Table 4.
Available relative risk*, odds ratio (OR), confidence interval and p value data, and additional key findings to highlight important reported associations between ethnicity and restrictive practices
| Restrictive practices | Study | Country | Variable | OR | 95% CI | p value | Notes and additional key findings |
|---|---|---|---|---|---|---|---|
| Mechanical restraint | Alda Díez et al. [38] | Spain | Immigrant | 2.6 | 1.9–3.0 | NR | Immigrants were significantly balanced with national subjects after 3 years in Spain |
| Bak et al. [57] | Denmark/Norway | Ethnicity | NR | NR | NR | No significant difference between countries were reported in relation to ethnicity However, a small difference was observed in the number of mechanical restraints per unit | |
| Bak et al. [58] | Denmark/Norway | Ethnicity | NR | NR | NR | No significant difference in ethnicity between countries | |
| Currier et al. [76] | USA | Race | NR | NR | 0.18 | Proportional difference between ethnic groups were reported | |
| Tarsitani et al. [25] | Italy | Immigrant | 3.67* | 1.05–12.7 | 0.027 | Non-significant results between ethnic groups in relation to rates of repeated mechanical restraints and in the overall duration of restraint | |
| Flammer et al. [74] | Germany | German citizenship | 0.56 | 0.33–0.94 | < 0.05 | ||
| 0.29 | 0.17–0.5 | < 0.001 | Psychotic subgroup results | ||||
| Husum et al. [75] | Norway | Other than Norwegian | 0.39 | 0.16–0.96 | < 0.05 | Adjusted for patients' individual psychopathology | |
| Rapid tranquillisation | Beames and Onwumere [7]† | UK | Ethnicity | NR | NR | NR | Reporting about significant and non-significant results in the literature |
| Flammer et al. [74] | Germany | German citizenship | 1.17 | 0.56–2.45 | NR | ||
| 0.88 | 0.31–2.5 | NR | Psychotic subgroup results | ||||
| Gowda et al. [77] | India | Religion | 0.43 | NR | NR | ||
| Lay et al. [39] | Switzerland | Foreign national | 1.14 | 1.1–1.18 | NR | ||
| 1.23 | 0.96–1.5 | NR | Adjusted for other sociodemographic variables However, proportional difference between ethnic groups was reported | ||||
| Opitz-Welke and Konrad [66] | Germany | German | NR | NR | NR | Proportional difference between ethnic groups was reported | |
| Verlinde et al. [78] | Netherlands | Non-western descent | NR | NR | NR | Policy change did not affect the use of rapid tranquillisation | |
| Seclusion | Beames and Onwumere [7]† | UK | Ethnicity | NR | NR | NR | Reporting about significant and non-significant results in the literature |
| Bowers et al. [1] | UK | Ethnicity | NR | NR | NR | Ethnicity was not reported as being associated with the likelihood of seclusion, number of seclusion episodes or when in the hospital stay seclusion occurs | |
| Bowers et al. [59] | UK | Asian | NR | NR | 0.001 | Seclusion was not strongly associated with the type of patients. Additional p values available in the paper. However, the associations were relatively weak and non-significant after adjusted analysis | |
| Cullen et al. [81] | UK | Black African/Caribbean | 1.13 | 0.71–1.79 | 0.609 | Adjusted for all demographic/clinical factors and behavioural precursors. ORs for other ethnic groups are available in the paper. However, all were non-significant. Proportional differences between ethnic groups were reported | |
| Drown et al. [60] | New Zealand | Māori | NR | NR | NR | Seclusion among Māori slightly increased between 2007 and 2013, whereas among other groups seclusion decreased (no significant difference) However, in 2014 Māori received seclusion proportionally more often than non-Māori | |
| Flammer et al. [74] | Germany | German citizenship | 0.68 | 0.42–1.11 | NR | ||
| 0.51 | 0.25–1.07 | NR | Psychotic subgroup results | ||||
| Gowda et al. [77] | India | Religion | NR | NR | NR | No significant results were reported | |
| Happell and Koehn [9] | Australia | Indigenous people | NR | NR | 0.066 | Proportional difference between ethnic groups was reported; with significant results in relation to age group | |
| Hendryx et al. [69] | USA | Black/Hispanic/native | NR | NR | NR | No significant differences in relation to ethnicity between people who received seclusion and people who did not. Ethnicity was not a significant predictor of seclusion | |
| Hui et al. [2]† | UK | Ethnicity | NR | NR | NR | Reporting about proportional (non-significant) difference between ethnic groups | |
| Husum et al. [75] | Norway | Other than Norwegian | 1.15 | 0.7–1.88 | NR | Adjusted for patients' individual psychopathology | |
| Jury et al. [40] | New Zealand | Pasifika | 1.89 | 1.44–2.47 | < 0.001 | Additional significant ORs available in the paper in relation to ethnic group | |
| Lai et al. [79] | New Zealand | Māori | NR | NR | < 0.001 | Lower seclusion rates association with higher proportion of Māori | |
| McLeod et al. [62] | New Zealand | Māori | 1.39* | 1.05–1.83 | NR | ||
| 1.33* | 0.97–1.81 | NR | Adjusted for a range of demographic and admission variables Additional RRs available in the paper, including in relation to various adjustments Age was reported as an important contributor to the ethnic disparities in seclusion | ||||
| Mellow et al. [82]† | UK | Ethnicity | NR | NR | NR | Reporting about experiences of being in seclusion from the literature | |
| Sambrano and Cox [67] | Australia | Indigenous status | NR | NR | NR | Indigenous people experienced seclusion as discriminatory and degrading | |
| Tyrer et al. [80] | New Zealand | Māori/European | NR | NR | < 0.05 | ||
| Trauer et al. [65] | Australia | Australian born/ Indigenous people | NR | NR | NR | No significant differences in relation to ethnicity between people who received seclusion and people who did not | |
| van de Sande et al. [68] | Netherlands | Non-western | 1.68 | 1.06–2.67 | 0.022 | ||
| 0.45 | 0.24–0.84 | 0.012 | Adjusted for within-patient variation | ||||
| Verlinde et al. [78] | Netherlands | Non-western descent | NR | NR | NR | Use of seclusion was slightly reduced after policy change | |
| Multiple restrictive practices | Beames and Onwumere [7]† | UK | Ethnicity/migrant status | NR | NR | NR | Reporting of significant and non-significant results in the literature |
| Beghi et al. [8]† | Italy | Non-autochthonous | NR | NR | NR | Reporting of significant and non-significant results in the literature | |
| Bennewith et al. [61] | UK | Black | 2.19 | 1.47–3.27 | NR |
ORs for ethnicity and other ethnic groups available in the paper However, all were non-significant |
|
| Black | 1.09 | 0.66–1.81 | NR |
Adjusted for age, gender, diagnosis and mental health trust. ORs for ethnicity and other ethnic groups available in the paper However, all were non-significant |
|||
| Bilanakis et al. [83] | Greece | Other than Greek | NR | NR | 0.470 | Proportional (non-significant) association was reported | |
| Collazos et al. [63] | Spain | North African | 4.23 | 1.26–14.17 | < 0.05 |
Adjusted for patient’s geographical origin. ORs for other migrant groups available in the paper However, all were non-significant |
|
| North African | 2.12 | 0.54–8.32 | NR |
Adjusted for patient’s geographical origin and further demographic and clinical variables. ORs for other migrant groups available in the paper However, all were non-significant |
|||
| Flammer et al. [74] | Germany | German citizenship | 0.75 | 0.54–1.05 | NR | Ethnicity was not related to the number of restrictive practices recorded | |
| 0.49 | 0.32–0.77 | NR | Psychotic subgroup | ||||
| Gowda et al. [77] | India | Religion | NR | NR | NR | No significant results reported | |
| Hendryx et al. [69] | USA | Black | NR | NR | 0.02 | No significant differences in relation to ethnicity between people receiving seclusion and people who did not. However, ethnicity was a significant predictor of restrictive practices | |
| Knutzen et al. [71] | Norway | Immigrant | NR | NR | NR | Ethnicity was not related with the duration of restrictive practices or the restrictive type received | |
| Knutzen et al. [72] | Norway | Immigrant | NR | NR | 0.552 | Ethnicity was not related with the number of episodes | |
| Knutzen et al. [73] | Norway | Immigrant | 1.52 | 1.05–2.17 | 0.03 | ||
| Lay et al. [39] | Switzerland | Foreign national | 1.045 | 0.838–1.302 | NR | Adjusted for other sociodemographic variables. However, before this adjustment, there are no reported significant associations either | |
| Miodownik et al. [84] | Israel | Ethnicity | NR | NR | NR | No association found between ethnicity and frequency or length of restrictive practices | |
| Norredam et al. [49] | Denmark | Migrant status | NR | NR | NR | Use of restrictive practices were about twice as high for both refugees and immigrants as for non-migrant Danes | |
| Opitz-Welke and Konrad [66] | Germany | German | NR | NR | NR | Proportional difference between ethnic groups was reported | |
| Taylor et al. [70] | USA | Race | NR | NR | 0.115 | Ethnicity was not related to the number of restrictive episodes | |
| Thomsen et al. [64] | Denmark | Immigrant | 1.64 | 1.54–1.74 | < 0.001 | Adjusted for sex, age and calendar period. ORs for other migrant group and geographical categories available in the paper. However, both significant and non-significant | |
| 0.99 | 0.85–1.17 | NR | Adjusted for sex, age, calendar period and further demographic variables | ||||
| Europe | 0.43 | 0.35–0.53 | < 0.001 | Adjusted for sex, age and calendar period. ORs for other migrant group and geographical categories available in the paper. However, both significant and non-significant | |||
| 0.7 | 0.51–0.97 | < 0.05 | Adjusted for sex, age, calendar period and further demographic variables |
NR not reported
†Review study