The role of race in diagnostic and disposition decision making in a pediatric psychiatric emergency service

Gen Hosp Psychiatry. May-Jun 2008;30(3):269-76. doi: 10.1016/j.genhosppsych.2008.01.003.


Objective: We investigated the influence of race/ethnicity in diagnostic and disposition decision-making for children and adolescents presenting to an urban psychiatric emergency service (PES).

Method: Medical records were reviewed for 2991 child and adolescent African-American, Hispanic/Latino and white patients, treated in an urban PES between October 2001 and September 2002. A series of bivariate and binomial logistic regression analyses were used to delineate the role of race in the patterns and correlates of psychiatric diagnostic and treatment disposition decisions.

Results: Binomial logistic regression analyses reveal that African-American (OR=2.28, P<.001) and Hispanic/Latino (OR=2.35, P<.05) patients are more likely to receive psychotic disorders and behavioral disorders diagnoses (African American: OR=1.66, P<.001; Hispanic/Latino: OR=1.36, P<.05) than white children/adolescents presenting to PES. African-American youth compared to white youth are also less likely to receive depressive disorder (OR=0.78, P<.05), bipolar disorder (OR=.44, P<.001) and alcohol/substance abuse disorder (OR=.18, P<.01) diagnoses. African-American pediatric PES patients are also more likely to be hospitalized (OR=1.50, P<.05), controlling for other sociodemographic and clinical factors (e.g., Global Assessment of Functioning).

Conclusions: The results highlight that nonclinical factors such as race/ethnicity are associated with clinical diagnostic decisions as early as childhood suggesting the pervasiveness of such disparities.

Publication types

  • Comparative Study
  • Research Support, N.I.H., Extramural

MeSH terms

  • Adolescent
  • Adult
  • Alcoholism / diagnosis
  • Alcoholism / ethnology
  • Alcoholism / therapy
  • Bipolar Disorder / diagnosis
  • Bipolar Disorder / ethnology
  • Bipolar Disorder / therapy
  • Blacks / psychology*
  • Blacks / statistics & numerical data
  • Child
  • Child, Preschool
  • Depressive Disorder / diagnosis
  • Depressive Disorder / ethnology
  • Depressive Disorder / therapy
  • Emergency Services, Psychiatric / statistics & numerical data*
  • Female
  • Healthcare Disparities / statistics & numerical data
  • Hispanic or Latino / psychology*
  • Hispanic or Latino / statistics & numerical data
  • Hospitalization / statistics & numerical data*
  • Hospitals, Psychiatric / statistics & numerical data
  • Humans
  • Male
  • Mental Disorders / diagnosis
  • Mental Disorders / ethnology*
  • Mental Disorders / therapy
  • Philadelphia
  • Psychotic Disorders / diagnosis
  • Psychotic Disorders / ethnology
  • Psychotic Disorders / therapy
  • Substance-Related Disorders / diagnosis
  • Substance-Related Disorders / ethnology
  • Substance-Related Disorders / therapy
  • Whites / psychology*
  • Whites / statistics & numerical data