Association of ethnic concordance between patients and psychiatrists with the management of suicide attempts in the emergency department.
Crisis Intervention
Emergency psychiatry
Ethnic concordance
Suicide attempts
Journal
Psychiatry research
ISSN: 1872-7123
Titre abrégé: Psychiatry Res
Pays: Ireland
ID NLM: 7911385
Informations de publication
Date de publication:
05 2023
05 2023
Historique:
received:
28
12
2022
revised:
10
03
2023
accepted:
11
03
2023
medline:
18
4
2023
pubmed:
27
3
2023
entrez:
26
3
2023
Statut:
ppublish
Résumé
Suicide attempt is a psychiatric emergency that can be treated with different approaches. Understanding of patient- and physician-related determinants of psychiatric interventions may help to identify sources of bias and improve clinical care. To evaluate the demographic predictors of psychiatric intervention in the emergency department (ED) following a suicide attempt. We analyzed all ED visits in Rambam Health Care Campus following suicide attempts carried out by adults between 2017-2022. Two logistic regression models were built to examine whether patient and psychiatrist's demographic variables can predict 1) the clinical decision to provide a continued psychiatric intervention and 2) the setting for the psychiatric intervention (inpatient or outpatient). In total, 1,325 ED visits were evaluated, corresponding to 1,227 unique patients (mean age; 40.47±18.14 years, 550 men [41.51%]; 997 Jewish [75.25%] and 328 Arabs [24.75%]]), and 30 psychiatrists (9 men [30%]; 21 Jewish [70%] and 9 Arabs [30%]). Demographic variables had a limited predictive power for the decision to intervene (R²=0.0245). Yet, a significant effect of age was observed as intervention rates increased with age. In contrast, the type of intervention was strongly associated with demography (R²=0.289), with a significant interaction between patient and psychiatrist's ethnic identities. Further analysis revealed that Arab psychiatrists preferentially referred Arab patients to outpatient over inpatient treatment. The results indicate that while demographic variables, and specifically patient and psychiatrist's ethnicity, do not affect clinical judgement for psychiatric intervention following a suicide attempt, they do play a major role in selecting treatment setting. Further studies are required to better understand the causes underlying this observation and its association with long-term outcomes. Yet, acknowledging the existence of such bias is a first step towards better culturally mindful psychiatric interventions.
Sections du résumé
BACKGROUND
Suicide attempt is a psychiatric emergency that can be treated with different approaches. Understanding of patient- and physician-related determinants of psychiatric interventions may help to identify sources of bias and improve clinical care.
OBJECTIVE
To evaluate the demographic predictors of psychiatric intervention in the emergency department (ED) following a suicide attempt.
METHODS
We analyzed all ED visits in Rambam Health Care Campus following suicide attempts carried out by adults between 2017-2022. Two logistic regression models were built to examine whether patient and psychiatrist's demographic variables can predict 1) the clinical decision to provide a continued psychiatric intervention and 2) the setting for the psychiatric intervention (inpatient or outpatient).
RESULTS
In total, 1,325 ED visits were evaluated, corresponding to 1,227 unique patients (mean age; 40.47±18.14 years, 550 men [41.51%]; 997 Jewish [75.25%] and 328 Arabs [24.75%]]), and 30 psychiatrists (9 men [30%]; 21 Jewish [70%] and 9 Arabs [30%]). Demographic variables had a limited predictive power for the decision to intervene (R²=0.0245). Yet, a significant effect of age was observed as intervention rates increased with age. In contrast, the type of intervention was strongly associated with demography (R²=0.289), with a significant interaction between patient and psychiatrist's ethnic identities. Further analysis revealed that Arab psychiatrists preferentially referred Arab patients to outpatient over inpatient treatment.
CONCLUSIONS
The results indicate that while demographic variables, and specifically patient and psychiatrist's ethnicity, do not affect clinical judgement for psychiatric intervention following a suicide attempt, they do play a major role in selecting treatment setting. Further studies are required to better understand the causes underlying this observation and its association with long-term outcomes. Yet, acknowledging the existence of such bias is a first step towards better culturally mindful psychiatric interventions.
Identifiants
pubmed: 36966695
pii: S0165-1781(23)00118-X
doi: 10.1016/j.psychres.2023.115167
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
115167Informations de copyright
Copyright © 2023 Elsevier B.V. All rights reserved.
Déclaration de conflit d'intérêts
Declaration of Competing Interest The authors declare no conflicts of interest.