Social and clinical factors associated with psychiatric emergency service use and civil commitment among African-American youth☆
Received 13 August 2009; accepted 5 January 2010. published online 05 February 2010.
Abstract
Purpose
We examined the social and clinical factors associated with arrival status (e.g., involuntary versus voluntary) and civil commitment decisions in psychiatric emergency services (PES) to assess African-American youths' help-seeking patterns and entrée into care.
Methods
Patient records were reviewed for 1621 African-American youth from an inner-city PES between October 2001 and September 2002. Multivariate logistic regression was used to examine the social and clinical factors associated with arrival status (e.g., involuntary vs. voluntary admission) and case disposition among youth who were involuntarily and voluntarily admitted (e.g., disposition upheld vs. dismissed).
Results
Low-income youth with behavior disorders were less likely to arrive voluntarily to PES. Medical insurance, suicidality, DSM diagnosis, substance involvement, Global Assessment of Function (GAF) scores and time of day the youth arrived to PES were predictors of voluntary arrival. Older age and GAF scores significantly predicted the decision to uphold an involuntary commitment. Age (younger age less likely), higher GAF scores, insurance status, substance abuse involvement and arrival time (evening shift) significantly predicted the decision to uphold a voluntary decision.
Implications
Our findings suggest that psychiatric and nonpsychiatric factors influence both how African-American youth arrive to PES and the decisions made regarding their voluntary/involuntary commitment.
☆ Dr. Joe was supported to collect the data and for his time in preparation of this manuscript by grants K01-MH068619 and R01-MH82807 from the National Institute of Mental Health. Dr. Lindsey was supported for his time in preparation of this manuscript by the University of Maryland Multidisciplinary Research Career Development Program - MCRDP (NIH K12RR023250; PI: Alan R. Shuldiner). Dr. Lindsey was awarded a personal competitive 5-year K12 scholar career development award as allocated under the institutional MCRDP K12 grant awarded to the University of Maryland.
ABSTRACT