Treating immigrant patients in psychiatric emergency rooms

Francisco Collazos, Ángeles Malagón-Amor, Irene Falgas-Bague, Adil Qureshi, Jose Maria Gines, Maria del Mar Ramos, Samantha McPeck, Isra Hussain, Ye Wang, Margarita Alegría*

*Corresponding author for this work

Research output: Contribution to journalArticleResearchpeer-review

10 Citations (Scopus)

Abstract

We examine whether patient variables (geographic origin, gender, Spanish language proficiency) and subjective clinician aspects in emergency department psychiatric encounters (diagnostic certainty, clinician’s comfort level with patient) are associated with diagnosis and the use of coercive measures. Using a descriptive cross-sectional design, we recorded 467 visits (400 foreign-born and 67 native-born patients) in hospital psychiatry emergency rooms (ERs) in Barcelona between 2007 and 2015. We first assessed the association of patient variables and subjective clinician aspects of psychiatric encounters with service use outcomes and with mental illness diagnosis. Fitted logistic models predicted the likelihood of service use outcomes and estimated the propensity of receiving each diagnosis. The null model evaluated the role of patient’s geographical origin, while the full model evaluated the additional roles of patient’s gender and language, the clinician’s assessment of the influence of culture in diagnosis, and clinician comfort with two outcomes: patient’s diagnosis and use of coercive measures in the ER. Women were less likely to receive coercive measures or intramuscular medications compared to men. Significant ethnic/racial and gender differences were found in receiving certain diagnoses. Additionally, a patient’s lower Spanish proficiency was correlated with a higher probability of receiving a psychosis diagnosis. The clinician’s level of diagnostic certainty was also positively correlated with increasing clinician-reported comfort with patient. Overall, ethnic factors and the subjective aspects of psychiatric encounters were found to influence diagnosis and the use of coercive measures. Cultural competency programs and interpreter services within psychiatric ER settings should thus be required.

Original languageEnglish
Pages (from-to)126-139
Number of pages14
JournalTranscultural Psychiatry
Volume58
Issue number1
DOIs
Publication statusPublished - Feb 2021

Keywords

  • coercive measures
  • culture
  • diagnosis
  • emergency department
  • ethnicity
  • immigrant

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