Ethnic disparities in rapid tranquillisation use and justifications in adult mental health inpatient settings: a systematic review and meta-analysis

Question Evidence on the likelihood of receiving rapid tranquillisation (RT) across ethnic groups is mixed, with some studies suggesting that ethnic minorities are more likely to receive RT than others. We aimed to investigate the association between ethnicity and RT use in adult mental health inpatient settings and to explore explanations for RT use in relation to ethnicity.

Study selection and analysis We searched six databases, grey sources, and references from their inception to 15 April 2024. We included studies reporting the association between RT and ethnic groups in adult mental health inpatient settings. A meta-analysis with a random-effects model was performed using odds ratio (OR) to estimate the association. Grading of Recommendations Assessment, Development, and Evaluation (GRADE) was used to assess the overall certainty of the evidence. We reported narratively any explanations for RT use in relation to ethnicity. PROSPERO: CRD42024423831.

Findings Fifteen studies with 38 622 individuals were included, mainly using white or native as the ethnic majority group compared with other ethnic groups. Individuals from ethnic minority backgrounds were significantly more likely to receive RT than those with ethnic majority backgrounds (OR=1.49; 95% confidence interval (CI): 1.25 to 1.78; moderate certainty), corresponding to a relative risk of 1.32 (95% CI: 1.17 to 1.48).

Conclusion Disparities appear to exist in RT use across ethnic groups in adult mental health inpatient settings, disproportionately affecting ethnic minorities. Further research is required to gain a more comprehensive understanding of this issue.