Racial disparities during admission to an academic psychiatric hospital in a large urban area |
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| Institution: | 1. Department of Psychiatry and Behavioral Sciences, The University of Texas Medical School at Houston, Houston, TX, USA;2. The University of Texas Harris County Psychiatric Center, Houston, TX, USA;1. Department of Psychiatry, University of Turku, Kunnallissairaalantie 20, Building 9, 20700 Turku, Finland;2. Psychiatry Services, Turku University Hospital, Kiinamyllynkatu 4-8, 20520 Turku, Finland;3. Psychiatric Services, Turku City, Kunnallissairaalantie 20, Building 9, 20700 Turku, Finland;1. Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA;2. SUNY Downstate Medical Center, Department of Psychiatry, Brooklyn, NY, USA;3. The Zucker Hillside Hospital, Psychiatry Research, North Shore - Long Island Jewish Health System, Glen Oaks, NY, USA;4. Hofstra North Shore LIJ School of Medicine, Departments of Psychiatry and Molecular Medicine, Hempstead, NY, USA;5. The Feinstein Institute for Medical Research, Manhasset, NY, USA;6. Albert Einstein College of Medicine, Department of Psychiatry and Behavioral Sciences, Bronx, NY, USA;7. Center for Psychiatric Rehabilitation, Departments of Occupational Therapy, Psychology, & Psychiatry, Boston University, Boston, MA, USA;8. Department of Social Medicine, University of North Carolina, Chapel Hill, NC, USA;9. Hotchkiss Brain Institute, Department of Psychiatry, University of Calgary, Calgary, Canada;10. School of Psychology, Australian Catholic University, Melbourne, VIC, Australia;1. Child and Adolescent Services Research Center, Department of Psychology, San Diego State University, 6363 Alvarado Ct., Ste 102, San Diego, CA 92120, United States;2. Department of Psychiatry, University of California, San Francisco, Box 0984, CAS, 401 Parnassus Ave, 246, San Francisco, CA 94143, United States;3. Department of Psychology, Florida International University, 11200 SW 8th St, AHC1-140, Miami, FL 33199, United States;4. Department of Psychology, University of Wyoming, 1000 E. University Ave., Laramie, WY 82071, United States |
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| Abstract: | Multiple studies confirm that African Americans are less likely than non-Hispanic whites to receive needed mental health services. Research has consistently shown that African Americans are under-represented in outpatient mental health treatment settings and are over-represented in inpatient psychiatric settings. Further, African Americans are more likely to receive a diagnosis of schizophrenia and are less likely receive an affective disorder diagnosis during inpatient psychiatric hospitalization compared to non-Hispanic white patients, pointing to a need for examining factors contributing to mental health disparities. Using Andersen's Behavioral Model of Health Service Use, this study examined predisposing, enabling and need factors differentially associated with health service utilization among African American and non-Hispanic white patients (n = 5183) during psychiatric admission. We conducted univariate and multivariate logistic regression analyses to examine both main effects and interactions. In the multivariate model, African American race at admission was predicted by multiple factors including younger age, female gender, multiple psychiatric hospitalizations, elevated positive and negative symptoms of psychosis, a diagnosis of schizophrenia and substance use, as well as having housing and commercial insurance. Additionally, screening positive for cannabis use at intake was found to moderate the relationship between being female and African American. Our study findings highlight the importance of examining mental health disparities using a conceptual framework developed for vulnerable populations (such as racial minorities and patients with co-occurring substance use). |
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