Rethinking hospital psychiatry in Italy in light of COVID-19 experience

Table 1 Factors associated with hospital admission, derived from the 20-item checklist described in the study design and ranked according to frequency in the year 2020, n (%)

	2019		2020
Reasons	No	Yes	No	Yes	P value
Illness severity	12 (16.9)	59 (83.1)	16 (36.4)	28 (63.6)	0.02
Difficulties in instigating treatment	64 (90.1)	7 (9.9)	35 (79.5)	9 (20.5)	0.11
Organic co-morbidity	64 (90.1)	7 (9.9)	35 (79.5)	9 (20.5)	0.11
Negative relationship with patients’ relatives	64 (90.1)	7 (9.9)	35 (79.5)	9 (20.5)	0.11
Difficulties in planning care outside the hospital	70 (98.6)	1 (1.4)	39 (88.6)	5 (11.4)	0.02
Insufficient relationship with social agencies	70 (98.6)	1 (1.4)	41 (93.2)	3 (6.8)	0.12
Objective difficulties in the family system	70 (98.6)	1 (1.4)	42 (95.5)	2 (4.5)	0.31
Insufficient relationship with elderly care facilities	69 (97.2)	2 (2.8)	43 (97.7)	1 (2.3)	0.86
Unclear reason for admission	69 (97.2)	2 (2.8)	43 (97.7)	1 (2.3)	0.86
Insufficient communication with outpatient clinic	70 (98.6)	1 (1.4)	43 (97.7)	1 (2.3)	0.73
Negative doctor-patient relationship	70 (98.6)	1 (1.4)	43 (97.7)	1 (2.3)	0.73
Legal acts	71 (100.0)	0 (0.0)	43 (97.7)	1 (2.3)	0.20
Insufficient relationship with rehabilitation facilities	66 (93.0)	5 (7.0%)	44 (100.0)	0 (0.0)	0.07
Insufficient relationship with legal system	68 (95.8)	3 (4.2)	44 (100.0)	0 (0.0)	0.17
Diagnostic difficulties	70 (98.6)	1 (1.4)	44 (100.0)	0 (0.0)	0.43
Insufficient patient’s evaluation	70 (98.6)	1 (1.4)	44 (100.0)	0 (0.0)	0.43

Four items out of 20 (defensive psychiatry; delay in specialist consultations and diagnostic tests; hospital organizational problems; exceptional personal, familial and social events) were null in both 2019 and 2020. More than one factor might be operating on each admission.