Risk of involuntary admission among first-generation ethnic minority groups with early psychosis: a retrospective cohort study using health administrative data.

Rebecca Rodrigues,Arlene G Macdougall,Kelly K Anderson,Michael Lebenbaum,Salimah Z Shariff,Lihua Li,Guangyong Zou,Paul Kurdyak

doi:10.1017/s2045796019000556

Abstract

Ethnic minority groups often have more complex and aversive pathways to mental health care. However, large population-based studies are lacking, particularly regarding involuntary hospitalisation. We sought to examine the risk of involuntary admission among first-generation ethnic minority groups with early psychosis in Ontario, Canada. Using health administrative data, we constructed a retrospective cohort (2009-2013) of people with first-onset non-affective psychotic disorder aged 16-35 years. This cohort was linked to immigration data to ascertain migrant status and country of birth. We identified the first involuntary admission within 2 years and compared the risk of involuntary admission for first-generation migrant groups to the general population. To control for the role of migrant status, we restricted the sample to first-generation migrants and examined differences by country of birth, comparing risk of involuntary admission among ethnic minority groups to a European reference. We further explored the role of migrant class by adjusting for immigrant vs refugee status within the migrant cohort. We also explored effect modification of migrant class by ethnic minority group. We identified 15 844 incident cases of psychotic disorder, of whom 19% (n = 3049) were first-generation migrants. Risk of involuntary admission was higher than the general population in five of seven ethnic minority groups. African and Caribbean migrants had the highest risk of involuntary admission (African: risk ratio (RR) = 1.52, 95% CI = 1.34-1.73; Caribbean: RR = 1.58, 95% CI = 1.37-1.82), and were the only groups where the elevated risk persisted when compared to the European reference group within the migrant cohort (African: RR = 1.24, 95% CI = 1.04-1.48; Caribbean: RR = 1.29, 95% CI = 1.07-1.56). Refugee status was independently associated with involuntary admission (RR = 1.16, 95% CI = 1.02-1.32); however, this risk varied by ethnic minority group, with Caribbean refugees having an elevated risk of involuntary admission compared with Caribbean immigrants (RR = 1.72, 95% CI = 1.15-2.58). Our findings are consistent with the international literature showing increased rates of involuntary admission among some ethnic minority groups with early psychosis. Interventions aimed at improving pathways to care could be targeted at these groups to reduce disparities.

Highlights

International evidence has demonstrated notably higher rates of involuntary admission among some ethnic minority groups, with the largest risk observed among Black-Caribbean and Black-African patients compared with White patients, and moderate risk for South Asian patients (Bhui et al, 2003; Singh et al, 2007; Halvorsrud et al, 2018; Barnett et al, 2019)
The secondary aim was to examine the risk of involuntary admission within a subsample restricted to first-generation migrants, in order to isolate the effects of ethnicity and to examine the role of refugee status on the risk of involuntary admission
All migrant groups had a higher proportion of people residing in the lowest two income quintiles compared with the general population, with the Caribbean and African groups having the highest proportions

Summary

Introduction

International evidence has demonstrated notably higher rates of involuntary admission among some ethnic minority groups, with the largest risk observed among Black-Caribbean and Black-African patients compared with White patients, and moderate risk for South Asian patients (Bhui et al, 2003; Singh et al, 2007; Halvorsrud et al, 2018; Barnett et al, 2019). Less evidence exists regarding involuntary admission among other ethnic minority groups with early psychosis, given that these groups tend to be underrepresented in prior studies (Anderson et al, 2014; Mann et al, 2014a). These disparities in service experiences among ethnic minority groups early in the course of psychotic illness may have long-term consequences. The secondary aim was to examine the risk of involuntary admission within a subsample restricted to first-generation migrants, in order to isolate the effects of ethnicity and to examine the role of refugee status on the risk of involuntary admission

Methods

Study design and case definition

Results

Discussion

Limitations

Conclusions