Ethnic bias in risk assessment of patients with early-onset first episode psychosis

Background: First episode psychosis (FEP) constitutes a common psychiatric emergency. A key decision in the management of FEP involves risk assessment, which directly influences the need for involuntary hospitalization. However, the impact of demographic variables of patients and psychiatrists on FEP risk assessment remains incompletely characterized. We sought to test whether the ethnicity of patients and psychiatrists influences the risk assessment of FEP. Design: A retrospective cohort study examined emergency department visits from 2014 to 2023 at Rambam Health Care Campus involving adults aged 18 to 40 with FEP. A generalized linear mixed model assessed whether patient and psychiatrist demographics affected risk assessment outcomes. Results: A total of 625 FEP cases were examined (mean age of 26.24 years, SD = 5.69, 66.88 % men, 67.52 % Jewish). The analysis included 27 psychiatrists (55.56 % women; 66.67 % Jewish). An unadjusted comparison revealed a higher proportion of immediate risk among Arab patients compared to Jewish patients (59.11 % vs. 49.52 %, P = 0.025). Further regression analysis revealed a significant interaction between patient and psychiatrist ethnicity (OR = 0.38, P = 0.013), suggesting that the higher proportion of cases with positive immediate risk assessments among Arabs was attributable to Jewish psychiatrists, who were more likely to classify them as being at immediate risk. Conclusions: The results suggest that what appears to be an ethnic difference in the proportions of cases with immediate risk may reflect a bias among Jewish psychiatrists in evaluating Arab patients. This emphasizes the complexities of assessing minority groups and highlights the need for culturally sensitive psychiatric care.