Race Disparities in Psychiatric Rates in Emergency Departments.

Abstract

Psychiatric diagnoses based on the International Classification of Diseases--Ninth Revision were examined in the medical discharge records of 33,000 emergency department (ED) patients to determine if (a) psychiatric disorders were underdiagnosed, (b) there were race and gender disparities in psychiatric rates, and (c) psychiatric rates varied as a function of type of injury (e.g., self vs. other-inflicted injuries) and medical diagnosis. The observed psychiatric rate of 5.27% was far below the national prevalence rate of 20%-28%. Both race groups were underdiagnosed, but the underdiagnosis was larger for African Americans. Younger patients had fewer psychiatric diagnoses than older patients. Men had more psychiatric diagnoses overall, whereas women had more mood and anxiety diagnoses. Self-injury patients had much higher psychiatric rates than the other injury groups. This psychiatric underdiagnosis contributes to needless emotional suffering, especially for minorities and the poor who rely on EDs for most of their health care.

Increased Rates of Bipolar Disorder Diagnoses Among U.S. Child, Adolescent, and Adult Inpatients, 1996–2004

“…Demographic differences in BPD diagnoses in the earlier survey years showed lower rates among Black individuals, and Black males even more so, than among those in the White and Other NHDS race groups. This result echoes the similar discrepancies in diagnostic rates between racial groupings reported in adults (Kunen et al 2005,Neighbors et al 2003, and Strakowski et al 2003 and adolescents (Delbello et al 2001), but not previously reported among preadolescents. However, the latest three NHDS years show a steep increase in BPD discharges, especially for Black males.…”

Undiagnosed Mental Illness in the Emergency Department

“…Richmond et al found that psychiatric comorbidity disorders were frequently found in individuals who presented to the ED with minor injuries (6). Others have found that psychiatric conditions are more oppressive for those of lower socioeconomic status (7,8). These studies show that an unplanned contact with the ED for treatment of a physical illness or injury should be viewed as an opportunity to identify undiagnosed psychiatric disorders.…”

Organizational and Individual Factors Affecting Consumer Outcomes of Care in Mental Health Services

“…Further, we hypothesized that individual clinical and demographic characteristics of consumers; such as age, gender, ethnicity, diagnosis, and prior history of service utilization, would also affect outcomes of care. More specifically, demographic variables, such as age, gender, and ethnicity, have been linked to differences in mental health status and service utilization (Carrington, 2006;Chow, Jaffee, & Snowden, 2003;Harris, Edlund, & Larson, 2005;Kunen, Niederhauser, Smith, Morris, & Marx, 2005;Snowden, 2005). Therefore, we expected that there would be differences in outcomes as a function of these variables; with women, older consumers, and ethnic minorities faring relatively worse than others.…”