Saturday, 15 January 2005 - 4:00 PM

This presentation is part of: Assessing the Context of Mental Health Service Delivery for Youth: Opportunities for Targeted Intervention

Racial and Ethnic Disparities in Psychiatric Hospitalization among Youth: Clinical and Organizational Influences

Purpose: To reach our national mental health goal for all Americans to share equally in the best available services and outcomes, regardless of race, we need better information on failures in service equity, their reasons, and consequences. The purpose of this study is to examine rates of admission to psychiatric hospitalization versus outpatient mental health treatment among White, Black and Hispanic youth, and to analyze the extent to which clinical need, insurance coverage or organizational profit making may influence selection processes. Methods. Two data sets managed by the U.S. Department of Health and Human Services, Center for Mental Health Services were merged for this study: the 1994 Inventory of Mental Health Organizations and General Hospital Mental Health Services (IMHO) is the universe of specialty inpatient, outpatient, and residential mental health programs in the U.S., and the 1997 Client/Patient Sample Survey (CPSS), the most recently available data on persons receiving specialty mental health care throughout the nation. The IMHO served as the sampling frame for the CPSS, which used a two-stage cluster design survey. After 1,599 facilities were randomly selected from the IMHO, clients within facilities were randomly selected, with youth under age 18 years oversampled. This study is based on 3,468 youth admitted for services over the course of a year, representing a weighted estimate of about 1.2 million youth, located in about 800 facilities.

The merged CPSS-IMHO dataset is used to investigate individual and organizational effects on selection to inpatient versus outpatient care (the dependent measure). Individual-level independent variables include: race-ethnicity (non-Hispanic White, non-Hispanic Black, Hispanic), gender, age, living situation (with family or in out-of-home arrangements), principal diagnosis (ICD or DSM), global assessment of functioning score (GAF), and principal source of payment (public vs. private). The organizational-level independent variable is organizational ownership (public, private for-profit, private non-profit). Multivariate analyses were conducted with SAS-callable SUDAAN to account for the complex survey design. We focus on the differences between race-ethnic groups in selection processes, and test for significant interactions between individual- and organizational-level variables.

Results. Black youth were less likely than White youth to be hospitalized, controlling on illness factors, including type of diagnosis, dual vs. single diagnosis, and global assessment of functioning, in addition to facility ownership, source of payment and living situation. Logistic regression analyses showed that the odds of being hospitalized for the more severely ill children (GAF scores < 35) were two to three times greater for Whites than Blacks. The differences between race-ethnic groups vanished at higher GAF scores. Regardless of ability to pay or for-profit status of the facility, Black and White youth do not appear to receive comparable care.

Implications. When minority and non-minority youth suffer from equally severe illnesses, they do not seem to receive equal care. The results suggest that hospitalization may be a scarce resource preferentially delivered to White youth. Reasons for inequities may reside in geographic variation in availability, clinical decision making processes or cultural preferences. Recommendations for outreach, the organization of service delivery, and future research are discussed.

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