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Illness Severity and Psychiatric Hospitalization Rates Among Asian Americans and Pacific Islanders
Tetine Sentell, Ph.D.; George Jay Unick, Ph.D.; Hyeong Jun Ahn, Ph.D.; Kathryn L. Braun, Dr.P.H.; Jill Miyamura, Ph.D.; Martha Shumway, Ph.D.
Psychiatric Services 2013; doi: 10.1176/appi.ps.201200408
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Dr. Sentell and Dr. Braun are with the Office of Public Health Studies, University of Hawai‘i at Manoa, 1960 East-West Road, Honolulu, HI 96822 (e-mail: tsentell@hawaii.edu). Dr. Unick is with the School of Social Work, University of Maryland, Baltimore. Dr. Ahn is with the Biostatistics Core, John A. Burns School of Medicine, University of Hawai‘i at Manoa. Dr. Miyamura is with the Hawai‘i Health Information Corporation, Honolulu. Dr. Shumway is with the Department of Psychiatry, University of California, San Francisco, and San Francisco General Hospital. Findings from this study were presented at the Advancing Native Health and Wellness Conference, July 31 through August 5, 2012, Anchorage, Alaska, and at the American Public Health Association Conference, October 27–31, 2012, San Francisco.

Copyright © 2013 by the American Psychiatric Association

Abstract

Objective  The study objective was to fill research gaps about inpatient psychiatric service utilization among Asian Americans and Pacific Islanders (AA/PIs).

Methods  Rates of psychiatric hospitalization, illness severity, and length of stay were compared among AA/PI adults overall and across diagnoses (schizophrenia, depression, bipolar, anxiety, and other psychiatric disorders identified by All Patient Refined Diagnosis Related Groups) by using discharge data from all hospitalizations in Hawaii from December 2006 to 2010. Multivariable models adjusted for gender, age, payer, and residence.

Results  In multivariable analyses of total psychiatric hospitalizations, Chinese (rate ratio [RR]=.22), Japanese (RR=.23), Filipinos (RR=.30), and Native Hawaiians (RR=.37) had significantly lower rates than whites. Native Hawaiians had significantly higher hospitalization rates compared with other AA/PI groups. Length of stay was significantly longer for Chinese (length of stay ratio [LOSR]=1.53), Filipinos (LOSR=1.20), and Japanese (LOSR=1.19) compared with whites, whereas severity of illness was significantly higher for Japanese (odds ratio [OR]=1.36) and Filipinos (OR=1.30). Within specific diagnoses, Native Hawaiians had higher hospitalization rates than other AA/PI groups for depression, bipolar disorder, and anxiety disorder. Chinese, Japanese, and Filipinos had significantly higher illness severity or longer stays than whites for at least one diagnostic category.

Conclusions  AA/PI subgroups had lower psychiatric hospitalization rates than whites, but rates varied across AA/PI subgroups. Native Hawaiians had higher hospitalization rates for many diagnoses. Chinese, Japanese, and Filipinos had greater illness severity or longer stays than whites overall and for some diagnoses, whereas Native Hawaiians did not. Disaggregating AA/PI groups provides important insight into mental health services utilization and need.

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Table 1Description of all psychiatric hospitalizations in Hawaii of Asian-American and Pacific Islander subgroups and whites, December 2006–December 2010a
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a N=10,831 psychiatric hospitalizations out of 303,621 total hospitalizations

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b Possible scores range from 1–4, with higher scores indicating greater severity.

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Table 2Unadjusted rates and ratios for psychiatric hospitalizations in Hawaii by race-ethnicity across all hospitalizations, December 2006–2010a
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a Rate denominators were determined with race-ethnicity percentages from the 2008 Hawaii Health Survey of adults age ≥18 applied to 2010 census population totals.

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Table 3Adjusted rate ratios from multivariate models for psychiatric hospitalizations in Hawaii, by Asian-American/Pacific Islander subgroup compared with whites, December 2006–December 2010a
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a Multivariable models controlled for gender, age, payer, and living in Oahu. Rate denominators were determined with race-ethnicity percentages from the 2008 Hawaii Health Survey of adults age ≥18 applied to 2010 census population totals.

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**p<.01,***p<.001

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Table 4Adjusted estimates of length of psychiatric hospitalization and severity of illness among Asian-American and Pacific Islander subgroups versus whites in Hawaii, December 2006–December 2010a
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a The reference group is white for all comparisons. The multivariate models for severity of illness and for length of stay controlled for gender, age, payer, and living in Oahu; modeling for length of stay also adjusted for severity of illness.

Table Footer Note

*p<.05, **p<.01, ***p<.001

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References

Stensland  M;  Watson  PR;  Grazier  KL:  An examination of costs, charges, and payments for inpatient psychiatric treatment in community hospitals.  Psychiatric Services 63:666–671, 2012
[CrossRef] | [PubMed]
 
Blader  JC:  Acute inpatient care for psychiatric disorders in the United States, 1996 through 2007.  Archives of General Psychiatry 68:1276–1283, 2011
[CrossRef] | [PubMed]
 
Padgett  DK;  Patrick  C;  Burns  BJ  et al:  Ethnic differences in use of inpatient mental health services by blacks, whites, and Hispanics in a national insured population.  Health Services Research 29:135–153, 1994
[PubMed]
 
Snowden  LR;  Cheung  FK:  Use of inpatient mental health services by members of ethnic minority groups.  American Psychologist 45:347–355, 1990
[CrossRef] | [PubMed]
 
Overview of Race and Hispanic Origin: 2010. 2010 Census Brief. Washington, DC, US Census Bureau, March 2011. Available at www.census.gov/prod/cen2010/briefs/c2010br-02.pdf
 
Bilheimer  LT;  Sisk  JE:  Collecting adequate data on racial and ethnic disparities in health: the challenges continue.  Health Affairs 27:383–391, 2008
[CrossRef] | [PubMed]
 
Ghosh  C:  A national health agenda for Asian Americans and Pacific Islanders.  JAMA 304:1381–1382, 2010
[CrossRef] | [PubMed]
 
Akutsu  P;  Snowden  LR;  Organista  KC:  Referral patterns in ethnic-specific and mainstream programs for ethnic minorities and Whites.  Journal of Counseling Psychology 43:56–64, 1996
[CrossRef]
 
Spencer  MS;  Chen  J:  Effect of discrimination on mental health service utilization among Chinese Americans.  American Journal of Public Health 94:809–814, 2004
[CrossRef] | [PubMed]
 
Mental Health: Culture, Race, and Ethnicity—A Supplement to Mental Health: A Report of the Surgeon General. Rockville, Md, US Department of Health and Human Services, US Public Health Service, 2001
 
Kitano  H:  Mental health in the Japanese-American community; in  Minority Mental Health . Edited by Jones  EE;  Korchin  SJ.  New York,  Praeger, 1982
 
Sue  S;  Morishima  JK:  The Mental Health of Asian Americans .  San Francisco,  Jossey-Bass, 1982
 
Hu  TW;  Snowden  LR;  Jerrell  JM  et al:  Ethnic populations in public mental health: services choice and level of use.  American Journal of Public Health 81:1429–1434, 1991
[CrossRef] | [PubMed]
 
Shin  JK:  Inpatient stays of Asian patients with psychiatric diagnoses in New York City.  Issues in Mental Health Nursing 30:112–121, 2009
[CrossRef] | [PubMed]
 
Chen  HJ:  Mental illness and principal physical diagnoses among Asian American and Pacific Islander users of emergency services.  Issues in Mental Health Nursing 26:1061–1079, 2005
[CrossRef] | [PubMed]
 
Chow  JC;  Jaffee  K;  Snowden  L:  Racial/ethnic disparities in the use of mental health services in poverty areas.  American Journal of Public Health 93:792–797, 2003
[CrossRef] | [PubMed]
 
Moy  KL;  Sallis  JF;  David  KJ:  Health indicators of Native Hawaiian and Pacific Islanders in the United States.  Journal of Community Health 35:81–92, 2010
[CrossRef] | [PubMed]
 
Yuen  NY;  Nahulu  LB;  Hishinuma  ES  et al:  Cultural identification and attempted suicide in Native Hawaiian adolescents.  Journal of the American Academy of Child and Adolescent Psychiatry 39:360–367, 2000
[CrossRef] | [PubMed]
 
Salvail FR, Smith JM: Prevalence of anxiety and depression among Hawaii’s adults derived from HBRFSS 2006. Survey Shows . . . The Hawaii Behavioral Risk Factor Surveillance System Special Report, Year 5, Issue 2, Nov 2007. Honolulu, State of Hawaii Department of Health, 2007. Available athawaii.gov/health/statistics/brfss/reports/Mental_2707rptA.pdf
 
Salvail FR, Liang S, Nguyen S: Frequent mental distress prevalence and disparity: Hawaii BRFSS 2005–2007. Survey Shows . . . The Hawaii Behavioral Risk Factor Surveillance System Special Report, Year 6, Issue 2, 2008. Honolulu, State of Hawaii Department of Health, 2008. Available at hawaii.gov/health/statistics/brfss/reports/FMD_rpt_1007.pdf
 
Ta  VM;  Juon  HS;  Gielen  AC  et al:  Disparities in use of mental health and substance abuse services by Asian and Native Hawaiian/other Pacific Islander women.  Journal of Behavioral Health Services and Research 35:20–36, 2008
[CrossRef] | [PubMed]
 
Salvail FR, Liang S, Gross PL: Hawaii BRFSS 2007: Mental Health and Stigma Report. Survey Shows . . . The Hawaii Behavioral Risk Factor Surveillance System Special Report, Year 7, Issue 1, 2009. Honolulu, State of Hawaii Department of Health, 2009. Available at hawaii.gov/health/statistics/brfss/reports/Mental07_rpt.pdf
 
Hawai’i Health Survey 2008 data. Honolulu, State of Hawaii Department of Health, 2008. Available at health.hawaii.gov/hhs/files/2013/05/hhs08t40.pdf
 
Grouper APR-DRG: Version 29.0.  Wellingford, Conn,  3M Health Information Systems, 2011
 
Averill RF, Goldfield N, Hughes JS, et al: All Patient Refined Diagnosis Related Groups (APR-DRGs), Version 20.0: Methodology Overview. Murray, Utah, 3M Health Information Systems, 2003. Available at www.hcup-us.ahrq.gov/db/nation/nis/APR-DRGsV20MethodologyOverviewandBibliography.pdf
 
APR-DRG Classification Software—Overview. Rockville, Md, Agency for Health Care Research and Quality, 2011. Available at www.ahrq.gov/qual/mortality/Hughessumm.pdf
 
State and County QuickFacts. Washington, DC, US Census Bureau. Available at quickfacts.census.gov/qfd/states/15000.html. Accessed July 31, 2012
 
Park  CB;  Braun  KL;  Horiuchi  BY  et al:  Longevity disparities in multiethnic Hawaii: an analysis of 2000 life tables.  Public Health Reports 124:579–584, 2009
[PubMed]
 
Braun  KL;  Browne  CV:  Perceptions of dementia, caregiving, and help seeking among Asian and Pacific Islander Americans.  Health and Social Work 23:262–274, 1998
[CrossRef] | [PubMed]
 
Saba DK, Levit KR, Elixhauser A: Hospital Stays Related to Mental Health, 2006. HCUP Statistical Brief 62. Rockville, Md, Agency for Health Care Research and Quality, 2008. Available at www.hcup-us.ahrq.gov/reports/statbriefs/sb62.pdf
 
Kaneshiro  B;  Geling  O;  Gellert  K  et al:  The challenges of collecting data on race and ethnicity in a diverse, multiethnic state.  Hawaii Medical Journal 70:168–171, 2011
[PubMed]
 
Spencer  MS;  Chen  J;  Gee  GC  et al:  Discrimination and mental health–related service use in a national study of Asian Americans.  American Journal of Public Health 100:2410–2417, 2010
[CrossRef] | [PubMed]
 
Unick  GJ;  Kessell  E;  Woodard  EK  et al:  Factors affecting psychiatric inpatient hospitalization from a psychiatric emergency service.  General Hospital Psychiatry 33:618–625, 2011
[CrossRef] | [PubMed]
 
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