Overrepresentation of black Americans in psychiatric inpatient care.
OBJECTIVE
Numerous studies have documented overrepresentation of the black population in psychiatric inpatient settings, but none have included certain important covariates or examined heterogeneity within the black population. After controlling for key social, demographic, and clinical factors, the investigators sought to determine whether blacks are overrepresented in inpatient psychiatric settings; they examined differences within the black population by separately examining the prevalence of inpatient treatment of African Americans and U.S.- and foreign-born Caribbean blacks.


METHODS
Secondary analysis was performed on data from two population-based household surveys, the National Survey of American Life (NSAL) and the National Comorbidity Survey Replication (NCS-R), which provided a population-based sample of 9,371 community-dwelling adults, including 3,570 African Americans, 1,621 blacks of Caribbean descent, and 4,180 non-Hispanic whites. Using logistic regression, the investigators estimated self-reported lifetime psychiatric hospitalization as a function of racial-ethnic background after controlling for sociodemographic differences and differences in lifetime counseling or therapy and psychiatric diagnosis.


RESULTS
With controls for demographic and clinical factors, both African Americans (odds ratio [OR]=2.52, 95% confidence interval [CI]=1.91-3.33) and Caribbean blacks (OR=2.74, CI=1.98-3.82) had higher odds than whites of having a psychiatric hospitalization in their lifetime. U.S.-born Caribbean blacks had much higher odds of hospitalization (OR=5.47, CI=3.60-8.32) than whites, whereas the likelihood of hospitalization of foreign-born Caribbean blacks did not differ from that of whites (OR=.96, CI=.51-1.82).


CONCLUSIONS
Disparities between blacks and whites in the prevalence of psychiatric inpatient treatment appear to be persistent, but global comparisons mask important heterogeneity within the black population.
Snowden
Lonnie R
LR
School of Public Health, University of California, Berkeley, 120 Haviland Hall MC-7400, Berkeley, CA 94720-7400, USA.
Hastings
Julia F
JF
Alvidrez
Jennifer
J
D000293:Adolescent; D000328:Adult; D001741:Black or African American / Q000523:psychology*; D000368:Aged; D003625:Data Collection; D005260:Female; D006630:Hispanic or Latino; D006778:Hospitals, Psychiatric / Q000706:statistics & numerical data*; D006801:Humans; D007297:Inpatients; D016015:Logistic Models; D008297:Male; D001523:Mental Disorders / Q000208:ethnology / Q000628:therapy; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D014481:United States; D014900:West Indies / Q000208:ethnology; D055815:Young Adult