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Published Online: 19 October 2023

Race-Based Disparities in the Frequency and Duration of Restraint Use in a Psychiatric Inpatient Setting

Sonali Singal, B.S., Danielle Howell, M.D., Lauren Hanna, M.D., Sunny X. Tang, M.D., Anna Van Meter, Ph.D., Ema Saito, M.D., John M. Kane, M.D., and Timothy I. Michaels, Ph.D. [email protected]Authors Info & Affiliations
Publication: Psychiatric Services
Volume 75, Number 4
https://doi.org/10.1176/appi.ps.20230057
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Abstract

Objective:

Patients’ race and age have each been identified as risk factors for experiencing restraint events during psychiatric hospitalization. Restraint duration is also an important variable in determining disparities in treatment. To the authors’ knowledge, no studies to date have examined the effect of the interaction of race and age on restraint use and duration in inpatient psychiatric settings. This retrospective chart review of electronic medical records of patients admitted between 2012 and 2019 sought to examine whether race and age interacted in predicting differences in the use and duration of restraints in a psychiatric inpatient setting.

Methods:

Logistic and hierarchical regression analyses were conducted on data from a sample of 29,739 adolescent (ages 12–17 years) and adult (ages ≥18 years) inpatients to determine whether the interaction of race and age group (adolescent or adult) significantly predicted a restraint event or differences in restraint duration.

Results:

Black (adjusted OR [AOR]=1.85) and multiracial (AOR=1.36) patients were more likely to experience a restraint event than were their White peers. Black race was also significantly (p=0.001) associated with longer restraint duration. No significant interaction was detected between race and age in predicting restraint events or duration.

Conclusions:

Although the interaction between race and age did not predict restraint events or duration, the findings indicate racial disparities in the frequency and duration of restraint events among Black and multiracial individuals and may inform efforts to reduce these events.

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Information & Authors

Information

Published In

Go to Psychiatric Services
Go to Psychiatric Services
Psychiatric Services
Volume 75 • Number 4 • April 01, 2024
Pages: 308 - 315
PubMed: 37855100

History

Received: 9 February 2023
Revision received: 3 July 2023
Accepted: 10 August 2023
Published online: 19 October 2023
Published in print: April 01, 2024

Keywords

  1. Racial disparities
  2. Restraint
  3. Structural racism
  4. Age disparities
  5. Health disparities
  6. Inpatient psychiatric treatment

Authors

Affiliations

Sonali Singal, B.S.
Institute of Behavioral Science, Feinstein Institutes for Medical Research, Manhasset, New York (Singal, Tang, Kane); Department of Clinical Psychology, Graduate School of Applied and Professional Psychology, Rutgers, State University of New Jersey, New Brunswick (Singal); Donald and Barbara Zucker School of Medicine, Hofstra/Northwell Health, Hempstead, New York (Howell, Hanna, Kane, Michaels); Department of Psychiatry, Zucker Hillside Hospital, Northwell Health, Glen Oaks, New York (Hanna, Tang, Van Meter, Saito, Michaels); Department of Child and Adolescent Psychiatry, Grossman School of Medicine, New York University, New York City (Van Meter).
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Danielle Howell, M.D.
Institute of Behavioral Science, Feinstein Institutes for Medical Research, Manhasset, New York (Singal, Tang, Kane); Department of Clinical Psychology, Graduate School of Applied and Professional Psychology, Rutgers, State University of New Jersey, New Brunswick (Singal); Donald and Barbara Zucker School of Medicine, Hofstra/Northwell Health, Hempstead, New York (Howell, Hanna, Kane, Michaels); Department of Psychiatry, Zucker Hillside Hospital, Northwell Health, Glen Oaks, New York (Hanna, Tang, Van Meter, Saito, Michaels); Department of Child and Adolescent Psychiatry, Grossman School of Medicine, New York University, New York City (Van Meter).
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Lauren Hanna, M.D.
Institute of Behavioral Science, Feinstein Institutes for Medical Research, Manhasset, New York (Singal, Tang, Kane); Department of Clinical Psychology, Graduate School of Applied and Professional Psychology, Rutgers, State University of New Jersey, New Brunswick (Singal); Donald and Barbara Zucker School of Medicine, Hofstra/Northwell Health, Hempstead, New York (Howell, Hanna, Kane, Michaels); Department of Psychiatry, Zucker Hillside Hospital, Northwell Health, Glen Oaks, New York (Hanna, Tang, Van Meter, Saito, Michaels); Department of Child and Adolescent Psychiatry, Grossman School of Medicine, New York University, New York City (Van Meter).
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Sunny X. Tang, M.D.
Institute of Behavioral Science, Feinstein Institutes for Medical Research, Manhasset, New York (Singal, Tang, Kane); Department of Clinical Psychology, Graduate School of Applied and Professional Psychology, Rutgers, State University of New Jersey, New Brunswick (Singal); Donald and Barbara Zucker School of Medicine, Hofstra/Northwell Health, Hempstead, New York (Howell, Hanna, Kane, Michaels); Department of Psychiatry, Zucker Hillside Hospital, Northwell Health, Glen Oaks, New York (Hanna, Tang, Van Meter, Saito, Michaels); Department of Child and Adolescent Psychiatry, Grossman School of Medicine, New York University, New York City (Van Meter).
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Anna Van Meter, Ph.D.
Institute of Behavioral Science, Feinstein Institutes for Medical Research, Manhasset, New York (Singal, Tang, Kane); Department of Clinical Psychology, Graduate School of Applied and Professional Psychology, Rutgers, State University of New Jersey, New Brunswick (Singal); Donald and Barbara Zucker School of Medicine, Hofstra/Northwell Health, Hempstead, New York (Howell, Hanna, Kane, Michaels); Department of Psychiatry, Zucker Hillside Hospital, Northwell Health, Glen Oaks, New York (Hanna, Tang, Van Meter, Saito, Michaels); Department of Child and Adolescent Psychiatry, Grossman School of Medicine, New York University, New York City (Van Meter).
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Ema Saito, M.D.
Institute of Behavioral Science, Feinstein Institutes for Medical Research, Manhasset, New York (Singal, Tang, Kane); Department of Clinical Psychology, Graduate School of Applied and Professional Psychology, Rutgers, State University of New Jersey, New Brunswick (Singal); Donald and Barbara Zucker School of Medicine, Hofstra/Northwell Health, Hempstead, New York (Howell, Hanna, Kane, Michaels); Department of Psychiatry, Zucker Hillside Hospital, Northwell Health, Glen Oaks, New York (Hanna, Tang, Van Meter, Saito, Michaels); Department of Child and Adolescent Psychiatry, Grossman School of Medicine, New York University, New York City (Van Meter).
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John M. Kane, M.D.
Institute of Behavioral Science, Feinstein Institutes for Medical Research, Manhasset, New York (Singal, Tang, Kane); Department of Clinical Psychology, Graduate School of Applied and Professional Psychology, Rutgers, State University of New Jersey, New Brunswick (Singal); Donald and Barbara Zucker School of Medicine, Hofstra/Northwell Health, Hempstead, New York (Howell, Hanna, Kane, Michaels); Department of Psychiatry, Zucker Hillside Hospital, Northwell Health, Glen Oaks, New York (Hanna, Tang, Van Meter, Saito, Michaels); Department of Child and Adolescent Psychiatry, Grossman School of Medicine, New York University, New York City (Van Meter).
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Timothy I. Michaels, Ph.D. [email protected]
Institute of Behavioral Science, Feinstein Institutes for Medical Research, Manhasset, New York (Singal, Tang, Kane); Department of Clinical Psychology, Graduate School of Applied and Professional Psychology, Rutgers, State University of New Jersey, New Brunswick (Singal); Donald and Barbara Zucker School of Medicine, Hofstra/Northwell Health, Hempstead, New York (Howell, Hanna, Kane, Michaels); Department of Psychiatry, Zucker Hillside Hospital, Northwell Health, Glen Oaks, New York (Hanna, Tang, Van Meter, Saito, Michaels); Department of Child and Adolescent Psychiatry, Grossman School of Medicine, New York University, New York City (Van Meter).
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Notes

Send correspondence to Dr. Michaels ([email protected]).

Competing Interests

Dr. Hanna reports owning stocks in Doximity. Dr. Tang reports owning equity in North Shore Therapeutics and Psyrin, serving as a consultant for North Shore Therapeutics and Winterlight Labs, serving on the advisory board of Psyrin, and receiving research funding from Winterlight Labs. Dr. Kane reports serving as a consultant to or receiving honoraria from Alkermes, Allergan, Boehringer-Ingelheim, Cerevel Therapeutics, Dainippon Sumitomo, H. Lundbeck, HealthRhythms, HLS Therapeutics, Indivior, Intracellular Therapies, Janssen Pharmaceutical, Johnson & Johnson, LB Pharmaceuticals, Merck, Minerva, Neurocrine Biosciences, Newron Pharmaceuticals, Novartis, NW PharmaTech, Otsuka, Roche, Saladax Biomedical, Sunovion, and Teva; serving on advisory boards for Cerevel, Click Therapeutics, H. Lundbeck, Merck, Newron, Novartis, Otsuka, Sumitomo, and Teva; receiving grant support from H. Lundbeck, Janssen, Otsuka, and Sunovion; holding shares in LB Pharmaceuticals, MedinCell, North Shore Therapeutics, Sage Therapeutics, and Vanguard Research Group; and receiving royalties from UpToDate. The other authors report no financial relationships with commercial interests.

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