McLeod Melissa, King Paula, Stanley James, Lacey Cameron, Cunningham Ruth
Department of Public Health, University of Otago, Wellington.
Department of Public Health and General Practice, University of Otago, Christchurch.
N Z Med J. 2017 Apr 28;130(1454):30-39.
This study aims to investigate disparities in seclusion between Māori and non-Māori non-Pacific (nMnP) adults in mental health inpatient units in New Zealand.
This study uses data on 7,239 inpatient psychiatric admissions and 782 seclusion events for nine district health boards (servicing 39% of the New Zealand population) for the period 1 July 2008 to 30 June 2010, from a New Zealand Ministry of Health dataset (PRIMHD). We calculate the age-standardised rates of seclusion per monthly inpatient admissions. Regression modelling of seclusion event rate ratios for Māori compared to nMnP adjusted for age, gender, socioeconomic deprivation (NZDep2006), legal status, referral pathway and diagnosis.
Māori psychiatric inpatients are 39% more likely to experience a seclusion episode than nMnP adults in New Zealand. Important contributors to the disparity in seclusion rates between Māori and nMnP were age and legal status on admission. Adjustment for a range of demographic and admission variables accounted for part of the measured disparity between Māori and nMnP (RR 1.33, fully adjusted).
To reduce seclusion use for Māori, community mental health services responsive to Māori needs are required to prevent the need for inpatient admission, and reduce the acuity of illness where admission is required.
本研究旨在调查新西兰心理健康住院单元中毛利人与非毛利非太平洋岛民（nMnP）成年人在被隔离方面的差异。
本研究使用了2008年7月1日至2010年6月30日期间来自新西兰卫生部数据集（PRIMHD）的九个地区卫生委员会（服务于39%的新西兰人口）的7239例住院精神科入院病例和782起隔离事件的数据。我们计算了每月住院入院病例的年龄标准化隔离率。对毛利人与nMnP的隔离事件发生率比值进行回归建模，并根据年龄、性别、社会经济剥夺程度（NZDep2006）、法律地位、转诊途径和诊断进行调整。
在新西兰，毛利精神科住院患者经历隔离事件的可能性比nMnP成年人高39%。毛利人与nMnP隔离率差异的重要因素是入院时的年龄和法律地位。对一系列人口统计学和入院变量进行调整后，解释了毛利人与nMnP之间部分已测量到的差异（风险比1.33，完全调整）。
为减少对毛利人的隔离使用，需要有响应毛利人需求的社区心理健康服务，以防止住院需求，并在需要住院时降低疾病的严重程度。
