Associations of Restraint and Seclusion With Race and Ethnicity on an Adolescent Inpatient Psychiatry Service

• Published in: Journal of the American Academy of Child and Adolescent Psychiatry Vol. 62; no. 5; pp. 503 - 506
• Main Authors: Daniels, Teresa E., Victor, Colleen, Smith, Eric M., Belgrave, Christa, Robinson, Erica, Wolff, Jennifer C., Hunt, Jeffrey, Brannan, Elizabeth H.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.05.2023; Elsevier BV
• Subjects: Adolescent; Adolescent Psychiatry; Adolescents; African Americans; Age; American Indians; Associations; Child; Child & adolescent psychiatry; Child welfare; Computerized medical records; Electronic medical records; Ethnic Groups; Ethnicity; Focus groups; Gender; Gender Discrimination; Health disparities; Hospitalization; Hospitals; Humans; Indigenous peoples; Inequality; Inpatient care; Inpatients; Length of Stay; Medical diagnosis; Medical records; Medical Services; Mental disorders; Mental health; Minority & ethnic groups; Multiracial Persons; Patient admissions; Patients; Pediatrics; Privacy; Psychiatric Services; Psychiatric units; Psychiatric/Mental Health; Race; Racial differences; Reference Groups; Reference Materials; Regression (Statistics); Regression analysis; Retrospective Studies; Risk assessment; Social isolation; Stakeholders; Statistical analysis; Study Guides; Systemic racism
• ISSN: 0890-8567; 1527-5418; 1527-5418
• DOI: 10.1016/j.jaac.2022.11.012

There is limited work examining the association of race and ethnicity with restraint and seclusion (R/S) in pediatric inpatient psychiatric units. The present study assessed risk of R/S by race and ethnicity based on a retrospective review of electronic medical records (EMRs) from an adolescent inpatient psychiatric service. Demographic, diagnostic, and R/S data were analyzed for all 1,865 admissions of 1,327 patients from an adolescent unit at a child and adolescent psychiatric hospital from June 2018 to June 2021. R/S occurred in 459 of the admissions. For the purpose of patient privacy and statistical analysis, race was grouped into the following: Black or African American, other (American Indian or Alaskan Native, Asian, multiracial, other), and White. Patients identified as unknown were not included in the analysis. A binary logistic regression with a repeated subject effect regressed R/S onto race and adjusted for age, gender, and length of stay (LOS). There was an overall significant association of R/S and race (χ22 = 16.81, p < .001), but not ethnicity. In a regression model adjusted for age, gender, and LOS, patients identified as Black or African American were at significantly higher risk of R/S compared with patients identified as White (odds ratio = 1.66, p = .036). There was no significant difference in risk of R/S between patients identified as White vs other. Younger age and longer LOS were also significantly associated with R/S. These findings highlight a critical health care disparity related to race on an inpatient adolescent psychiatry service. There is likely a combination of individual and systemic factors leading to discriminatory practices in the use of R/S. Future work will assess potential associations with diagnosis and child welfare involvement and will examine additional characteristics of R/S. Focus groups held with hospital and community stakeholders will guide next steps to address these findings.