Telemed J E Health. 2009;15(4):336–41.CrossRefGoogle Scholar
  101. 101.
    Moreno FA, Chong J, Dumbauld J, Humke M, Byreddy S. Use of standard webcam and internet equipment for telepsychiatry treatment of depression among underserved Hispanics. Psychiatr Serv. 2012;63(12):1213–7.CrossRefGoogle Scholar
  102. 102.
    Mucic D. Transcultural telepsychiatry and its impact on patient satisfaction. J Telemed Telecare. 2010;16(5):237–42.CrossRefGoogle Scholar
  103. 103.
    Alegría M, Carson N, Flores M, Li X, Shi P, Lessios AS, Polo A, Allen M, Fierro M, Interian A, Jimenez A. Activation, self-management, engagement, and retention in behavioral health care: a randomized clinical trial of the DECIDE intervention. JAMA. 2014;71(5):557–65.Google Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Nhi-Ha T. Trinh
    • 1
    • 2
    Email author
  • Chun-Yi Joey Cheung
    • 2
  • Esther E. Velasquez
    • 3
  • Kiara Alvarez
    • 3
  • Christine Crawford
    • 4
  • Margarita Alegría
    • 3
    • 5
  1. 1.Psychiatry Center for Diversity, Department of PsychiatryMassachusetts General HospitalBostonUSA
  2. 2.Depression Clinical and Research Program, Department of PsychiatryMassachusetts General HospitalBostonUSA
  3. 3.Disparities Research Unit, Department of MedicineMassachusetts General Hospital and Harvard Medical SchoolBostonUSA
  4. 4.Division of Child and Adolescent Psychiatry, Department of PsychiatryMassachusetts General HospitalBostonUSA
  5. 5.Department of PsychiatryHarvard Medical SchoolBostonUSA

Personalised recommendations