title: Ethnic Differences in Mental Illness Severity: A Population-Based Study of Chinese and South Asian Patients in Ontario, Canada.
abstract: Little is known about the sociocultural determinants of mental illness at hospital presentation. Our objective was to examine ethnic differences in illness severity at hospital admission among Chinese, South Asian, and the general population living in Ontario, Canada.
  
  
  
  We conducted a large, population-based, cross-sectional study of psychiatric inpatients aged from 19 to 105 years who were discharged between 2006 and 2014. A total of 133,588 patients were classified as Chinese (n = 2,582), South Asian (n = 2,452), or the reference group (n = 128,554) using a validated surnames algorithm (specificity: 99.7%). Diagnoses were based on DSM-IV criteria. We examined the association between ethnicity and 4 measures of disease severity: involuntary admissions, aggressive behaviors, and the number and frequency of positive symptoms (ie, hallucinations, command hallucinations, delusions, and abnormal thought process) (Positive Symptoms Scale, Resident Assessment Instrument-Mental Health [RAI-MH]).
  
  
  
  After adjusting for sociodemographic characteristics, immigration status, and discharge diagnosis, Chinese patients had greater odds of involuntary admissions (odds ratio [OR] = 1.79; 95% CI, 1.64-1.95) and exhibiting severe aggressive behaviors (OR = 1.36; 95% CI, 1.23-1.51) and ≥ 3 positive symptoms (OR = 1.39; 95% CI, 1.24-1.56) compared to the general population. South Asian ethnicity was also an independent predictor of most illness severity measures. The association between Chinese ethnicity and illness severity was consistent across sex, diagnostic and immigrant categories, and first-episode hospitalization.
  
  
  
  Chinese and South Asian ethnicities are independent predictors of illness severity at hospital presentation. Understanding the role of patient, family, and health system factors in determining the threshold for hospitalization is an important future step in informing culturally specific care for these large and growing populations worldwide.
authors.affiliation: Mental Health and Addictions Program, Institute for Clinical Evaluative Sciences, G-106, 2075 Bayview Ave, Toronto ON M4N 3M5, Canada. maria.chiu@ices.on.ca.|Institute for Clinical Evaluative Sciences, Toronto, Canada.
authors.forename: Maria
authors.initials: M
authors.lastname: Chiu
authors.affiliation: Institute for Clinical Evaluative Sciences, Toronto, Canada.
authors.forename: Michael
authors.initials: M
authors.lastname: Lebenbaum
authors.affiliation: Institute for Clinical Evaluative Sciences, Toronto, Canada.
authors.forename: Alice M
authors.initials: AM
authors.lastname: Newman
authors.affiliation: Centre for Addiction and Mental Health, Toronto, Canada.
authors.forename: Juveria
authors.initials: J
authors.lastname: Zaheer
authors.affiliation: Institute for Clinical Evaluative Sciences, Toronto, Canada.|Centre for Addiction and Mental Health, Toronto, Canada.|Department of Psychiatry and Institute of Health Policy, Management and Evaluation, University of Toronto, Canada.
authors.forename: Paul
authors.initials: P
authors.lastname: Kurdyak
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001211:Asia, Western / Q000208:ethnology; D001526:Behavioral Symptoms / Q000208:ethnology*; D002681:China / Q000208:ethnology; D003430:Cross-Sectional Studies; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000208:ethnology*; D008875:Middle Aged; D009864:Ontario / Q000208:ethnology; D012720:Severity of Illness Index; D055815:Young Adult