Care patterns for affective psychosis across diverse ethnicities: exploring potential contributors to complications...

To explore associations between access to care and environmental stressors with emergency room admissions; to evaluate patterns of complications across diverse ethnic groups related to affective psychosis.

Data from the National Inpatient Sample were used to evaluate complications and frequency of hospitalization through the emergency room as a proportion of all hospital admissions for affective psychosis across diverse ethnic groups. Unemployment data, variations of trends of proportions of emergency room admissions after the September 11th tragedy, and ratios of primary care physicians/psychiatrists to the general population were evaluated.

Admissions through the emergency room as a percentage of all admissions for affective psychosis decreased from 1995 through 1999 but increased in 2001, showing a potential association with increasing unemployment rates and the September 11th tragedy. Over the same period, relatively higher frequencies of emergency room admissions as a proportion of all hospital admissions among African Americans decreased. No significant differences for complications or emergency room utilization were observed between African Americans and Whites by 2001. During the entire period, frequencies of complications in the Hispanic and Asian populations remained lower than frequencies in both African American and White populations. No associations were found between physician-to-population ratios and utilization of the emergency room.

Patterns of emergency room utilization and complications in African American and White populations appear to show some association with environmental stressors. Further study is warranted to evaluate protective factors associated with lower risk of complications in both Hispanic and Asian populations.