Department of Medicine (Smith, Turner, Thielman, Gagliardi), Department of Psychiatry and Behavioral Sciences (Smith, Tweedy, Gagliardi), and Duke Global Health Institute (Thielman, Egger), Duke University School of Medicine, Durham, North Carolina.
Psychiatr Serv. 2022 Jul;73(7):730-736. doi: 10.1176/appi.ps.202100474. Epub 2021 Dec 21.
Few studies have examined the disproportionate use of restraints for Black adults receiving emergency psychiatric care. This study sought to determine whether the odds of physical and chemical restraint use were higher for Black patients undergoing emergency psychiatric care compared with their White counterparts.
This single-center retrospective cohort study examined 12,977 unique encounters of adults receiving an emergency psychiatric evaluation between January 1, 2014, and September 18, 2020, at a large academic medical center in Durham, North Carolina. Self-reported race categories were extracted from the electronic medical record. Primary outcomes were the presence of a behavioral physical restraint order or chemical restraint administration during the emergency department encounter. Covariates included age, sex, ethnicity, height, time of arrival, positive urine drug screen results, peak blood alcohol concentration, and diagnosis of a bipolar or psychotic disorder.
A total of 961 (7.4%) encounters involved physical restraint, and 2,047 (15.8%) involved chemical restraint. Models with and without a race covariate were compared by using quasi-likelihood information criterion scores; in each instance, the model with race performed better than the model without. Black patients were more likely to be physically (adjusted odds ratio [AOR]=1.35; 95% confidence interval [CI]=1.07-1.72) and chemically (AOR=1.33; 95% CI=1.15-1.55) restrained than White patients.
After analyses were adjusted for measured confounders, Black patients undergoing psychiatric evaluation were at higher odds of experiencing physical or chemical restraint compared with White patients, which is consistent with the growing body of evidence revealing racial disparities in psychiatric care.
很少有研究调查在接受紧急精神科护理的黑人成年人中过度使用约束的情况。本研究旨在确定在接受紧急精神科护理的黑人患者中，与白人患者相比，使用身体和化学约束的几率是否更高。
这项单中心回顾性队列研究调查了 2014 年 1 月 1 日至 2020 年 9 月 18 日期间在北卡罗来纳州达勒姆市的一家大型学术医疗中心接受紧急精神评估的 12977 名独特的成年人的就诊情况。从电子病历中提取了自我报告的种族类别。主要结果是在急诊科就诊期间是否存在行为身体约束令或化学约束管理。协变量包括年龄、性别、族裔、身高、到达时间、尿液药物筛查阳性结果、血酒精浓度峰值和双相或精神病诊断。
共有 961 次（7.4%）就诊涉及身体约束，2047 次（15.8%）涉及化学约束。使用拟似然信息准则评分比较了包含和不包含种族协变量的模型；在每种情况下，包含种族的模型表现都优于不包含种族的模型。与白人患者相比，黑人患者更有可能接受身体（调整后的优势比 [AOR]=1.35；95%置信区间 [CI]=1.07-1.72）和化学（AOR=1.33；95% CI=1.15-1.55）约束。
在对测量混杂因素进行调整后，与白人患者相比，接受精神科评估的黑人患者经历身体或化学约束的几率更高，这与越来越多的证据一致，这些证据表明精神科护理中的种族差异。
