Understanding the intersections between ethnicity, area-level deprivation, and inpatient-related features amongst patients with psychotic disorders: a mental health electronic records analysis.

Abstract

Purpose: Ethnic and area-level deprivation disparities in psychiatric inpatient outcomes amongst patients with psychotic disorders are known. However, how these two variables intersect to influence features of inpatient care is unclear. We investigated this intersection.

Methods: Using de-identified electronic health data from inpatient services at a large south London mental healthcare provider, we identified a sample of 6767 working-age patients with non-affective psychotic disorders who were admitted between 2016 and 2019. Logistic and negative binomial regressions were used to examine the relationships between ethnicity (and then deprivation) with inpatient-related features (compulsory admission, psychiatric intensive unit admission, length of stay and number of admissions), adjusting for confounders. The sample was stratified by area-level deprivation to understand the intersection of ethnicity, deprivation and these inpatient-related features.

Results: Patients from all areas except the least deprived were at greater risk of compulsory admission, admission to psychiatric intensive care units and more frequent admissions compared with patients from the least deprived areas. All minoritised ethnic patients were more likely to be compulsorily admitted compared with White British patients. Living in the least deprived areas appeared to offer protection against compulsory admission for some ethnic minority groups, but not Black British or Asian patients.

Conclusions: This study showed how psychiatric inpatient-related features for patients with non-affective psychotic disorders were explained not only by the separate effects of area-level deprivation and ethnicity but also by the unique intersections of these two factors. Our findings have implications for policy and interventions aimed at reducing the drivers of inpatient admissions by addressing social stressors in deprived areas and among ethnic minority patients.