Shea Timothy, Dotson Samuel, Tyree Griffin, Ogbu-Nwobodo Lucy, Beck Stuart, Shtasel Derri
Department of Psychiatry, Massachusetts General Hospital, and Harvard Medical School, Boston.
Psychiatr Serv. 2022 Dec 1;73(12):1322-1329. doi: 10.1176/appi.ps.202100342. Epub 2022 Aug 12.
Involuntary psychiatric treatment may parallel ethnoracial inequities present in the larger society. Prior studies have focused on restraint and seclusion, but less attention has been paid to the civil commitment system because of its diversity across jurisdictions. Using a generalizable framework, this study investigated inequities in psychiatric commitment.
A prospective cohort was assembled of all patients admitted to an inpatient psychiatric unit over 6 years (2012-2018). Patients were followed longitudinally throughout their admission; raters recorded legal status each day. Sociodemographic and clinical data were collected to adjust for confounding variables by using multivariate logistic regression.
Of the 4,393 patients with an initial admission during the study period, 73% self-identified as White, 11% as Black, 10% as primarily Hispanic or Latinx, 4% as Asian, and 3% as another race or multiracial. In the sample, 28% were involuntarily admitted, and court commitment petitions were filed for 7%. Compared with White patients, all non-White groups were more likely to be involuntarily admitted, and Black and Asian patients were more likely to have court commitment petitions filed. After adjustment for confounding variables, Black patients remained more likely than White patients to be admitted involuntarily (adjusted odds ratio [aOR]=1.57, 95% confidence interval [CI]=1.26-1.95), as were patients who identified as other race or multiracial (aOR=2.12, 95% CI=1.44-3.11).
Patients of color were significantly more likely than White patients to be subjected to involuntary psychiatric hospitalization, and Black patients and patients who identified as other race or multiracial were particularly vulnerable, even after adjustment for confounding variables.
非自愿精神科治疗可能与更广泛社会中存在的种族不平等现象相似。先前的研究主要关注约束和隔离措施，但由于民事强制住院制度在不同司法管辖区存在差异，对其关注较少。本研究使用一个可推广的框架，调查了精神科强制住院中的不平等现象。
对6年期间（2012 - 2018年）入住某住院精神科病房的所有患者组成了一个前瞻性队列。患者在整个住院期间接受纵向随访；评估人员每天记录其法律状态。收集社会人口统计学和临床数据，通过多变量逻辑回归调整混杂变量。
在研究期间首次入院的4393名患者中，73%自我认定为白人，11%为黑人，10%主要为西班牙裔或拉丁裔，4%为亚洲人，3%为其他种族或多种族。在该样本中，28%为非自愿入院，7%提交了法庭强制住院申请。与白人患者相比，所有非白人组更有可能非自愿入院，黑人和亚洲患者更有可能提交法庭强制住院申请。在调整混杂变量后，黑人患者比白人患者更有可能非自愿入院（调整后的优势比[aOR]=1.57，95%置信区间[CI]=1.26 - 1.95），自我认定为其他种族或多种族的患者也是如此（aOR=2.12，95% CI=1.44 - 3.11）。
有色人种患者比白人患者更有可能接受非自愿精神科住院治疗，即使在调整混杂变量后，黑人患者以及自我认定为其他种族或多种族的患者仍然特别容易受到影响。
