The role of race in diagnostic and disposition decision making in a pediatric psychiatric emergency service.
OBJECTIVE
We investigated the influence of race/ethnicity in diagnostic and disposition decision-making for children and adolescents presenting to an urban psychiatric emergency service (PES).


METHODS
Medical records were reviewed for 2991 child and adolescent African-American, Hispanic/Latino and white patients, treated in an urban PES between October 2001 and September 2002. A series of bivariate and binomial logistic regression analyses were used to delineate the role of race in the patterns and correlates of psychiatric diagnostic and treatment disposition decisions.


RESULTS
Binomial logistic regression analyses reveal that African-American (OR=2.28, P<.001) and Hispanic/Latino (OR=2.35, P<.05) patients are more likely to receive psychotic disorders and behavioral disorders diagnoses (African American: OR=1.66, P<.001; Hispanic/Latino: OR=1.36, P<.05) than white children/adolescents presenting to PES. African-American youth compared to white youth are also less likely to receive depressive disorder (OR=0.78, P<.05), bipolar disorder (OR=.44, P<.001) and alcohol/substance abuse disorder (OR=.18, P<.01) diagnoses. African-American pediatric PES patients are also more likely to be hospitalized (OR=1.50, P<.05), controlling for other sociodemographic and clinical factors (e.g., Global Assessment of Functioning).


CONCLUSIONS
The results highlight that nonclinical factors such as race/ethnicity are associated with clinical diagnostic decisions as early as childhood suggesting the pervasiveness of such disparities.
Muroff
Jordana
J
School of Social Work, Boston University, Boston, MA 02215, USA. jmuroff@bu.edu
Edelsohn
Gail A
GA
Joe
Sean
S
Ford
Briggett C
BC
D000293:Adolescent; D000328:Adult; D000437:Alcoholism / Q000175:diagnosis / Q000208:ethnology / Q000628:therapy; D001714:Bipolar Disorder / Q000175:diagnosis / Q000208:ethnology / Q000628:therapy; D044383:Black People / Q000523:psychology* / Q000706:statistics & numerical data; D002648:Child; D002675:Child, Preschool; D003866:Depressive Disorder / Q000175:diagnosis / Q000208:ethnology / Q000628:therapy; D004637:Emergency Services, Psychiatric / Q000706:statistics & numerical data*; D005260:Female; D054625:Healthcare Disparities / Q000706:statistics & numerical data; D006630:Hispanic or Latino / Q000523:psychology* / Q000706:statistics & numerical data; D006760:Hospitalization / Q000706:statistics & numerical data*; D006778:Hospitals, Psychiatric / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis / Q000208:ethnology* / Q000628:therapy; D015143:Philadelphia; D011618:Psychotic Disorders / Q000175:diagnosis / Q000208:ethnology / Q000628:therapy; D019966:Substance-Related Disorders / Q000175:diagnosis / Q000208:ethnology / Q000628:therapy; D044465:White People / Q000523:psychology* / Q000706:statistics & numerical data; D001741:Black or African American