This paper examines how patient race, rating of physical and emotional
health, expression of physical, emotional, and social problem symptom
s, and physician perceptions of patients' physical health, emotional h
ealth, and social problems influence psychotropic prescribing in patie
nts with chronic illness. Data were collected at 11 geographic areas i
n the United States and Canada. Patient visits were audio-tape recorde
d and research assistants interviewed each patient after their medical
visit. Physicians completed self-administered questionnaires after ea
ch visit with a participating patient. Whites were significantly more
likely to receive psychotropic prescriptions than non-whites (P < 0.05
). Twenty percent of white and 13.5% of black patients received prescr
iptions for one or more psychotropic medications. Logistic regression
techniques were used to predict psychotropic prescribing to white and
non-white patients respectively. Patient expression of emotional sympt
oms and physician perceptions of patient emotional health significantl
y influenced psychotropic prescribing to white patients, whereas only
patient expression of emotional symptoms significantly influenced psyc
hotropic prescribing to non-white patients. Patient expression of phys
ical and social problem symptoms and physician perceptions of patient
physical health and social problems did not influence psychotropic pre
scribing to white or non-white patients. The paper emphasizes the impo
rtance of training primary care physicians to probe and to provide pat
ients with an opportunity to discuss their emotional symptoms. (C) 199
8 Elsevier Science Ireland Ltd.