Characteristics associated with involuntary versus voluntary legal status at admission and discharge among psychiatric inpatients

Abstract

j Abstract Background The objective of this analysis was to determine the ways in which patients' legal statuses at hospital admission and discharge are associated with select sociodemographic and clinical variables. This study specifically investigated differences between patients who were voluntary during both admission and discharge, patients who were involuntary on admission but voluntary on discharge (having converted to voluntary status during hospitalization), and patients who were involuntary during both admission and discharge. Method Data were collected from the charts and treating clinicians of 227 consecutively discharged patients from two psychiatric units in a large, urban, county hospital in the southeastern United States. Based on results of bivariate tests, sociodemographic and clinical factors were entered into a polytomous logistic regression model to determine effect estimates (adjusted odds ratios). Results In the bivariate analyses, 15 variables were significantly associated with the trichotomous legal status. In the model, three factors were independently significantly associated with legal status, while controlling for four potential confounders: (1) whether or not the patient was experiencing psychotic symptoms at discharge, (2) whether or not the patient had documented medical problems requiring medication at discharge, and (3) the number of psychiatric medications. Conclusions A generalized lack of treatment engagement and adherence among involuntary patients likely underlies significant differences between the groups in terms of psychotic symptoms, diagnosed medical problems requiring medications, and number of psychiatric medications at discharge. Studying legal status (and the process of legal status conversion from involuntary to voluntary) and its correlates is an important topic for further research.

Involuntary admissions in Italy: the impact of seasonality

“…Second, the most frequent diagnoses among involuntary admissions were bipolar disorder and related disorders and schizophrenia and other psychosis. Several authors confirmed our findings regarding both schizophrenia and other psychoses (Craw & Compton 2006;Bauer et al 2007;Pantusa et al 2007;Zhou et al 2015) and bipolar and related disorders (Lee et al 2007;Schuepbach et al 2008;Amr & Volpe 2012). Third, analyzing the monthly distribution of admissions, we observed a significant increase of involuntary hospitalizations during changes of season in particular in spring/summer with a peak in June.…”

Correlates of Involuntary Admission: Findings From an Italian Inpatient Psychiatric Unit

“…Compulsory measures can weaken the therapeutic relationship and increase perceived coercion experienced by patients (Sheehan & Burns 2011). Different approaches have been developed to regulate the application of those measures -taking into account human rights, public safety, the need for adequate treatment (Salize et al 2002), and the fact that patients with mental illnesses commonly have undiagnosed or untreated medical problems (Craw & Compton 2006, Viron & Stern 2010 -to provide the most effective care and avoid negative outcomes (Kallert et al 2008). Moreover, the correct use of involuntary commitment is both a political and professional goal in terms of being a good indicator of the legal framework of the mental health care system and a marker of quality of services provided (Donisi et al 2014, Salize & Dreßing 2004.…”

Contenção física no hospital psiquiátrico: estudo transversal das práticas e fatores de risco

“…Em serviços psiquiátricos de outras partes do globo, essa ocorrência apresenta bastante variabilidade, de 0,3% a 59,0% [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17] . No Brasil, dois estudos semelhantes apresentaram valores superiores aos do presente estudo: 24,0% a 26,0% 11,30 .…”

“…Nas emergências e unidades de internação psiquiátricas, a contenção física é prática utilizada na maioria dos países, com incidências reportadas entre 0,3% a 59,0% [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17] . As condições psiquiátricas que usualmente requerem indicação de contenção física são agitação psicomotora, confusão mental e agressividade ou violência em relação a si próprio, a objetos e/ou a outros e que não responderam às intervenções menos invasivas 14 , e a prevenção de quedas 18 .…”

“…Isso envolve a descrição da incidência de seu uso e dos fatores associados, da técnica utilizada e dos riscos e benefícios de seu uso. Embora já exista um razoável corpo de publicações internacionais sobre as práticas da contenção física [1][2][3][4][5][6][7][8][9][10]12,[14][15][16][18][19][20][21][22][23][24][26][27][28][29] , no Brasil, de nosso conhecimento, existem poucas análises descritivas 11,17,30,31 . O objetivo deste estudo foi avaliar o uso da contenção física no contexto de um hospital psiquiátrico público de Belo Horizonte, descrevendo a frequência e as técnicas de sua utilização, as características dos pacientes submetidos e os fatores de risco associados.…”