Rotenberg Martin, Tuck Andrew, Ptashny Rachel, McKenzie Kwame
University of Toronto, Centre for Addiction and Mental Health, Toronto, ON, Canada.
Centre for Addiction and Mental Health, Toronto, ON, Canada.
BMC Psychiatry. 2017 Apr 13;17(1):137. doi: 10.1186/s12888-017-1285-3.
This study investigates the role of ethnicity in pathways to emergency mental health care in Toronto for clients with psychosis, while taking into account neighborhood factors. Previous literature has focused on Afro-Caribbean clients, reporting an increased risk of accessing mental health care through negative pathways.
A retrospective chart review for clients from 6 different ethnic origin groups presenting with psychosis - East Asian, South Asian, Black African, Black Caribbean, White European, and White North American - was undertaken in a psychiatric emergency department (ED). Logistic regression models were constructed to examine the relationship between pathways to care (involuntary detention under the Mental Health Act (MHA), police or ambulance referral, accompaniment by family or friends) with individual and neighbourhood factors.
A total of 765 clients were included in the study. East Asian (OR =2.36, p < 0.01) and South Asian (OR 2.99, p < 0.01) origin clients have increased odds of presenting to the ED while involuntarily detained under the MHA. Involuntary status under the MHA increased the odds of presenting via police or ambulance (OR 8.27, p < 0.001). East Asian origin clients have increased odds of presenting to the ED by police or ambulance (OR =2.10, p < 0.05). Clients from neighbourhoods with higher levels of residential instability have increased odds of presenting by police or ambulance (OR =1.35, p < 0.01), while clients from neighbourhoods with higher levels of ethnic concentration have increased odds of being accompanied to the ED by family or friends (OR =1.33, p < 0.01).
In contrast to previous studies, East Asian and South Asian origin clients with psychosis have increased odds of a coercive pathway to emergency psychiatric services in Toronto. Black African and Black Caribbean origin clients do not have increased odds of a coercive pathway. Clients living in areas with high levels of residential instability are more likely to encounter a negative pathway. Ethnic concentration may be a supportive factor in family and friend accompaniment.
本研究调查了种族因素在多伦多精神病患者紧急心理健康护理途径中的作用，同时考虑了社区因素。以往文献主要关注非洲裔加勒比海地区患者，报道了通过消极途径获得心理健康护理的风险增加。
在一家精神科急诊科，对6个不同种族来源的精神病患者进行了回顾性病历审查，这些种族包括东亚、南亚、非洲黑人、加勒比黑人、欧洲白人以及北美白人。构建逻辑回归模型，以检验护理途径（根据《精神健康法》（MHA）进行非自愿拘留、警方或救护车转诊、家人或朋友陪同）与个体及社区因素之间的关系。
本研究共纳入765名患者。东亚裔（OR = 2.36，p < 0.01）和南亚裔（OR = 2.99，p < 0.01）患者在根据MHA被非自愿拘留的情况下到急诊科就诊的几率增加。MHA规定的非自愿状态增加了通过警方或救护车转诊就诊的几率（OR = 8.27，p < 0.001）。东亚裔患者通过警方或救护车转诊到急诊科就诊的几率增加（OR = 2.10，p < 0.05）。居住不稳定程度较高社区的患者通过警方或救护车转诊就诊的几率增加（OR = 1.35，p < 0.01），而种族集中程度较高社区的患者由家人或朋友陪同到急诊科就诊的几率增加（OR = 1.33，p < 0.01）。
与以往研究不同，在多伦多，患有精神病的东亚裔和南亚裔患者通过强制途径获得紧急精神科服务的几率增加。非洲黑人和加勒比黑人患者通过强制途径就诊的几率并未增加。居住在居住不稳定程度高的地区的患者更有可能经历消极途径。种族集中可能是家人和朋友陪同就诊的一个支持因素。
