Ethnicity and involuntary hospitalisation: a study of intersectional effects.

PURPOSE: Studies have found that the Mental Health Act is used disproportionally among minoritised ethnicities. Yet, little research has been conducted to understand how the intersectionality of ethnicity with sociodemographic factors relates to involuntary admission. This study aimed to investigate whether an association between ethnicity and involuntary hospitalisation is altered by variations in service-users' sociodemographic positions. METHODS: A retrospective cohort study using records from the South London and Maudsley identified 18,569 service-users with a first episode of hospitalisation in a 13-year period. Logistic regression was used to calculate odds ratios for involuntary hospitalisation across ethnicities while adjusting for sociodemographic (age, gender, area-level deprivation, homelessness, and migration) and clinical factors (psychiatric diagnosis and HoNOS scores). Interaction analysis was conducted to identify intersectional effects between ethnicity and sociodemographic variables, potentially modifying the odds ratios of involuntary admission across ethnic groups. RESULTS: Increased odds of involuntary hospitalisation compared to White British service-users were observed among 10 of the 14 ethnicities, with around, or just under twice the odds observed for Asian Chinese, Black African, and Black Caribbean. Women were found to have increased odds of involuntary admission. Significant interactions were present between ethnicity and age, area-level deprivation, homelessness, and migration in the unadjusted models. These effect modifications were not significant after adjustment for confounders. CONCLUSIONS: Ethnic inequalities were observed in involuntary hospitalisation among service-users on first admission. No evidence of intersectional effects was present when adjusting for sociodemographic and clinical factors. Further research needs to identify the mechanisms causing the inequalities.