Disparities in Pharmacologic Restraint for Children Hospitalized in Mental Health Crisis

Abstract

BACKGROUND AND OBJECTIVES Children hospitalized with a mental health crisis often receive pharmacologic restraint for management of acute agitation. We examined associations between pharmacologic restraint use and race and ethnicity among children admitted for mental health conditions to acute care nonpsychiatric children’s hospitals. METHODS We performed a retrospective cohort study of children (aged 5–≤18 years) admitted for a primary mental health condition from 2018 to 2022 at 41 US children’s hospitals. Pharmacologic restraint use was defined as parenteral administration of medications for acute agitation. The association of race and ethnicity and pharmacologic restraint was assessed using generalized linear multivariable mixed models adjusted for clinical and demographic factors. Stratified analyses were performed based on significant interaction analyses between covariates and race and ethnicity. RESULTS The cohort included 61 503 hospitalizations. Compared with non-Hispanic Black children, children of non-Hispanic White (adjusted odds ratio [aOR], 0.81; 95% confidence interval [CI], 0.72–0.92), Asian (aOR, 0.82; 95% CI, 0.68–0.99), or other race and ethnicity (aOR, 0.68; 95% CI, 0.57–0.82) were less likely to receive pharmacologic restraint. There was no significant difference with Hispanic children. When stratified by sex, racial/ethnic differences were magnified in males (aORs, 0.49–0.68), except for Hispanic males, and not found in females (aORs, 0.83–0.93). Sensitivity analysis revealed amplified disparities for all racial/ethnic groups, including Hispanic youth (aOR, 0.65; 95% CI, 0.47–0.91). CONCLUSIONS Non-Hispanic Black children were significantly more likely to receive pharmacologic restraint. More research is needed to understand reasons for these disparities, which may be secondary to implicit bias and systemic and interpersonal racism.