在一个大城市的学术精神病医院住院期间的种族差异。

Racial disparities during admission to an academic psychiatric hospital in a large urban area.

机构信息

Department of Psychiatry and Behavioral Sciences, The University of Texas Medical School at Houston, Houston, TX, USA; The University of Texas Harris County Psychiatric Center, Houston, TX, USA.

Department of Psychiatry and Behavioral Sciences, The University of Texas Medical School at Houston, Houston, TX, USA.

出版信息

Compr Psychiatry. 2015 Nov;63:113-22. doi: 10.1016/j.comppsych.2015.08.010. Epub 2015 Sep 4.

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).

摘要

多项研究证实,非裔美国人获得所需心理健康服务的可能性低于非西班牙裔白人。研究一直表明,非裔美国人在门诊心理健康治疗环境中的代表性不足,而在住院精神病治疗环境中的代表性过高。此外,与非西班牙裔白人患者相比,非裔美国人更有可能被诊断为精神分裂症,而在住院精神病住院期间更不可能被诊断为情感障碍,这表明需要检查导致心理健康差距的因素。本研究使用安德森的卫生服务利用行为模型,检查了在精神科住院期间,与非裔美国人和非西班牙裔白人患者(n=5183)的卫生服务利用相关的倾向、使能和需求因素的差异。我们进行了单变量和多变量逻辑回归分析,以检查主要效应和相互作用。在多变量模型中,入院时的非裔美国人种族由多个因素预测,包括年龄较小、女性、多次精神病住院、精神病阳性和阴性症状升高、精神分裂症和物质使用的诊断,以及住房和商业保险。此外,在摄入时筛查出大麻使用呈阳性被发现可以调节女性和非裔美国人之间的关系。我们的研究结果强调了使用为弱势群体(如少数族裔和同时患有物质使用障碍的患者)制定的概念框架来检查心理健康差距的重要性。

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