Study shows culture shapes shared mental health decision making

A new study has revealed that cultural background can influence how mental health care staff approach shared decision-making with patients.

Experts from the University of Nottingham’s Faculty of Medicine and Health Sciences revealed that psychiatrists in more individualistic and enjoyment-oriented cultures prefer it, while those in more hierarchical cultures tend not to. Their findings have been published in European Psychiatry.

Shared decision-making (SDM) is when health care staff and patients work together to choose the best treatment, based on medical evidence and what matters most to the patient. In mental health, SDM can improve quality of life, reduce hospital admissions, and support patient rights. However, the way health care staff approach SDM can vary between countries.

The researchers surveyed 751 psychiatrists and psychiatry trainees from 38 European countries to find out how much they prefer involving patients in decisions. Their answers were compared with cultural values from each country, using a well-known model of national culture (Hofstede’s six cultural dimensions).

The study revealed that psychiatrists in countries that value individual choice (high Individualism) and enjoyment/freedom (high indulgence) were more likely to prefer SDM. In contrast, those in countries where hierarchy is strongly accepted (high power distance) were less likely to prefer SDM. These trends suggest that cultural background can influence how health care staff approach decision-making with patients.

“This study shows how influential culture can be in health care decision-making. It is also a complex and nuanced area too, as when we took into account other factors (such as how health care systems are organized and how staff are trained), these cultural differences became less important,” stated Associate Professor Yasuhiro Kotera, University of Nottingham.

“This means that while culture shapes attitudes, practical issues like time with patients and health care policy may have a bigger impact on whether SDM happens in practice.

“Overall these findings highlight the need for SDM training and policies that are sensitive to local culture as well as health care structures. By understanding both, we can better support collaborative, respectful mental health care across different countries.”