Two new studies from China on medical care, environmental mental health stressors

A recent review of medical practices in China found that female physicians are significantly more likely to give their male patients accurate diagnoses and medication dosages than their female patients.

The experimental study, led by Yale School of Public Health Associate Professor Xi Chen, PhD, examined nearly 500 interactions between 18 patients and 169 physicians of different genders. The researchers found there was a 23.4% increase in correct diagnosis and a 19% increase in correct drug prescriptions when female physicians treated men compared to women.

While male physicians were also less likely to reach accurate diagnoses or issue correct drug prescriptions for their female patients, the findings were statistically insignificant.

The study assessed patients with gender-neutral conditions, namely unstable angina and asthma. Quality of care was measured through consultation length (as a proxy for the effort doctors expended), medical costs, correct diagnosis, and correct drug prescription.

Despite the substantial differences in health care quality, male patients did not receive significant increases in medical costs or time investment from by female physicians. The gains in health care quality were partly attributed to better physician-patient communications, but not the presence of more clinical information.

“This study shows that we need training on better physician-patient communications, since more correct diagnosis or prescription in this group was not accompanied by longer consultation time or presenting more clinical information,” said Chen.

The findings are consistent with previous studies that have found women globally face prevalent gender disparities and disadvantages in health care use and health outcomes. In the paper, the researchers said their analysis suggests that a physicians’ awareness of and behavioral responses to a patient’s gender is an important but often overlooked driver of gender disparities in health.

The researchers also noted that cultural gender norms in China may influence physician-patient interactions. Broader sociological research has shown that traditional beliefs about male superiority continue to affect women's health care access, especially in China’s western and rural regions. For instance, male patients may receive more serious consideration, the researchers said. But the authors cautioned that more research is needed to account for the study’s results.

The study appears in the journal Social Science and Medicine.

Over 100 million children worldwide suffer from mental distress, a number that is on the rise. A new study led by researchers at the Yale School of Public Health showed that heightened air pollution levels and higher temperatures may exacerbate mental distress, as measured by increased absences from school.

The study, led by Yale School of Public Health Associate Professor Kai Chen, PhD, explored the mental health impact of short-term (0-14 day) exposure to elevated amounts of air pollution and high than normal temperatures in 89 counties in eastern China’s Jiangsu Province. The researchers analyzed over 95,000 primary and secondary school records and compared children’s reported mental health with daily environmental conditions during a 5-year span from 2016 to 2021.

High levels of air pollution, especially very fine particulate matter known as PM1, was significantly associated with increased risk of mental distress. This may be because these extremely small particles (1 micron or less in diameter) can penetrate the brain, affecting stress and emotional regulation, Chen said. Gender was not a predictor of distress response, but living in an urban setting was, especially for PM1 particles.

Higher than normal temperatures, however, significantly increased the risk to girls’ mental health compared to that for boys, the study found. The study also found that when temperature and air pollution were both at unusual levels it amplified mental health risks for children, especially girls. Children are particularly vulnerable to air pollution and temperature extremes due to their immature immune systems.

Given that global warming is likely to continue, the paper called for mitigation strategies such as early warning systems, installing temperature controls and air purification systems especially in under-resourced schools, and increasing awareness of the triggering effect of such conditions for girls in particular.

The study appears in the journal NPJ: Mental Health Research.