Disparate patterns of hospitalisation reflect unmet needs and persistent ethnic inequalities in mental health care

the Scottish health and ethnicity linkage study

Narinder Bansal, Raj Bhopal, Gina Netto, Donald Lyons, Markus F C Steiner, Sashi P. Sashidaran

Research output: Contribution to journalArticle

23 Citations (Scopus)

Abstract

Objectives. The presence and extent of mental health inequalities in Scotland is unclear. We investigated ethnic variations in psychiatric hospitalisations and compulsory treatment in relation to socioeconomic indicators. Design. In a retrospective cohort study design, using data linkage methods, we examined ethnic variations in psychiatric [any psychiatric, mood (affective), and psychotic disorders) hospitalisations and use of the Mental Health (Care and Treatment) (Scotland) Act 2003 (Emergency Detentions (ED), Short-Term Detentions (STD) and Compulsory Treatment Orders (CTO)] using age (and sex for compulsory treatment), car ownership, and housing tenure adjusted risk ratios (RR). 95% CIs for the data below exclude the reference White Scottish group value (100). Results. Compared to the White Scottish population, Other White British men and women had lower hospitalisation from any psychiatric disorder (RR = 77.8, 95% CI: 71.0-85.2 and 85.8, 95% CI: 79.3-92.9), mood disorder (91.2, 95% CI: 86.9-95.8 and 83.6, 95% CI: 75.1-93.1), psychotic disorder (67.1, 95% CI: 59.9-75.2 and 78.5, 95% CI: 67.6-91.1), CTO (84.6, 95% CI: 72.4-98.9) and STD (88.2, 95% CI: 78.6-99.0). Any Mixed Background women had higher hospitalisation from any psychiatric disorder (137.2, 95% CI: 110.9-169.6) and men and women had a higher risk of psychotic disorder (200.6, 95% CI: 105.7-380.7 and 175.5, 95% CI: 102.3-301.2), CTO (263.0, 95% CI: 105.4-656.3), ED (245.6, 95% CI: 141.6-426.1) and STD (311.7, 95% CI: 190.2-510.7). Indian women had lower risk of any psychiatric disorder (43.2, 95% CI: 28.0-66.7). Pakistani men had lower risk of any psychiatric disorder (78.7, 95% CI: 69.3-89.3), and higher risk of mood disorders (117.5, 95% CI: 100.2-137.9). Pakistani women had similar risk of any psychiatric and mood disorder however, a twofold excess risk of psychotic disorder (227.3, 95% CI: 195.8-263.8). Risk of STD was higher in South Asians (136.9, 95% CI: 109.0-171.9). Chinese men and women had the lowest risk of hospitalisation for any psychiatric disorder (35.3, 95% CI: 23.2-53.7 and 44.5, 95% CI: 30.3-65.5) and mood disorder (51.5, 95% CI: 31.0-85.4 and 47.5, 95% CI: 23.2-97.4) but not psychotic disorders and higher risk for CTO (181.4, 95% CI: 121.0-271.0). African women had higher risk of any psychiatric disorder (139.4, 95% CI: 119.0-163.2). African men and women had the highest risk for psychotic disorders (230.8, 95% CI: 177.8-299.5 and 240.7, 95% CI: 163.8-353.9) and were also overrepresented in STD (214.3, 95% CI: 122.4-375.0) and CTO (486.6, 95% CI: 231.9-1021.1). Differences in hospitalisations were not fully attenuated when adjusted for car ownership and housing tenure and the effect of these adjustments varied by ethnic group. Conclusion. Our data show disparate patterns of psychiatric hospitalisations by ethnic group in Scotland providing new observations concerning the mental health care experience of Chinese, Mixed background and White subgroups not fully explained by socioeconomic indicators. For South Asian and Chinese groups in particular, our data indicate under and late utilisation of mental health services. These data call for monitoring and review of services.
Original languageEnglish
Pages (from-to)217-239
Number of pages23
JournalEthnicity & Health
Volume19
Issue number2
DOIs
Publication statusPublished - 4 Mar 2014

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ethnic inequality
hospitalization
Psychiatry
Mental Health
compulsory treatment
Hospitalization
ethnicity
mental health
health care
Delivery of Health Care
Health
health
Psychotic Disorders
mood
Mood Disorders
Scotland
Psychotic Affective Disorders
Ownership
Therapeutics
Ethnic Groups

Keywords

  • ethnicity
  • mental health
  • psychiatric disorder
  • compulsory treatment
  • data linkage

Cite this

Disparate patterns of hospitalisation reflect unmet needs and persistent ethnic inequalities in mental health care : the Scottish health and ethnicity linkage study. / Bansal, Narinder; Bhopal, Raj; Netto, Gina ; Lyons, Donald; Steiner, Markus F C; Sashidaran, Sashi P. .

In: Ethnicity & Health, Vol. 19, No. 2, 04.03.2014, p. 217-239.

Research output: Contribution to journalArticle

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title = "Disparate patterns of hospitalisation reflect unmet needs and persistent ethnic inequalities in mental health care: the Scottish health and ethnicity linkage study",
abstract = "Objectives. The presence and extent of mental health inequalities in Scotland is unclear. We investigated ethnic variations in psychiatric hospitalisations and compulsory treatment in relation to socioeconomic indicators. Design. In a retrospective cohort study design, using data linkage methods, we examined ethnic variations in psychiatric [any psychiatric, mood (affective), and psychotic disorders) hospitalisations and use of the Mental Health (Care and Treatment) (Scotland) Act 2003 (Emergency Detentions (ED), Short-Term Detentions (STD) and Compulsory Treatment Orders (CTO)] using age (and sex for compulsory treatment), car ownership, and housing tenure adjusted risk ratios (RR). 95{\%} CIs for the data below exclude the reference White Scottish group value (100). Results. Compared to the White Scottish population, Other White British men and women had lower hospitalisation from any psychiatric disorder (RR = 77.8, 95{\%} CI: 71.0-85.2 and 85.8, 95{\%} CI: 79.3-92.9), mood disorder (91.2, 95{\%} CI: 86.9-95.8 and 83.6, 95{\%} CI: 75.1-93.1), psychotic disorder (67.1, 95{\%} CI: 59.9-75.2 and 78.5, 95{\%} CI: 67.6-91.1), CTO (84.6, 95{\%} CI: 72.4-98.9) and STD (88.2, 95{\%} CI: 78.6-99.0). Any Mixed Background women had higher hospitalisation from any psychiatric disorder (137.2, 95{\%} CI: 110.9-169.6) and men and women had a higher risk of psychotic disorder (200.6, 95{\%} CI: 105.7-380.7 and 175.5, 95{\%} CI: 102.3-301.2), CTO (263.0, 95{\%} CI: 105.4-656.3), ED (245.6, 95{\%} CI: 141.6-426.1) and STD (311.7, 95{\%} CI: 190.2-510.7). Indian women had lower risk of any psychiatric disorder (43.2, 95{\%} CI: 28.0-66.7). Pakistani men had lower risk of any psychiatric disorder (78.7, 95{\%} CI: 69.3-89.3), and higher risk of mood disorders (117.5, 95{\%} CI: 100.2-137.9). Pakistani women had similar risk of any psychiatric and mood disorder however, a twofold excess risk of psychotic disorder (227.3, 95{\%} CI: 195.8-263.8). Risk of STD was higher in South Asians (136.9, 95{\%} CI: 109.0-171.9). Chinese men and women had the lowest risk of hospitalisation for any psychiatric disorder (35.3, 95{\%} CI: 23.2-53.7 and 44.5, 95{\%} CI: 30.3-65.5) and mood disorder (51.5, 95{\%} CI: 31.0-85.4 and 47.5, 95{\%} CI: 23.2-97.4) but not psychotic disorders and higher risk for CTO (181.4, 95{\%} CI: 121.0-271.0). African women had higher risk of any psychiatric disorder (139.4, 95{\%} CI: 119.0-163.2). African men and women had the highest risk for psychotic disorders (230.8, 95{\%} CI: 177.8-299.5 and 240.7, 95{\%} CI: 163.8-353.9) and were also overrepresented in STD (214.3, 95{\%} CI: 122.4-375.0) and CTO (486.6, 95{\%} CI: 231.9-1021.1). Differences in hospitalisations were not fully attenuated when adjusted for car ownership and housing tenure and the effect of these adjustments varied by ethnic group. Conclusion. Our data show disparate patterns of psychiatric hospitalisations by ethnic group in Scotland providing new observations concerning the mental health care experience of Chinese, Mixed background and White subgroups not fully explained by socioeconomic indicators. For South Asian and Chinese groups in particular, our data indicate under and late utilisation of mental health services. These data call for monitoring and review of services.",
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author = "Narinder Bansal and Raj Bhopal and Gina Netto and Donald Lyons and Steiner, {Markus F C} and Sashidaran, {Sashi P.}",
note = "Acknowledgements, funding and independence We thank the Chief Scientist's Office for funding this study (grant (CZH/4/432), and NHS Health Scotland for a supplementary grant. The Equality and Diversity Information Programme of the Information Services Division (ISD) of NHS National Services Scotland. ISD and the General Register Office for Scotland both made ‘in-house’ contributions to the work. Joan Jamieson (ISD) was a co-investigator and general adviser. The researchers acted independently of the funding body and the study sponsor (the University of Edinburgh) at all stages of the work.",
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TY - JOUR

T1 - Disparate patterns of hospitalisation reflect unmet needs and persistent ethnic inequalities in mental health care

T2 - the Scottish health and ethnicity linkage study

AU - Bansal, Narinder

AU - Bhopal, Raj

AU - Netto, Gina

AU - Lyons, Donald

AU - Steiner, Markus F C

AU - Sashidaran, Sashi P.

N1 - Acknowledgements, funding and independence We thank the Chief Scientist's Office for funding this study (grant (CZH/4/432), and NHS Health Scotland for a supplementary grant. The Equality and Diversity Information Programme of the Information Services Division (ISD) of NHS National Services Scotland. ISD and the General Register Office for Scotland both made ‘in-house’ contributions to the work. Joan Jamieson (ISD) was a co-investigator and general adviser. The researchers acted independently of the funding body and the study sponsor (the University of Edinburgh) at all stages of the work.

PY - 2014/3/4

Y1 - 2014/3/4

N2 - Objectives. The presence and extent of mental health inequalities in Scotland is unclear. We investigated ethnic variations in psychiatric hospitalisations and compulsory treatment in relation to socioeconomic indicators. Design. In a retrospective cohort study design, using data linkage methods, we examined ethnic variations in psychiatric [any psychiatric, mood (affective), and psychotic disorders) hospitalisations and use of the Mental Health (Care and Treatment) (Scotland) Act 2003 (Emergency Detentions (ED), Short-Term Detentions (STD) and Compulsory Treatment Orders (CTO)] using age (and sex for compulsory treatment), car ownership, and housing tenure adjusted risk ratios (RR). 95% CIs for the data below exclude the reference White Scottish group value (100). Results. Compared to the White Scottish population, Other White British men and women had lower hospitalisation from any psychiatric disorder (RR = 77.8, 95% CI: 71.0-85.2 and 85.8, 95% CI: 79.3-92.9), mood disorder (91.2, 95% CI: 86.9-95.8 and 83.6, 95% CI: 75.1-93.1), psychotic disorder (67.1, 95% CI: 59.9-75.2 and 78.5, 95% CI: 67.6-91.1), CTO (84.6, 95% CI: 72.4-98.9) and STD (88.2, 95% CI: 78.6-99.0). Any Mixed Background women had higher hospitalisation from any psychiatric disorder (137.2, 95% CI: 110.9-169.6) and men and women had a higher risk of psychotic disorder (200.6, 95% CI: 105.7-380.7 and 175.5, 95% CI: 102.3-301.2), CTO (263.0, 95% CI: 105.4-656.3), ED (245.6, 95% CI: 141.6-426.1) and STD (311.7, 95% CI: 190.2-510.7). Indian women had lower risk of any psychiatric disorder (43.2, 95% CI: 28.0-66.7). Pakistani men had lower risk of any psychiatric disorder (78.7, 95% CI: 69.3-89.3), and higher risk of mood disorders (117.5, 95% CI: 100.2-137.9). Pakistani women had similar risk of any psychiatric and mood disorder however, a twofold excess risk of psychotic disorder (227.3, 95% CI: 195.8-263.8). Risk of STD was higher in South Asians (136.9, 95% CI: 109.0-171.9). Chinese men and women had the lowest risk of hospitalisation for any psychiatric disorder (35.3, 95% CI: 23.2-53.7 and 44.5, 95% CI: 30.3-65.5) and mood disorder (51.5, 95% CI: 31.0-85.4 and 47.5, 95% CI: 23.2-97.4) but not psychotic disorders and higher risk for CTO (181.4, 95% CI: 121.0-271.0). African women had higher risk of any psychiatric disorder (139.4, 95% CI: 119.0-163.2). African men and women had the highest risk for psychotic disorders (230.8, 95% CI: 177.8-299.5 and 240.7, 95% CI: 163.8-353.9) and were also overrepresented in STD (214.3, 95% CI: 122.4-375.0) and CTO (486.6, 95% CI: 231.9-1021.1). Differences in hospitalisations were not fully attenuated when adjusted for car ownership and housing tenure and the effect of these adjustments varied by ethnic group. Conclusion. Our data show disparate patterns of psychiatric hospitalisations by ethnic group in Scotland providing new observations concerning the mental health care experience of Chinese, Mixed background and White subgroups not fully explained by socioeconomic indicators. For South Asian and Chinese groups in particular, our data indicate under and late utilisation of mental health services. These data call for monitoring and review of services.

AB - Objectives. The presence and extent of mental health inequalities in Scotland is unclear. We investigated ethnic variations in psychiatric hospitalisations and compulsory treatment in relation to socioeconomic indicators. Design. In a retrospective cohort study design, using data linkage methods, we examined ethnic variations in psychiatric [any psychiatric, mood (affective), and psychotic disorders) hospitalisations and use of the Mental Health (Care and Treatment) (Scotland) Act 2003 (Emergency Detentions (ED), Short-Term Detentions (STD) and Compulsory Treatment Orders (CTO)] using age (and sex for compulsory treatment), car ownership, and housing tenure adjusted risk ratios (RR). 95% CIs for the data below exclude the reference White Scottish group value (100). Results. Compared to the White Scottish population, Other White British men and women had lower hospitalisation from any psychiatric disorder (RR = 77.8, 95% CI: 71.0-85.2 and 85.8, 95% CI: 79.3-92.9), mood disorder (91.2, 95% CI: 86.9-95.8 and 83.6, 95% CI: 75.1-93.1), psychotic disorder (67.1, 95% CI: 59.9-75.2 and 78.5, 95% CI: 67.6-91.1), CTO (84.6, 95% CI: 72.4-98.9) and STD (88.2, 95% CI: 78.6-99.0). Any Mixed Background women had higher hospitalisation from any psychiatric disorder (137.2, 95% CI: 110.9-169.6) and men and women had a higher risk of psychotic disorder (200.6, 95% CI: 105.7-380.7 and 175.5, 95% CI: 102.3-301.2), CTO (263.0, 95% CI: 105.4-656.3), ED (245.6, 95% CI: 141.6-426.1) and STD (311.7, 95% CI: 190.2-510.7). Indian women had lower risk of any psychiatric disorder (43.2, 95% CI: 28.0-66.7). Pakistani men had lower risk of any psychiatric disorder (78.7, 95% CI: 69.3-89.3), and higher risk of mood disorders (117.5, 95% CI: 100.2-137.9). Pakistani women had similar risk of any psychiatric and mood disorder however, a twofold excess risk of psychotic disorder (227.3, 95% CI: 195.8-263.8). Risk of STD was higher in South Asians (136.9, 95% CI: 109.0-171.9). Chinese men and women had the lowest risk of hospitalisation for any psychiatric disorder (35.3, 95% CI: 23.2-53.7 and 44.5, 95% CI: 30.3-65.5) and mood disorder (51.5, 95% CI: 31.0-85.4 and 47.5, 95% CI: 23.2-97.4) but not psychotic disorders and higher risk for CTO (181.4, 95% CI: 121.0-271.0). African women had higher risk of any psychiatric disorder (139.4, 95% CI: 119.0-163.2). African men and women had the highest risk for psychotic disorders (230.8, 95% CI: 177.8-299.5 and 240.7, 95% CI: 163.8-353.9) and were also overrepresented in STD (214.3, 95% CI: 122.4-375.0) and CTO (486.6, 95% CI: 231.9-1021.1). Differences in hospitalisations were not fully attenuated when adjusted for car ownership and housing tenure and the effect of these adjustments varied by ethnic group. Conclusion. Our data show disparate patterns of psychiatric hospitalisations by ethnic group in Scotland providing new observations concerning the mental health care experience of Chinese, Mixed background and White subgroups not fully explained by socioeconomic indicators. For South Asian and Chinese groups in particular, our data indicate under and late utilisation of mental health services. These data call for monitoring and review of services.

KW - ethnicity

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