Thursday, December 23, 2021

Black Patients More Likely to Be Restrained During Emergency Psychiatric Evaluation

Black patients continue to be at greater risk of physical or chemical restraint during an emergency psychiatric evaluation than White patients, suggests a report published this week in Psychiatric Services in Advance. The findings are based on analysis of the electronic medical records of adults 18 years and older who received an emergency psychiatric evaluation at Duke University Hospital in Durham, N.C., over a six-year period.

“The finding that Black patients are more likely to undergo physical and chemical restraint in an emergency psychiatry setting adds to a growing body of literature regarding emergency care settings and restraint use and extends these findings to an intersectionally vulnerable group: patients of color receiving psychiatric consultation,” wrote Colin M. Smith, M.D., of Duke University School of Medicine and colleagues.

The researchers analyzed the electronic medical records of adults who received an emergency psychiatric evaluation at Duke University Hospital between January 1, 2014, and September 18, 2020. Specifically, the authors focused on the use of physical and chemical restraint “invoked for patient behaviors including violence, severely aggressive behavior, self-injurious behavior, or inability to exhibit safe behaviors.” Physical restraints included physical holds, mitts, soft restraints, locking cuffs, or neoprene cuffs; chemical restraint was defined as documentation of a first- or second-generation antipsychotic available on the hospital formulary (chlorpromazine, fluphenazine, haloperidol, olanzapine, and ziprasidone).

A total of 12,977 unique emergency psychiatric encounters were included in the analysis. The median age of the cohort was 37 years, and 55% of the encounters involved male patients; 6,287 encounters involved Black patients and 5,263 involved White patients. During the study period, 961 (about 7%) encounters involved physical restraint, and 2,047 (about 16%) involved chemical restraint; 797 (83%) encounters involved both physical and chemical restraint. Black patients underwent physical restraint during 8.7% of encounters and chemical restraint during 18.1% of encounters, whereas White patients underwent physical restraint during 5.4% of encounters and chemical restraint during 12.3% of encounters.

Compared with White patients, those who identified as Black, multiracial, or who did not report race were more likely to have been physically or chemically restrained during the emergency department visit, the researchers found. After adjusting for age, sex, ethnicity, height, arrival time to the emergency department, urine drug screen results, peak alcohol concentration, and diagnosis, the association between Black race and restraint remained: Black patients were more likely to be physically (1.35 times the odds) and chemically (1.33 times the odds) restrained than White patients.

“The observational nature of the study limits our ability to make causal claims, but our findings nonetheless suggest ongoing disparities in psychiatric care for Black patients in the prehospital and emergency settings,” Smith and colleagues concluded.

For related information, see the Psychiatric News AlertEmergency Department Staff More Likely to Restrain Black Children Than White Children, Report Finds.”

(Image: iStock/MJFelt)

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