Delineating Sources of Racial, Ethnic, and Socioeconomic Differences in the Diagnosis of Generalized Anxiety Disorder

PROJECT SUMMARY/ABSTRACT This K01 award will launch Dr. Kerry Kinney’s independent research career focused on reducing disparities in the diagnosis and treatment of generalized anxiety disorder (GAD). GAD is the most common anxiety disorder in primary care settings, where the rate of GAD misdiagnosis is estimated at 67-71%. Misdiagnosis can delay

treatment, exacerbate chronicity, and increase personal and societal costs. GAD misdiagnosis appears especially high in those marginalized by systemic inequality, leading to disparities in access to quality GAD treatment. The proposed K01 research leverages large-scale, epidemiologic and electronic health record (EHR)

datasets to evaluate two potential contributors to GAD diagnostic disparities: 1) psychometric bias, or indications that GAD’s diagnostic criteria fail to capture the same construct across sociodemographic groups or over time, and 2) disparities in patient-centered care, which is characterized by collaborative decision-making and

respecting patients’ values, culture, and context. To accomplish Aim 1, Dr. Kinney will assess for the presence of measurement non-invariance and differential item functioning (indicators of psychometric bias) in GAD symptom criteria across racial, ethnic, and socioeconomic groups and over time in epidemiologic datasets. To

accomplish Aim 2, Dr. Kinney will employ natural language processing in EHR data to identify language indicative of non-patient-centered care in primary care notes. She will assess how non-patient-centered care relates to sociodemographic factors and GAD diagnosis. Dr. Kinney proposes to build upon her strong foundational training

by targeting career development in: 1) specialized research skills needed for responsibly and ethically conducting health disparities research; 2) advanced quantitative modeling to enhance theoretical models of GAD and clarify the role of social determinants of health in GAD diagnosis; 3) the technical biomedical informatics and textual

analysis skills necessary to harness EHR data for health disparities research; and 4) grant-writing skills to obtain independent extramural funding. Dr. Kinney has assembled a highly qualified, interdisciplinary team of mentors, collaborators, and consultants to support her in achieving these training aims. Collectively, the proposed mentor

and co-mentor (Drs. Matthew Morris and Ashley Watts), collaborators (Drs. Glenn Gobbel, Mohammed Al- Garadi, and David Cole), and consultants (Drs. Katja Beesdo-Baum, Matthew Diemer, and Siddharth Pratap) provide the optimal combination of expertise to facilitate the successful completion of the proposed research and

training plan and launch Dr. Kinney’s independent research career. The research and training aims will occur in the exceptional, multidisciplinary, resource-rich environment at Vanderbilt University. This K01 award will support Dr. Kinney in establishing an independent research program that aims to elucidate the mechanisms underlying

disparities in the identification and treatment of GAD. The project’s goals are strongly aligned with NIMHD’s scientific priorities to understand and address factors underlying disparities in health services.