Immigrants in emergency rooms: The role of culture in the diagnostic process and diagnostic certainty

Abstract

Introduction

Transnationalism provides a serious challenge in mental health care, especially due to the crucial role of communication. Emergency room interactions offer an opportunity to analyze the role of cultural competency among providers and how they relate to immigrants in the clinical encounter.

Objectives

This study addresses three aims: to assess the level of provider-perceived accuracy of diagnoses; to evaluate the use of restraints; and to compare diagnoses rates between patients of diverse racial/ethnic groups.

Methods

We examined patients’ race/ethnicity and their relation to service use and perceived certainty of mental health diagnoses. Three hundred and forty-seven migrants and 67 natives as well as their providers were interviewed in psychiatry emergency rooms in Barcelona (Spain).

Results

The perceived certainty of clinical diagnosis is lower for Asians (OR = 0.2, 95% CI [0.07–0.63]), and higher when the clinician feels comfortable with the patient (OR = 5.41, 95% CI [2.53–11.58]). The probability of restraints is higher for Maghreb patients compared to native born (OR = 3.56, 95% CI [1.03–12.26]). The probability of compulsory admission is lower for Latinos compared to native born (OR = 0.26, 95% CI [0.08–0.88]). The probability of receiving a diagnosis of psychosis is lower when the clinician can communicate in the patient's language (OR = 0.37, CI 95% [0.16–0.83]).

Conclusions

Cultural factors such as level of comfort and communication in the patient's language play a central role in diagnosis and treatment. This study highlights the importance of culture in psychiatric diagnosis and the role of cultural competency for mental health providers.

Disclosure of interest

The authors have not supplied their declaration of competing interest.