|
1
|
Stubbs JM, Chong S, Achat HM. Identifying Patients at Risk of Not Receiving Timely Community Mental Health Follow-Up After Psychiatric Hospitalisation Using Linked Routinely Collected Data. J Behav Health Serv Res 2025; 52:309-329. [PMID: 39317857 DOI: 10.1007/s11414-024-09910-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/11/2024] [Indexed: 09/26/2024]
Abstract
Timely receipt of community-based follow-up after inpatient psychiatric discharge is associated with positive outcomes. This retrospective cross-sectional study aimed to identify socio-demographic and clinical factors associated with failure to receive community mental health follow-up within 7 days. Routinely collected hospital and community mental health data were linked for all inpatients discharged with a mental health condition in 2017 to 2019 in a local health district in New South Wales, Australia. Of the 8780 patients discharged, 28% (n = 2466) did not have 7-day follow-up. Males were significantly more likely than females to fail follow-up. Adjusted logistic regression analyses revealed that both male and female patients aged 65 years and older were generally less likely to fail follow-up than those who were younger; conversely, patients referred to a hospital by a law enforcement agency and those who left the hospital at their own risk were more likely to fail follow-up. Other factors significantly related to failure to follow-up varied between the sexes. Improved outcomes may be achieved by enhancing the transition from inpatient to outpatient care through targeted strategies aimed at patients who are more likely to disengage with care.
Collapse
Affiliation(s)
- Joanne M Stubbs
- Epidemiology and Health Analytics, Research and Education Network, Western Sydney Local Health District, New South Wales, 5 Fleet Street, North Parramatta, 2151, Australia.
| | - Shanley Chong
- Epidemiology and Health Analytics, Research and Education Network, Western Sydney Local Health District, New South Wales, 5 Fleet Street, North Parramatta, 2151, Australia
| | - Helen M Achat
- Epidemiology and Health Analytics, Research and Education Network, Western Sydney Local Health District, New South Wales, 5 Fleet Street, North Parramatta, 2151, Australia
| |
Collapse
|
|
2
|
Shea T, Dotson S, Tyree G, Ogbu-Nwobodo L, Beck S, Shtasel D. Racial and Ethnic Inequities in Inpatient Psychiatric Civil Commitment. Psychiatr Serv 2022; 73:1322-1329. [PMID: 35959533 DOI: 10.1176/appi.ps.202100342] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Involuntary psychiatric treatment may parallel ethnoracial inequities present in the larger society. Prior studies have focused on restraint and seclusion, but less attention has been paid to the civil commitment system because of its diversity across jurisdictions. Using a generalizable framework, this study investigated inequities in psychiatric commitment. METHODS A prospective cohort was assembled of all patients admitted to an inpatient psychiatric unit over 6 years (2012-2018). Patients were followed longitudinally throughout their admission; raters recorded legal status each day. Sociodemographic and clinical data were collected to adjust for confounding variables by using multivariate logistic regression. RESULTS Of the 4,393 patients with an initial admission during the study period, 73% self-identified as White, 11% as Black, 10% as primarily Hispanic or Latinx, 4% as Asian, and 3% as another race or multiracial. In the sample, 28% were involuntarily admitted, and court commitment petitions were filed for 7%. Compared with White patients, all non-White groups were more likely to be involuntarily admitted, and Black and Asian patients were more likely to have court commitment petitions filed. After adjustment for confounding variables, Black patients remained more likely than White patients to be admitted involuntarily (adjusted odds ratio [aOR]=1.57, 95% confidence interval [CI]=1.26-1.95), as were patients who identified as other race or multiracial (aOR=2.12, 95% CI=1.44-3.11). CONCLUSIONS Patients of color were significantly more likely than White patients to be subjected to involuntary psychiatric hospitalization, and Black patients and patients who identified as other race or multiracial were particularly vulnerable, even after adjustment for confounding variables.
Collapse
Affiliation(s)
- Timothy Shea
- Department of Psychiatry, Massachusetts General Hospital, and Harvard Medical School, Boston
| | - Samuel Dotson
- Department of Psychiatry, Massachusetts General Hospital, and Harvard Medical School, Boston
| | - Griffin Tyree
- Department of Psychiatry, Massachusetts General Hospital, and Harvard Medical School, Boston
| | - Lucy Ogbu-Nwobodo
- Department of Psychiatry, Massachusetts General Hospital, and Harvard Medical School, Boston
| | - Stuart Beck
- Department of Psychiatry, Massachusetts General Hospital, and Harvard Medical School, Boston
| | - Derri Shtasel
- Department of Psychiatry, Massachusetts General Hospital, and Harvard Medical School, Boston
| |
Collapse
|
|
3
|
Drakonakis N, Stylianidis S, Peppou LE, Douzenis A, Nikolaidi S, Tzavara C, Baladima CE, Iatropoulou GO, Psarra V, Tsopanaki E, Barbato A. Outcome of Voluntary vs Involuntary Admissions in Greece over 2 years after Discharge: A Cohort Study in the Psychiatric Hospital of Attica "Dafni". Community Ment Health J 2022; 58:633-644. [PMID: 34370149 DOI: 10.1007/s10597-021-00865-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 06/20/2021] [Indexed: 10/20/2022]
Abstract
The increasing rates of involuntary hospitalization constitute a major ethical issue in psychiatric practice. The present cohort study endeavours to investigate the relationship between patients' legal status (involuntary vs voluntary) and the outcome of their hospitalization, over 2 years after discharge. All individuals admitted in the 3rd Psychiatric Department of the Psychiatric Hospital of Attica during February 2015-February 2017 took part in the study. 64.7% of patients were compulsory admitted. Findings indicate a statistically significant improvement in global functioning and symptomatology levels from admission to discharge for all treated patients, independently of their legal status. However, readmission rates over 2 years after discharge were high (34.8% vs. 21.9% in voluntary and involuntary patients, respectively). In conclusion, psychiatric admission, irrespectively of legal status leads to clinical improvement.
Collapse
Affiliation(s)
- Nektarios Drakonakis
- Psychiatric Hospital of Attica "Dafni", Athens, Greece. .,Department of Social Sciences, Faculty of Psychology, Panteion University of Social and Political Sciences, Athens, Greece.
| | - Stelios Stylianidis
- Association for Regional Development and Mental Health (EPAPSY), Athens, Greece.,Department of Social Sciences, Faculty of Psychology, Panteion University of Social and Political Sciences, Athens, Greece
| | - Lily Evangelia Peppou
- Department of Social Sciences, Faculty of Psychology, Panteion University of Social and Political Sciences, Athens, Greece.,University Mental Health, Neurosciences and Precision Medicine Research Institute "Costas Stefanis", Athens, Greece
| | - Athanasios Douzenis
- 2nd Department of Psychiatry, University of Athens, Attikon Hospital, Athens, Greece
| | - Sofia Nikolaidi
- Association for Regional Development and Mental Health (EPAPSY), Athens, Greece
| | - Chara Tzavara
- Department of Hygiene, Epidemiology and Medical Statistics, Centre for Health Services Research, National and Kapodistrian University of Athens, Athens, Greece
| | - Charikleia Eirini Baladima
- Department of Social Sciences, Faculty of Psychology, Panteion University of Social and Political Sciences, Athens, Greece
| | - Georgia Olga Iatropoulou
- Department of Social Sciences, Faculty of Psychology, Panteion University of Social and Political Sciences, Athens, Greece
| | | | | | - Angelo Barbato
- Laboratory of Epidemiology and Social Psychiatry, IRCCS Istituto Di Ricerche Farmacologiche 'Mario Negri', Milan, Italy.,IRIS Postgraduate Psychotherapy School, Milan, Italy
| |
Collapse
|
|
4
|
Dey S, Mellsop G, Obertova Z, Jenkins M. Sociodemographic and clinical variables associated with discharge under compulsory treatment orders. Australas Psychiatry 2021; 29:163-168. [PMID: 33354991 DOI: 10.1177/1039856220970054] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To document the sociodemographic and clinical variables associated with discharge under compulsory treatment orders in patients with schizophrenia or related disorders. METHOD Information on various sociodemographic and clinical variables were extracted from the clinical files of 349 patients discharged from an adult (age 18-65) inpatient psychiatric unit with diagnoses of schizophrenia or related disorders. Univariate and multiple logistic regression analyses with legal compulsion (compulsory versus voluntary) as outcomes were applied. RESULTS Two hundred of the 349 discharged patients were placed under compulsory treatment orders. In the univariate logistic regression analysis, unemployment, diagnosis of schizophrenia, forensic history, dosage of antipsychotics, prescription and frequency of injectable antipsychotics, polypharmacy and a hospital stay of more than 28 days were associated with compulsory status. Being married or in partnership and living with partner was associated with voluntary status. Multiple regression models respectively confirmed most of these relationships observed in the univariate analyses. CONCLUSION Clarification of the apparent drivers for compulsory treatment may help thoughtful reductions in the use of compulsion.
Collapse
Affiliation(s)
| | | | - Zuzana Obertova
- Centre for Forensic Anthropology, University of Western Australia, Crawley, WA, Australia
| | | |
Collapse
|
|
5
|
Martinho S, Poças A, Simões M, Laureano C. Antipsychotic Polypharmacy and High-Dose Antipsychotics in Involuntary Patients: a Seven-Year Audit of Discharge Prescriptions in an Acute Care Unit. Psychiatr Q 2021; 92:1-14. [PMID: 32430698 DOI: 10.1007/s11126-020-09762-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Antipsychotic polypharmacy (APP) is a psychopharmacological practice in which two or more antipsychotics are prescribed simultaneously. Despite the absence of evidence to support it, it is highly prevalent in clinical settings. Another recurrent practice strongly associated with APP is the prescription of high-dose antipsychotics (HDAs). Compulsory treatment is a legal means to impose treatment on an individual suffering from mental illness who refuses therapeutic intervention. Compulsory treatment has been associated with APP and HDAs and rates of both have been proposed to represent indicators of the quality of prescribing. We aimed to perform an antipsychotic prescription audit in a vulnerable psychiatric population, at the psychiatry department of a district hospital in Portugal, across 7 years. We evaluated APP and HDAs in 403 compulsorily admitted patients by reviewing their files at discharge. We used logistic regression to search for factors associated with APP and HDAs. APP was found in 70.5% of individuals, whereas HDAs were found in 51.4%. After adjustment, APP was significantly associated with male gender (Odds Ratio[OR] = 1.85 [1.04; 3.30] 95% Confidence Interval [CI]), involuntary outpatient treatment (OR = .40 [.18; .82] 95% CI), activation of the hospital social services (OR = 1.91 [1.08; 3.38] 95%CI), prescription of antidepressants (OR = .43 [.22; .82] 95%CI) and long-acting injectables (LAI) (OR = 28.29 [13.13; 60.97] 95%CI). HDAs were associated with male gender (OR = 1.76 [1.06; 2.94] 95%CI), the prescription of LAI (OR = 12.92 [6.93; 24.09] 95%CI) and oral first-generation antipsychotics (OR = 2.90 [1.51; 5.60] 95%CI).
Collapse
Affiliation(s)
- Sérgio Martinho
- Psychiatry and Mental Health Department, Leiria Hospital Center, Leiria, Portugal.
| | - Ana Poças
- Psychiatry and Mental Health Department, Leiria Hospital Center, Leiria, Portugal
| | - Mário Simões
- Psychiatry and Mental Health Department, Leiria Hospital Center, Leiria, Portugal
| | - Cláudio Laureano
- Psychiatry and Mental Health Department, Leiria Hospital Center, Leiria, Portugal
| |
Collapse
|
|
6
|
Kaikoushi K, Middleton N, Chatzittofis A, Bella E, Alevizopoulos G, Karanikola M. Socio-Demographic and Clinical Characteristics of Adults With Psychotic Symptomatology Under Involuntary Admission and Readmission for Compulsory Treatment in a Referral Psychiatric Hospital in Cyprus. Front Psychiatry 2021; 12:602274. [PMID: 33679473 PMCID: PMC7925878 DOI: 10.3389/fpsyt.2021.602274] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 01/18/2021] [Indexed: 01/23/2023] Open
Abstract
Socio-demographic and clinical characteristics of adults under compulsory psychiatric treatment, have not been reported adequately in Southern European countries. We investigated the socio-demographic and clinical characteristics of adults with psychotic symptomatology who were involuntarily treated in the acute Mental Health Services in Cyprus. A descriptive cross-sectional study was applied. Data collection (December 2016 to February 2018) achieved via a structured questionnaire including demographic and clinical variables. Census sampling was applied in Cyprus referral center for compulsory psychiatric treatment. The sample included 406 individuals (262 males, 144 females). Approximately 86.2% were single, 77.6% were unemployed, and 24.9% held a bachelor's degree. The most frequent clinical diagnosis was schizophrenia or a relevant psychotic disorder (86.4%). The most frequent admission cause was non-adherence to pharmacotherapy along with disorganized behavior (agitation and/or self-care deficit, and/or aggressive behavior, and/or suicidal behavior) (53.6%). Moreover, 70.7% of the sample reported a positive personal history of mental health problems, while 42.1% reported a positive family history of mental health disorders. Half of the participants (52%) were previously involuntarily admitted for compulsory treatment. Adjusted associations of readmission status were reported with Cypriot ethnicity (OR: 4.40, 95%CI: 2.58-7.50), primary education only (OR: 3.70, 95%CI: 1.64-8.37), readmission due to disorganized behavior along with non-adherence to pharmacotherapy (OR: 10.84, 95%CI: 2.69-43.72), as well as along with substance use (OR: 6.39, 95%CI: 1.52-26.82). Readmission was almost five times more likely to occur due to suicidal behavior (OR: 5.01, 95%CI: 1.09-22.99) compared to disorganized behavior not otherwise specified. Additionally, those with a diagnosis of schizophrenia were more than 12 times more frequently readmitted for compulsory treatment compared to other diagnoses (OR 12.15, 95%CI: 1.04-142). Moreover, the participants with higher secondary education had 54.6% less odds to be involuntarily re-admitted compared to Bachelor degree holders (OR 0.442, 95%CI: 0.24-0.79). A high percentage of involuntary treatment was noted due to non-adherence to pharmacotherapy and substance use. Re-evaluation of the effectiveness of relevant community interventions is suggested, as well as implementation of structured educational programs on therapy adherence during psychiatric hospitalization.
Collapse
Affiliation(s)
- Katerina Kaikoushi
- Cyprus Nursing Services, Ministry of Health, Nicosia, Cyprus
- Nursing Department, Faculty of Health Sciences, Cyprus University of Technology, Limassol, Cyprus
| | - Nicos Middleton
- Nursing Department, Faculty of Health Sciences, Cyprus University of Technology, Limassol, Cyprus
| | | | | | - Giorgos Alevizopoulos
- Psychiatric Clinic, Agioi Anargyroi Hospital, Faculty of Nursing, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria Karanikola
- Nursing Department, Faculty of Health Sciences, Cyprus University of Technology, Limassol, Cyprus
| |
Collapse
|
|
7
|
Lachner C, Maniaci MJ, Vadeboncoeur TF, Dawson NL, Rummans TA, Roy A, Hall LL, Burton MC. Are pre-existing psychiatric disorders the only reason for involuntary holds in the emergency department? Int J Emerg Med 2020; 13:4. [PMID: 32013869 PMCID: PMC6998304 DOI: 10.1186/s12245-020-0265-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Accepted: 01/21/2020] [Indexed: 11/24/2022] Open
Abstract
Objectives To determine the role of previous psychiatric disorders including substance use disorders on emergency department (ED) patients on involuntary holds and compare presentations, treatment, and outcomes based on cause. Methods We conducted a retrospective study of patients ≥ 18 years old on involuntary holds in the ED of a tertiary care center from January 1, 2013, to November 30, 2015. Demographic and clinical information were collected. Those with and without prior psychiatric disorder including substance use disorder were compared. Results We identified 251 patients of which 129 (51.4%) had a psychiatric disorder, 23 (9.2%) had a substance use disorder, and 86 (34.3%) had both. Thirteen patients (5.2%) had no psychiatric disorder or substance use disorder and the majority 10 (76.9%) were on involuntary holds due to suicidal threats related to pain or another medical problem. Patients without a psychiatric or substance use disorder were older (55 years [17.8] vs 42 [19]; P = 0.01), more likely to be married (10 [76.9%] vs 64 [26.9%]; P < 0.001), and had more medical comorbidities (10 [76.9%] vs 114 [47.9%]; P = 0.049) compared with those without a psychiatric or substance use disorder. Conclusion Patients on involuntary holds most commonly have pre-existing psychiatric disorder including substance use disorder. Patients on involuntary holds without history of psychiatric disorder often have severe pain or other active medical conditions which may contribute to suicidal thoughts. Addressing these underlying medical issues may be crucial in preventing further psychiatric decompensation.
Collapse
|
|
8
|
Karasch O, Schmitz-Buhl M, Mennicken R, Zielasek J, Gouzoulis-Mayfrank E. Identification of risk factors for involuntary psychiatric hospitalization: using environmental socioeconomic data and methods of machine learning to improve prediction. BMC Psychiatry 2020; 20:401. [PMID: 32770970 PMCID: PMC7414567 DOI: 10.1186/s12888-020-02803-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 07/30/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND The purpose of this study was to identify factors associated with a high risk of involuntary psychiatric in-patient hospitalization both on the individual level and on the level of mental health services and the socioeconomic environment that patients live in. METHODS The present study expands on a previous analysis of the health records of 5764 cases admitted as in-patients in the four psychiatric hospitals of the Metropolitan City of Cologne, Germany, in the year 2011 (1773 cases treated under the Mental Health Act and 3991 cases treated voluntarily). Our previous analysis had included medical, sociodemographic and socioeconomic data of every case and used a machine learning-based prediction model employing chi-squared automatic interaction detection (CHAID). Our current analysis attempts to improve the previous one through (1) optimizing the machine learning procedures (use of a different type of decision-tree prediction model (Classification and Regression Trees (CART) and application of hyperparameter tuning (HT)), and (2) the addition of patients' environmental socioeconomic data (ESED) to the data set. RESULTS Compared to our previous analysis, model fit was improved. Main diagnoses of an organic mental or a psychotic disorder (ICD-10 groups F0 and F2), suicidal behavior upon admission, admission outside of regular service hours and absence of outpatient treatment prior to admission were confirmed as powerful predictors of detention. Particularly high risks were shown for (1) patients with an organic mental disorder, specifically if they were retired, admitted outside of regular service hours and lived in assisted housing, (2) patients with suicidal tendencies upon admission who did not suffer from an affective disorder, specifically if it was unclear whether there had been previous suicide attempts, or if the affected person lived in areas with high unemployment rates, and (3) patients with psychosis, specifically those who lived in densely built areas with a large proportion of small or one-person households. CONCLUSIONS Certain psychiatric diagnoses and suicidal tendencies are major risk factors for involuntary psychiatric hospitalization. In addition, service-related and environmental socioeconomic factors contribute to the risk for detention. Identifying modifiable risk factors and particularly vulnerable risk groups should help to develop suitable preventive measures.
Collapse
Affiliation(s)
- O. Karasch
- LVR-Institute for Healthcare Research, Wilhelm-Griesinger-Strasse 23, 51109 Cologne (Köln), Germany
| | | | - R. Mennicken
- grid.448793.50000 0004 0382 2632LVR Clinical Group Department, Cologne, and FOM University of Applied Sciences, Essen, Germany
| | - J. Zielasek
- LVR-Institute for Healthcare Research, Wilhelm-Griesinger-Strasse 23, 51109 Cologne (Köln), Germany
| | - E. Gouzoulis-Mayfrank
- LVR-Institute for Healthcare Research, Wilhelm-Griesinger-Strasse 23, 51109 Cologne (Köln), Germany ,LVR Clinics Cologne, Cologne, Germany
| |
Collapse
|
|
9
|
Retrospective Chart Review of Voluntary Admissions to an Inpatient Psychiatric Hospital in New York City: A Demographic Breakdown. Community Ment Health J 2020; 56:448-455. [PMID: 31654251 DOI: 10.1007/s10597-019-00498-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 10/18/2019] [Indexed: 10/25/2022]
Abstract
The current paper evaluates psychiatric needs of voluntary admissions in a large urban psychiatric hospital through a retrospective chart review, as this research is limited within the United States. A total of 581 voluntary adult psychiatric admission charts were reviewed. Continuous variables were evaluated using an ANOVA while associations between variables were examined by an unadjusted Pearson correlation coefficient a stepwise linear regression analysis. Men were significantly more likely to have a past admission for psychiatric services (p = .016), suicidal ideation (p < .001) and test positive for substances (p < .001) than women, and were more likely to be unemployed, homeless and without insurance. Women were more likely to have a past suicide attempt and a depressive disorder. A significant relationship between gender and rationale for seeking voluntary admission (p < .001) was found. This study offers understanding of male and female voluntary admissions, and a foundation for improving treatment interventions to reduce recurrent readmissions.
Collapse
|
|
10
|
Walker S, Mackay E, Barnett P, Sheridan Rains L, Leverton M, Dalton-Locke C, Trevillion K, Lloyd-Evans B, Johnson S. Clinical and social factors associated with increased risk for involuntary psychiatric hospitalisation: a systematic review, meta-analysis, and narrative synthesis. Lancet Psychiatry 2019; 6:1039-1053. [PMID: 31777340 PMCID: PMC7029280 DOI: 10.1016/s2215-0366(19)30406-7] [Citation(s) in RCA: 102] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 09/26/2019] [Accepted: 09/27/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Use of involuntary psychiatric hospitalisation varies widely within and between countries. The factors that place individuals and populations at increased risk of involuntary hospitalisation are unclear, and evidence is needed to understand these disparities and inform development of interventions to reduce involuntary hospitalisation. We did a systematic review, meta-analysis, and narrative synthesis to investigate risk factors at the patient, service, and area level associated with involuntary psychiatric hospitalisation of adults. METHODS We searched MEDLINE, PsycINFO, Embase, and the Cochrane Controlled Clinical Register of Trials from Jan 1, 1983, to Aug 14, 2019, for studies comparing the characteristics of voluntary and involuntary psychiatric inpatients, and studies investigating the characteristics of involuntarily hospitalised individuals in general population samples. We synthesised results using random effects meta-analysis and narrative synthesis. Our review follows Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and is registered on PROSPERO, CRD42018095103. FINDINGS 77 studies were included from 22 countries. Involuntary rather than voluntary hospitalisation was associated with male gender (odds ratio 1·23, 95% CI 1·14-1·32; p<0·0001), single marital status (1·47, 1·18-1·83; p<0·0001), unemployment (1·43, 1·07-1·90; p=0·020), receiving welfare benefits (1·71, 1·28-2·27; p<0·0001), being diagnosed with a psychotic disorder (2·18, 1·95-2·44; p<0·0001) or bipolar disorder (1·48, 1·24-1·76; p<0·0001), and previous involuntary hospitalisation (2·17, 1·62-2·91; p<0·0001). Using narrative synthesis, we found associations between involuntary psychiatric hospitalisation and perceived risk to others, positive symptoms of psychosis, reduced insight into illness, reduced adherence to treatment before hospitalisation, and police involvement in admission. On a population level, some evidence was noted of a positive dose-response relation between area deprivation and involuntary hospitalisation. INTERPRETATION Previous involuntary hospitalisation and diagnosis of a psychotic disorder were factors associated with the greatest risk of involuntary psychiatric hospitalisation. People with these risk factors represent an important target group for preventive interventions, such as crisis planning. Economic deprivation on an individual level and at the population level was associated with increased risk for involuntary hospitalisation. Mechanisms underpinning the risk factors could not be identified using the available evidence. Further research is therefore needed with an integrative approach, which examines clinical, social, and structural factors, alongside qualitative research into clinical decision-making processes and patients' experiences of the detention process. FUNDING Commissioned by the Department of Health and funded by the National Institute of Health Research (NIHR) via the NIHR Mental Health Policy Research Unit.
Collapse
Affiliation(s)
- Susan Walker
- Division of Psychiatry, University College London, London, UK; Great Ormond Street Institute of Child Health, University College London, London, UK.
| | - Euan Mackay
- Department of Clinical Educational and Health Psychology, Centre for Outcomes Research and Effectiveness, University College London, London, UK
| | - Phoebe Barnett
- Department of Clinical Educational and Health Psychology, Centre for Outcomes Research and Effectiveness, University College London, London, UK
| | - Luke Sheridan Rains
- Division of Psychiatry, University College London, London, UK; National Institute of Health Research Mental Health Policy Research Unit, University College London, London, UK
| | - Monica Leverton
- Division of Psychiatry, University College London, London, UK
| | - Christian Dalton-Locke
- Division of Psychiatry, University College London, London, UK; National Institute of Health Research Mental Health Policy Research Unit, University College London, London, UK
| | - Kylee Trevillion
- National Institute of Health Research Mental Health Policy Research Unit, University College London, London, UK; Section of Women's Mental Health, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Brynmor Lloyd-Evans
- Division of Psychiatry, University College London, London, UK; National Institute of Health Research Mental Health Policy Research Unit, University College London, London, UK
| | - Sonia Johnson
- Division of Psychiatry, University College London, London, UK; National Institute of Health Research Mental Health Policy Research Unit, University College London, London, UK
| |
Collapse
|
|
11
|
Luo C, Chen H, Zhong S, Guo H, Li Q, Cai W, de Girolamo G, Zhou J, Wang X. Manic episode, aggressive behavior and poor insight are significantly associated with involuntary admission in patients with bipolar disorders. PeerJ 2019; 7:e7339. [PMID: 31355058 PMCID: PMC6644629 DOI: 10.7717/peerj.7339] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2019] [Accepted: 06/23/2019] [Indexed: 12/24/2022] Open
Abstract
Objectives Serious mental illnesses, such as bipolar disorders and schizophrenia, are closely associated with involuntary admission. Many studies have focused on involuntary admission in people with schizophrenia, but little is known about the factors associated with involuntary admission in Chinese patients with bipolar disorders. This study aimed to investigate socio-demographic and clinical factors associated with involuntary admission in Chinese patients with bipolar disorders. Methods In this multi-center cross-sectional survey in China, a total of 155 newly admitted patients with bipolar disorders were consecutively recruited from 16 psychiatric institutions from 15 March to 14 April, 2013. Patients' socio-demographic and clinical data were collected from their medical records. The Modified Overt Aggression Scale and the Insight and Treatment Attitudes Questionnaire were used to measure patients' level of aggression and insight of current psychiatric illness. Results The prevalence of involuntary admission was 52% in this sample of Chinese inpatients with bipolar disorders. In multiple logistic regression, a high level of aggression (odds ratio (OR) = 2.48), diagnosis of manic episode (OR = 3.65), poor insight (OR = 7.52), and a low level of education (OR = 3.13) were significantly associated with involuntary admission. Conclusion Manic episode, aggressive behavior, and poor insight were the significant contributing factors to involuntary admission in Chinese patients with bipolar disorders.
Collapse
Affiliation(s)
- Chenyuli Luo
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China.,National Clinical Research Center on Mental Disorders, Changsha, Hunan, China.,National Technology Institute on Mental Disorders, Changsha, Hunan, China.,Hunan Key Laboratory of Psychiatry and Mental Health, Changsha, Hunan, China
| | - Hui Chen
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China.,National Clinical Research Center on Mental Disorders, Changsha, Hunan, China.,National Technology Institute on Mental Disorders, Changsha, Hunan, China.,Hunan Key Laboratory of Psychiatry and Mental Health, Changsha, Hunan, China
| | - Shaoling Zhong
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China.,National Clinical Research Center on Mental Disorders, Changsha, Hunan, China.,National Technology Institute on Mental Disorders, Changsha, Hunan, China.,Hunan Key Laboratory of Psychiatry and Mental Health, Changsha, Hunan, China
| | - Huijuan Guo
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China.,National Clinical Research Center on Mental Disorders, Changsha, Hunan, China.,National Technology Institute on Mental Disorders, Changsha, Hunan, China.,Hunan Key Laboratory of Psychiatry and Mental Health, Changsha, Hunan, China
| | - Qiguang Li
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China.,National Clinical Research Center on Mental Disorders, Changsha, Hunan, China.,National Technology Institute on Mental Disorders, Changsha, Hunan, China.,Hunan Key Laboratory of Psychiatry and Mental Health, Changsha, Hunan, China
| | - Weixiong Cai
- Shanghai Forensic Service Platform, Academy of Forensic Science, Shanghai Key Laboratory of Forensic Medicine, Shanghai, China
| | | | - Jiansong Zhou
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China.,National Clinical Research Center on Mental Disorders, Changsha, Hunan, China.,National Technology Institute on Mental Disorders, Changsha, Hunan, China.,Hunan Key Laboratory of Psychiatry and Mental Health, Changsha, Hunan, China
| | - Xiaoping Wang
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China.,National Clinical Research Center on Mental Disorders, Changsha, Hunan, China.,National Technology Institute on Mental Disorders, Changsha, Hunan, China.,Hunan Key Laboratory of Psychiatry and Mental Health, Changsha, Hunan, China
| |
Collapse
|
|
12
|
Roy A, Lachner C, Dumitrascu A, Dawson NL, Vadeboncoeur TF, Maniaci MJ, Lamoureux IC, Lewis PC, Rummans TA, Burton MC. Patients on Involuntary Hold Status in the Emergency Department. South Med J 2019; 112:265-270. [DOI: 10.14423/smj.0000000000000968] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
|
13
|
Schmitz-Buhl M, Gairing SK, Rietz C, Häussermann P, Zielasek J, Gouzoulis-Mayfrank E. A retrospective analysis of determinants of involuntary psychiatric in-patient treatment. BMC Psychiatry 2019; 19:127. [PMID: 31035963 PMCID: PMC6489329 DOI: 10.1186/s12888-019-2096-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Accepted: 03/29/2019] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND The purpose of our study was to identify predictors of a high risk of involuntary psychiatric in-patient treatment. METHODS We carried out a detailed analysis of the 1773 mental health records of all the persons treated as in-patients under the PsychKG NRW (Mental Health Act for the state of North Rhine-Westphalia, Germany) in a metropolitan region of Germany (the City of Cologne) in 2011. 3991 mental health records of voluntary in-patients from the same hospitals served as a control group. We extracted medical, sociodemographic and socioeconomic data from these records. Apart from descriptive statistics, we used a prediction model employing chi-squared automatic interaction detection (CHAID). RESULTS Among involuntary patients, organic mental disorders (ICD10: F0) and schizophrenia and other psychotic disorders (ICD10: F2) were overrepresented. Patients treated as in-patients against their will were on average older, they were more often retired and had a migratory background. The Exhaustive CHAID analysis confirmed the main diagnosis to be the strongest predictor of involuntary in-patient psychiatric treatment. Other predictors were the absence of outpatient treatment prior to admission, admission outside of regular service hours and migratory background. The highest risk of involuntary treatment was associated with patients with organic mental disorders (ICD 10: F0) who were married or widowed and patients with non-organic psychotic disorders (ICD10: F2) or mental retardation (ICD10: F7) in combination with a migratory background. Also, referrals from general hospitals were frequently encountered. CONCLUSIONS We identified modifiable risk factors for involuntary psychiatric in-patient treatment. This implies that preventive measures may be feasible and should be implemented to reduce the rate of involuntary psychiatric in-patient treatment. This may include efforts to establish crisis resolution teams to improve out-patient treatment, train general hospital staff in deescalation techniques, and develop special programs for patients with a migratory background.
Collapse
Affiliation(s)
- Mario Schmitz-Buhl
- LVR Clinics Cologne (LVR-Klinik Köln), Wilhelm-Griesinger-Strasse 23, 51109, Cologne (Köln), Germany.
| | - Stefanie Kristiane Gairing
- LVR Institute for Healthcare Research, Wilhelm-Griesinger-Strasse 23, 51109 Cologne (Köln), Germany ,Current address: St. Agatha Hospital Cologne, Feldgärtenstrasse 97, 50735 Cologne (Köln), Germany
| | - Christian Rietz
- 0000 0001 2264 5158grid.461780.cUniversity of Education Heidelberg, Keplerstrasse 87, 69120 Heidelberg, Germany
| | - Peter Häussermann
- LVR Clinics Cologne (LVR-Klinik Köln), Wilhelm-Griesinger-Strasse 23, 51109 Cologne (Köln), Germany
| | - Jürgen Zielasek
- LVR Institute for Healthcare Research, Wilhelm-Griesinger-Strasse 23, 51109 Cologne (Köln), Germany
| | - Euphrosyne Gouzoulis-Mayfrank
- LVR Clinics Cologne (LVR-Klinik Köln), Wilhelm-Griesinger-Strasse 23, 51109 Cologne (Köln), Germany ,LVR Institute for Healthcare Research, Wilhelm-Griesinger-Strasse 23, 51109 Cologne (Köln), Germany
| |
Collapse
|
|
14
|
Nwachukwu I, Crumlish N, Heron EA, Gill M. Irish Mental Health Act 2001: impact on involuntary admissions in a community mental health service in Dublin. ACTA ACUST UNITED AC 2018. [DOI: 10.1192/pb.bp.109.028043] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Aims and methodOn 1 November 2006, Ireland's Mental Health Act 2001 was implemented, replacing the country's Mental Treatment Act 1945. We aimed to assess the impact of this change in legislation on the number and duration of involuntary admissions. We undertook a retrospective review of all admissions to a psychiatric admissions unit from January to October 2006 (pre-implementation) and January to October 2007 (post-implementation).ResultsThere were 46 involuntary admissions in the 10-month period under study in 2006, or 33.8 per 100 000 population. There were 53 in 2007, or 39.3 per 100 000 population. This increase was not significant (z = – 0.7, P = 0.46), however involuntary admissions formed a larger proportion of all admissions under the Mental Health Act 2001 than under the Mental Treatment Act 1945 (χ2 = 4.2, P =0.04). There was no difference in the duration of involuntary admissions but under the 2001 Act, involuntary patients had longer periods of voluntary status as part of their admissions than under the 1945 Act.Clinical implicationsThe introduction of more rigorous procedures for involuntary admission did not significantly change the rate or duration of involuntary admissions in our centre. The finding that involuntary admissions included longer periods of voluntary status suggests that more care is being taken to revoke involuntary admission orders under the Mental Health Act 2001 than under the Mental Treatment Act 1945.
Collapse
|
|
15
|
Gabriel A. Development of an instrument to measure patients’ attitudes towards involuntary hospitalization. World J Psychiatry 2017; 7:89-97. [PMID: 28713686 PMCID: PMC5491480 DOI: 10.5498/wjp.v7.i2.89] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Revised: 04/13/2017] [Accepted: 05/05/2017] [Indexed: 02/05/2023] Open
Abstract
AIM To construct and assess the psychometric properties of an instrument to measure patients’ attitudes towards involuntary hospitalization.
METHODS This is a two phase study. In the first phase, based on comprehensive literature review, a twenty one item scale to measure patients’ attitudes to involuntary admission was constructed. Forensic and inpatient Psychiatrists, patients’ advocates and legal experts (n = 15) were invited to participate in the validation process of the written instrument, by formally rating each item of the instrument for its relevancy in measuring patients’ attitudes to involuntary admission. In the second phase of the project, the instrument was administered to a sample of eighty consecutive patients, who were admitted involuntarily to an acute psychiatric unit of a teaching hospital. All patients completed the constructed attitudes towards involuntary admission scale, and the client satisfaction questionnaire.
RESULTS Responses from psychiatry and advocacy experts provided evidence for face and content validity for the constructed instrument. The internal consistency reliability of the instrument is 0.84 (Chronbach’ alpha), factor analysis resulted in three correlated, and theoretically meaningful factors. There was evidence for content, convergent, and concurrent validity.
CONCLUSION A reliable twenty one item instrument scale to measure patients’ attitudes to involuntary admission was developed. The developed instrument has high reliability, there is strong evidence for validity, and it takes ten minutes to complete.
Collapse
|
|
16
|
Stylianidis S, Peppou LE, Drakonakis N, Douzenis A, Panagou A, Tsikou K, Pantazi A, Rizavas Y, Saraceno B. Mental health care in Athens: Are compulsory admissions in Greece a one-way road? INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2017; 52:28-34. [PMID: 28431745 DOI: 10.1016/j.ijlp.2017.04.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Revised: 03/08/2017] [Accepted: 04/04/2017] [Indexed: 06/07/2023]
Abstract
Involuntary hospitalization has long been a contentious issue worldwide. In Greece, the frequency of compulsory admissions is assumed to be alarmingly high; however, no study has systematically investigated this issue. In line with this, the present study aims to estimate the frequency of compulsory admissions in a psychiatric hospital and to explore its underpinnings. All individuals who were admitted to the Psychiatric Hospital of Attica during June-October 2011 were included into the study. Information about their socio-demographic and clinical characteristics as well as their previous contact with mental health services was obtained from interviewing the patient and his/her physician. Furthermore, information about the initiation of the process of compulsory admission as well as patient's referral upon discharge was retrieved from patients' administrative record. Out of the 946 admissions 57.4% were involuntary. A diagnosis of unipolar depression, high social support and previous contact with community mental health services were found to yield a protective effect against involuntary hospitalization. Moreover, 69.8% of civil detentions were instigated by close relatives and 30.2% ex officio. These two groups differed in patients' social support levels and in medication discontinuation being the reason for initiation of the process. Lastly, only 13.8% of patients were referred to community mental health services at discharge. Our findings suggest that civil detentions are deeply entrenched in clinical routine in Greece. Moreover, poor coordination among services and relatives' burden seem to contribute substantially to the elevated rates.
Collapse
Affiliation(s)
- Stelios Stylianidis
- Association for Regional Development and Mental Health (EPAPSY), Athens, Greece; Panteion University of Social Sciences, Athens, Greece.
| | | | | | - Athanasios Douzenis
- 2nd Department of Psychiatry, University of Athens, Attikon Hospital, Athens, Greece
| | | | | | | | | | | |
Collapse
|
|
17
|
Aguglia A, Moncalvo M, Solia F, Maina G. Involuntary admissions in Italy: the impact of seasonality. Int J Psychiatry Clin Pract 2016; 20:232-8. [PMID: 27551753 DOI: 10.1080/13651501.2016.1214736] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE The aim of this study is to assess the prevalence of involuntary admissions with regard to seasonality and clinical associated features, in a sample of patients admitted to a psychiatric unit in a period of 24 months. METHODS All subjects consecutively admitted to the Psychiatric Inpatient Unit of the San Luigi Gonzaga Hospital, Orbassano (University of Turin, Italy) from September 2013 to August 2015 were recruited. Socio-demographic and clinical characteristics were collected. RESULTS Seven hundred and thirty admissions in psychiatric ward were recognized. The prevalence of involuntary admission was 15.4%. Patients with involuntary hospitalizations showed a higher education level, a higher prevalence of admission in spring/summer with a significant peak in June, a longer duration of hospitalization and a lower suicide ideation. Among involuntary admissions, physical restraint and suicide attempts were more prevalent during spring compared to the other seasons. CONCLUSIONS Seasonality has an important role in the psychopathology of psychiatric disorders, particularly in bipolar and related disorder, and may represent an influencing factor in hospital admissions and hospitalizations. Seasonal pattern must be considered while managing diagnosis and treatment of mental disorders, with regard to prevention and psychoeducation of patients.
Collapse
Affiliation(s)
- Andrea Aguglia
- a Department of Neuroscience, Psychiatric Unit, S Luigi Gonzaga Hospital , University of Turin , Turin , Italy
| | - Marta Moncalvo
- a Department of Neuroscience, Psychiatric Unit, S Luigi Gonzaga Hospital , University of Turin , Turin , Italy
| | - Francesca Solia
- a Department of Neuroscience, Psychiatric Unit, S Luigi Gonzaga Hospital , University of Turin , Turin , Italy
| | - Giuseppe Maina
- a Department of Neuroscience, Psychiatric Unit, S Luigi Gonzaga Hospital , University of Turin , Turin , Italy
| |
Collapse
|
|
18
|
Braga IP, Souza JCD, Leite MB, Fonseca V, Silva EMD, Volpe FM. Contenção física no hospital psiquiátrico: estudo transversal das práticas e fatores de risco. JORNAL BRASILEIRO DE PSIQUIATRIA 2016. [DOI: 10.1590/0047-2085000000103] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
RESUMO Objetivos Descrever a utilização da contenção física em um hospital psiquiátrico público e analisar os fatores de risco associados com seu uso, no contexto da implantação de um protocolo clínico. Métodos Em um hospital psiquiátrico público de Belo Horizonte-MG, os formulários de registro e monitoramento de contenção física (2011-2012) foram analisados e comparados com os registros das demais internações englobadas no mesmo período. Neste estudo transversal, além das análises descritivas das características clínicas e demográficas dos pacientes contidos, das técnicas utilizadas e das complicações reportadas, os fatores de risco associados com o uso da contenção foram analisados por meio de regressão logística múltipla. Resultados A contenção foi utilizada em 13,4% das internações, sendo mais comum em pacientes jovens, do sexo masculino, portadores de psicoses não orgânicas, apresentando agitação/agressividade. A técnica foi geralmente de quatro pontos, durando entre 61-240 minutos. Os únicos fatores de risco significativos para o uso da contenção incluíram a idade (OR = 0,98; p = 0,008) e o tempo de permanência (OR = 1,01; p < 0,001). Conclusões A contenção física foi utilizada usualmente na abordagem aguda do paciente agitado/agressivo inabordável verbalmente, no contexto de um transtorno psicótico. O registro dos dados vitais e dos efeitos adversos foram os itens menos aderentes aos protocolos vigentes.
Collapse
Affiliation(s)
- Isabela Pinto Braga
- Fundação Hospitalar do Estado de Minas Gerais, Brasil; Fundação de Amparo à Pesquisa do Estado de Minas Gerais, Brasil
| | - Jaqueline Conceição de Souza
- Fundação Hospitalar do Estado de Minas Gerais, Brasil; Fundação de Amparo à Pesquisa do Estado de Minas Gerais, Brasil
| | - Milena Bellei Leite
- Fundação Hospitalar do Estado de Minas Gerais, Brasil; Fundação de Amparo à Pesquisa do Estado de Minas Gerais, Brasil
| | | | | | - Fernando Madalena Volpe
- Fundação Hospitalar do Estado de Minas Gerais, Brasil; Fundação Hospitalar do Estado de Minas Gerais, Brasil
| |
Collapse
|
|
19
|
Racial disparities during admission to an academic psychiatric hospital in a large urban area. Compr Psychiatry 2015; 63:113-22. [PMID: 26555499 DOI: 10.1016/j.comppsych.2015.08.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Revised: 08/17/2015] [Accepted: 08/27/2015] [Indexed: 01/27/2023] Open
Abstract
Multiple studies confirm that African Americans are less likely than non-Hispanic whites to receive needed mental health services. Research has consistently shown that African Americans are under-represented in outpatient mental health treatment settings and are over-represented in inpatient psychiatric settings. Further, African Americans are more likely to receive a diagnosis of schizophrenia and are less likely receive an affective disorder diagnosis during inpatient psychiatric hospitalization compared to non-Hispanic white patients, pointing to a need for examining factors contributing to mental health disparities. Using Andersen's Behavioral Model of Health Service Use, this study examined predisposing, enabling and need factors differentially associated with health service utilization among African American and non-Hispanic white patients (n=5183) during psychiatric admission. We conducted univariate and multivariate logistic regression analyses to examine both main effects and interactions. In the multivariate model, African American race at admission was predicted by multiple factors including younger age, female gender, multiple psychiatric hospitalizations, elevated positive and negative symptoms of psychosis, a diagnosis of schizophrenia and substance use, as well as having housing and commercial insurance. Additionally, screening positive for cannabis use at intake was found to moderate the relationship between being female and African American. Our study findings highlight the importance of examining mental health disparities using a conceptual framework developed for vulnerable populations (such as racial minorities and patients with co-occurring substance use).
Collapse
|
|
20
|
Ritsner M, Kurs R, Grinshpoon A. Short-Term Hospitalization Underlies the Similarity between Involuntarily and Voluntarily Admitted Patients: A One-Year Cohort Study. INTERNATIONAL JOURNAL OF MENTAL HEALTH 2014. [DOI: 10.1080/00207411.2015.1009306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
|
21
|
La décision d’hospitalisation sans consentement aux urgences : approche dimensionnelle ou catégorielle ? Encephale 2014; 40:247-54. [DOI: 10.1016/j.encep.2013.03.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2012] [Accepted: 03/21/2013] [Indexed: 11/18/2022]
|
|
22
|
Myklebust LH, Sørgaard K, Wynn R. Local psychiatric beds appear to decrease the use of involuntary admission: a case-registry study. BMC Health Serv Res 2014; 14:64. [PMID: 24506810 PMCID: PMC3923252 DOI: 10.1186/1472-6963-14-64] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2013] [Accepted: 02/06/2014] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Studies on the effect of organizational factors on the involuntary admission of psychiatric patients have been few and yielded inconclusive results. The objective was to examine the importance of type of service-system, level of care, length of inpatient stay, gender, age, and diagnosis on rates of involuntary admission, by comparing one deinstitutionalized and one locally institutionalized service-system, in a naturalistic experiment. METHODS 5538 admissions to two specialist psychiatric service-areas in North Norway were studied, covering a four-year period (2003-2006). The importance of various predictors on involuntary admission were analyzed in a logistic regression model. RESULTS Involuntary admission to the services was associated with the diagnosis of psychosis, male sex, being referred to inpatient treatment, as well as type of service-system. Patients from the deinstitutionalized system were more likely to be involuntarily admitted. CONCLUSIONS Several factors predicted involuntary status, including male sex, the diagnosis of psychosis, and type of service-system. The results suggests that having psychiatric beds available locally may be more favourable than a traditional deinstitutionalized service system with local outpatient clinics and central mental hospitals, with respect to the use of involuntary admission.
Collapse
Affiliation(s)
- Lars Henrik Myklebust
- Psychiatric Research Centre of Northern Norway, Nordland Hospital Trust, Bodø N-8092, Norway
| | - Knut Sørgaard
- Psychiatric Research Centre of Northern Norway, Nordland Hospital Trust, Bodø N-8092, Norway
- Department of Clinical Medicine, University of Tromsø, Tromsø N-9037, Norway
| | - Rolf Wynn
- Department of Clinical Medicine, University of Tromsø, Tromsø N-9037, Norway
- Division of Addictions and Specialized Psychiatric Services, University Hospital of North Norway, Tromsø N-9291, Norway
| |
Collapse
|
|
23
|
Chang TMM, Ferreira LK, Ferreira MP, Hirata ES. Clinical and demographic differences between voluntary and involuntary psychiatric admissions in a university hospital in Brazil. CAD SAUDE PUBLICA 2013; 29:2347-52. [DOI: 10.1590/0102-311x00041313] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2013] [Accepted: 07/10/2013] [Indexed: 11/22/2022] Open
Abstract
To assess the frequency of involuntary psychiatric hospitalizations from 2001 to 2008 and to determine associated clinical and socio-demographic characteristics, a retrospective cohort study was conducted. Adult admission data were collected from a university hospital in Brazil. Hospitalizations were classified as voluntary (VH) or involuntary (IH). Groups were compared using chi-square test for categorical variables and Mann-Whitney test for continuous non-parametric variables. The relative risk of certain events was estimated by the odds ratio statistic. Of 2,289 admissions, 13.3% were IH. The proportion of IH increased from 2.5% to 21.2% during the eight year period. IH were more frequently associated with female gender, unmarried status, unemployment, and more than 9 years of schooling. Psychotic symptoms were more common among IH. There were no differences in age, duration of hospitalization, or rate of attendance at first appointment after hospital discharge. Understanding of the characteristics associated with IH is necessary to improve the treatment of psychiatric disorders.
Collapse
|
|
24
|
Nawka A, Kalisova L, Raboch J, Giacco D, Cihal L, Onchev G, Karastergiou A, Solomon Z, Fiorillo A, Del Vecchio V, Dembinskas A, Kiejna A, Nawka P, Torres-Gonzales F, Priebe S, Kjellin L, Kallert TW. Gender differences in coerced patients with schizophrenia. BMC Psychiatry 2013; 13:257. [PMID: 24118928 PMCID: PMC3852852 DOI: 10.1186/1471-244x-13-257] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2013] [Accepted: 10/01/2013] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Despite the recent increase of research interest in involuntary treatment and the use of coercive measures, gender differences among coerced schizophrenia patients still remain understudied. It is well recognized that there are gender differences both in biological correlates and clinical presentations in schizophrenia, which is one of the most common diagnoses among patients who are treated against their will. The extent to which these differences may result in a difference in the use of coercive measures for men and women during the acute phase of the disease has not been studied. METHODS 291 male and 231 female coerced patients with schizophrenia were included in this study, which utilized data gathered by the EUNOMIA project (European Evaluation of Coercion in Psychiatry and Harmonization of Best Clinical Practice) and was carried out as a multi-centre prospective cohort study at 13 centers in 12 European countries. Sociodemographic and clinical characteristics, social functioning and aggressive behavior in patients who received any form of coercive measure (seclusion and/or forced medication and/or physical restraint) during their hospital stay were assessed. RESULTS When compared to the non-coerced inpatient population, there was no difference in sociodemographic or clinical characteristics across either gender. However coerced female patients did show a worse social functioning than their coerced male counterparts, a finding which contrasts with the non-coerced inpatient population. Moreover, patterns of aggressive behavior were different between men and women, such that women exhibited aggressive behavior more frequently, but men committed severe aggressive acts more frequently. Staff used forced medication in women more frequently and physical restraint and seclusion more frequently with men. CONCLUSIONS Results of this study point towards a higher threshold of aggressive behavior the treatment of women with coercive measures. This may be because less serious aggressive actions trigger the application of coercive measures in men. Moreover coerced women showed diminished social functioning, and more importantly more severe symptoms from the "excitement/hostile" cluster in contrast to coerced men. National and international recommendation on coercive treatment practices should include appropriate consideration of the evidence of gender differences in clinical presentation and aggressive behaviors found in inpatient populations.
Collapse
Affiliation(s)
- Alexander Nawka
- Department of Psychiatry, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Lucie Kalisova
- Department of Psychiatry, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Jiri Raboch
- Department of Psychiatry, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Domenico Giacco
- Unit for Social and Community Psychiatry, Queen Mary, University of London, London, UK
- Department of Psychiatry, University of Naples, Naples, Italy
| | - Libor Cihal
- Central land office, Ministry of Agriculture, Prague, Czech Republic
| | - Georgi Onchev
- Department of Psychiatry, Medical University of Sofia, Sofia, Bulgaria
| | | | - Zahava Solomon
- School of Social Work and Geha Mental Health Center, University of Tel Aviv, Tel Aviv, Israel
| | - Andrea Fiorillo
- Department of Psychiatry, University of Naples, Naples, Italy
| | | | - Algirdas Dembinskas
- Psychiatric Clinic, Vilnius Mental Health Centre, University of Vilnius, Vilnius, Lithuania
| | - Andrzej Kiejna
- Department of Psychiatry, Medical University, Wroclaw, Poland
| | - Petr Nawka
- Psychiatric private practice, Dresden, Germany
| | | | - Stefan Priebe
- Unit for Social and Community Psychiatry, Queen Mary, University of London, London, UK
| | - Lars Kjellin
- Psychiatric Research Centre, Orebro County Council, Orebro, Sweden
- School of Health and Medical Sciences, Orebro University, Orebro, Sweden
| | - Thomas W Kallert
- Department of Psychiatry, Psychosomatic Medicine, and Psychotherapy, Park Hospital Leipzig, Leipzig, Germany
- Soteria Hospital Leipzig, Leipzig, Germany
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, Dresden University of Technology, Dresden, Germany
| |
Collapse
|
|
25
|
Krivoy A, Fischel T, Zahalka H, Shoval G, Weizman A, Valevski A. Outcomes of compulsorily admitted schizophrenia patients who agreed or disagreed to prolong their hospitalization. Compr Psychiatry 2012; 53:995-9. [PMID: 22520086 DOI: 10.1016/j.comppsych.2012.03.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2011] [Revised: 03/11/2012] [Accepted: 03/12/2012] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Compulsory admission is practiced around the world with legislative variations. The legal status during compulsory hospitalization might be changed to consent or the patient might be discharged against medical advice (AMA), if he no longer poses a risk. OBJECTIVE In the present study, we investigated the outcome of compulsory admitted patients who left the hospital after commitment period despite request by the treating psychiatrist to remain in the hospital (AMA) vs those who agreed to prolong their hospitalization. RESULTS Of 320 patients with schizophrenia admitted involuntarily, 157 (49%) were discharged without converting to consent, and 163 (51%) agreed to stay in the hospital. There was no difference in baseline clinical and demographic characteristics and outcome measures (rate of readmission, legal status of next admission, and length of stay in the next admission) between the 2 groups. CONCLUSIONS Prolongation of length of stay in compulsorily psychiatrist-ordered schizophrenia patients did not affect their rate of rehospitalizations or the length of next admission compared with those who left the hospital immediately after the change in their legal status AMA.
Collapse
Affiliation(s)
- Amir Krivoy
- Geha Mental Health Center, Petach-Tikva, Israel.
| | | | | | | | | | | |
Collapse
|
|
26
|
Iversen VC, Berg JE, Småvik R, Vaaler AE. Clinical differences between immigrants voluntarily and involuntarily admitted to acute psychiatric units: a 3-year prospective study. J Psychiatr Ment Health Nurs 2011; 18:671-6. [PMID: 21896109 DOI: 10.1111/j.1365-2850.2011.01718.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Involuntary psychiatric admissions are widespread among patients with an immigrant background. According to a study in Norway, involuntary admissions are about 75% of admissions among immigrants compared to roughly 50% among ethnic Norwegians. The aim of the present study was to compare clinical and demographic characteristics of immigrant patients with involuntary or voluntary admissions to two acute psychiatric units. A 3-year prospective study of 94 immigrant patients involuntarily and voluntarily admitted to acute psychiatric units was carried out. Sixty-two patients (66.0%) were voluntarily and 30 (31.9%) involuntarily admitted. Involuntary admissions were significantly higher among men (22, 73.3%) compared to women (8, 26.7%; χ(2) = 4.507, d.f. = 1, P= 0.03). The mean length of stay for voluntary and involuntary patients were 7.8 (SD = 6.6) and 21.6 (SD = 27.3; t=-2.7, d.f. = 88, P= 0.01). Patients diagnosed with schizophrenia and psychotic disorder were more often admitted involuntarily (63.0%; χ(2) = 17.83, P= 0.001). This study confirms that immigrant patients diagnosed with psychotic disorders are more often involuntarily than voluntarily admitted. Comparing the clinical and demographic characteristics of immigrants helps identify the reasons behind involuntary admissions and might improve efforts towards reducing such admissions in the future.
Collapse
Affiliation(s)
- V C Iversen
- Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway.
| | | | | | | |
Collapse
|
|
27
|
Involuntary commitment and detainment in adolescent psychiatric inpatient care. Soc Psychiatry Psychiatr Epidemiol 2010; 45:785-93. [PMID: 19690788 DOI: 10.1007/s00127-009-0116-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2009] [Accepted: 07/31/2009] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To evaluate whether adolescents committed to psychiatric inpatient care are the most disturbed, and whether psychosocial factors other than psychiatric symptoms are associated with commitment to and detainment in psychiatric care among adolescents. MATERIALS AND METHODS The case histories of 187 13- to 17-year-old adolescents consecutively admitted to the study clinic were scrutinized with the help of a structured data collection form. Psychiatric, demographic and family-related characteristics of those referred involuntarily (n = 93) and voluntarily (n = 94), and those detained involuntarily (n = 42) and treated on a voluntary basis (n = 145) were compared. RESULTS Involuntary referral and involuntary detainment were associated with psychotic symptoms, temper tantrums and breaking property, involuntary referral also with violent and hostile behaviours and suicidal ideation and talk. They were not associated to family adversities, previous treatment history or sociodemographic factors. The risk for being committed when presenting with aggressive behaviours was greater in girls. CONCLUSION Involuntary referral and detainment in adolescents is associated with symptom severity, and not with aspects of the adolescent's living conditions. This is in agreement with the legislation. Gender bias resulting in girls' greater risk of being involuntarily committed if displaying aggressive behaviours may be an ethical and legal problem.
Collapse
|
|
28
|
Kortrijk HE, Staring ABP, van Baars AWB, Mulder CL. Involuntary admission may support treatment outcome and motivation in patients receiving assertive community treatment. Soc Psychiatry Psychiatr Epidemiol 2010; 45:245-52. [PMID: 19412561 DOI: 10.1007/s00127-009-0061-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2008] [Accepted: 04/14/2009] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Patients with severe mental illness who are treated in assertive community treatment (ACT) teams are sometimes involuntarily admitted when they are dangerous to themselves or others, and are not motivated for treatment. However, the consequences of involuntary admission in terms of psychosocial outcome and treatment motivation are largely unknown. We hypothesized that involuntary admission would improve psychosocial outcome and not adversely affect their treatment motivation. METHODS In the context of routine 6-monthly outcome monitoring in the period January 2003-March 2008, we used the Health of the Nation Outcome Scales (HoNOS) and a motivation-for-treatment scale to assess 260 severely mentally ill patients at risk for involuntary admission. Mixed models with repeated measures were used for data analyses. RESULTS During the observation period, 77 patients (30%) were involuntarily admitted. Relative to patients who were not involuntarily admitted, these patients improved significantly in HoNOS total scores (F = 17,815, df = 1, p < 0.001) and in motivation for treatment (F = 28.139, df = 1, p < 0.001). Patients who were not involuntarily admitted had better HoNOS and motivation scores at baseline, but did not improve. CONCLUSIONS Involuntary admission in the context of ACT was associated with improvements in psychosocial outcome and motivation for treatment. There are no indications that involuntary admission leads to deterioration in psychosocial outcome or worsening of motivation for treatment.
Collapse
|
|
29
|
Araújo EMD, Martins ES, Adams CE, Coutinho ESF, Huf G. Inquérito sobre o uso de contenção física em um hospital psiquiátrico de grande porte no Rio de Janeiro. JORNAL BRASILEIRO DE PSIQUIATRIA 2010. [DOI: 10.1590/s0047-20852010000200003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJETIVO: Investigar o uso da contenção física em hospital psiquiátrico no Rio de Janeiro. MÉTODOS: Um inquérito foi conduzido em agosto de 2009. As informações - sexo, idade, diagnóstico, ocorrência e duração de contenção física - foram coletadas no prontuário. RESULTADO: A amostra consistiu em 66 pacientes, dos quais 59% eram mulheres, com idade média de 44 anos. Durante o período estudado, 24% dos pacientes foram contidos no leito pelo menos uma vez, mas não é prática corrente o registro detalhado do procedimento. Não ocorreram eventos adversos importantes. Não houve associação entre o uso de contenção e variáveis sociodemográficas e clínicas. CONCLUSÕES: A prática de contenção física parece consistente nas emergências psiquiátricas do Rio de Janeiro: esse mesmo percentual foi observado em estudos conduzidos em três hospitais em outros momentos, 2001 e 2004, e situa-se em uma faixa intermediária em relação aos resultados observados em outros países. Não existem estudos randomizados para se fazer uma avaliação objetiva dos benefícios e riscos dessa prática, mas a segurança e a eficácia dessa intervenção deveriam ser objeto do mesmo escrutínio científico normalmente destinado aos outros tratamentos.
Collapse
|
|
30
|
Abstract
PURPOSE OF REVIEW This paper highlights issues in the field of coercion in psychiatry which have gained importance in 2007. RECENT FINDINGS Reviews on 'involuntary hospital admission' demonstrated negative and positive consequences on various outcome domains. Papers on 'coercion and the law' identified cross-national differences of legal regulations, or addressed justice and equality issues. Studies on the 'patient's perspective', and 'family burden of coercion' showed that involuntariness is associated with feeling excluded from participation in the treatment. A review on 'outpatient commitment' recommended the evaluation of a range of outcomes if this specific legislation is introduced. 'Coercion in special (healthcare) settings and patient subgroups' needs to be assessed in detail. This refers to somatic hospitals, establishments for mentally retarded patients, prisons, forensic settings, and coercion mechanisms for addiction treatment, eating disorders, and minors. Empirical findings in other areas focused on attitudes towards involuntary treatment; decision variables for involuntary commitment; guidelines on the use of coercive measures; and intervention programs for staff victims of patient assaults. SUMMARY Coercion in psychiatry is an important area for future clinical and research initiatives. Because of the linkages with legal, human rights and ethical issues, a huge number of individual questions needs to be addressed.
Collapse
|