Determinants of compulsory admissions in a state psychiatric hospital–Case control study

Indu, Nair V; Vidhukumar, K; Sarma, P. S.

doi:10.1016/j.ajp.2016.11.007

Cited by 19 publications

(24 citation statements)

References 18 publications

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“…Our findings are in line with previous research that identified unemployment as a risk factor for involuntary psychiatric hospitalization not only at the individual level, but also at an environmental, population-based level [7,9,10,22,23,34]. Economic deprivation has also been identified as a risk factor both on the individual and the population level [10,35].…”

Section: Discussionsupporting

confidence: 92%

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Identification of risk factors for involuntary psychiatric hospitalization: using environmental socioeconomic data and methods of machine learning to improve prediction

et al. 2020

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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.

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Section: Discussionsupporting

confidence: 92%

“…On the level of social environment, living in urban regions with high population density and living in socially deprived areas with a high unemployment rate, small household size and high percentage of immigrants were identified as risk factors for detention [7,9,22,23].…”

Section: Introductionmentioning

confidence: 99%

Identification of risk factors for involuntary psychiatric hospitalization: using environmental socioeconomic data and methods of machine learning to improve prediction

et al. 2020

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“…Regarding sociodemographic factors, male gender was signi cantly associated with higher risk of involuntary hospitalizations. This nding is congruent with several previous studies [31, 32, 45−47, 52, 53, 55, 57, 58, 60, 64], while other studies have shown a higher risk in female gender [51,65,66]. Possible explanations might be related to societal attitudes and treatment culture that lead to different helpseeking behavior in males and females, or that mentally ill men are perceived as being more violent, suggesting that perception of dangerousness and overtly dangerous behavior are important contributing factors to involuntary hospitalizations [31,32,53,60].…”

Section: Association Between Involuntary Hospitalization(s) and Sociosupporting

confidence: 93%

Factors Associated With Involuntary Psychiatric Hospitalization in Portugal

Silva

Antunes

Azeredo‐Lopes

et al. 2020

Preprint

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BackgroundIdentifying which factors contribute to involuntary psychiatric hospitalization may support initiatives to reduce its frequency. This study examines the sociodemographic, clinical, and contextual factors associated with involuntary hospitalization of patients from five Portuguese psychiatric departments in 2002, 2007 and 2012.MethodsData from all admissions were extracted from clinical files. A Poisson generalized linear model estimated the association between the number of involuntary hospitalizations per patient in one year and sociodemographic, clinical, and contextual factors.ResultsMale gender [exp(β̂) = 1.31; 95%CI:1.06-1.62, p<0.05], having secondary and higher education [exp(β̂) = 1.45; 95%CI:1.05-2.01, p<0.05, and exp(β̂) = 1.89; 95%CI:1.38-2.60, p<0.001, respectively], a psychiatric diagnosis of psychosis [exp(β̂) = 2.02; 95%CI:1.59-2.59, p<0.001], and being admitted in 2007 and in 2012 [exp(β̂) = 1.61; 95%CI:1.21-2.16, p<0.01, and exp(β̂) = 1.73; 95%CI:1.31-2.32, p<0.001, respectively] were associated with an increment of involuntary hospitalizations. Being married/cohabitating [exp(β̂) = 0.74; 95%CI:0.56-0.99, p<0.05], having experienced a suicide attempt [exp(β̂) = 0.26; 95%CI:0.15-0.42, p<0.001], and belonging to the catchment area of three of the psychiatric units evaluated [exp(n) =0.65; 95%CI:0.49-0.86, p<0.01, exp(β̂) = 0.67; 95%CI:0.49-0.90, p<0.01, and exp(β̂) = 0.67; 95%CI:0.46-0.96, p<0.05 for Hospital de Magalhães Lemos, Centro Hospitalar Psiquiátrico de Lisboa and Unidade Local de Saúde do Baixo Alentejo, respectively] were associated with a decrease in involuntary hospitalizations.ConclusionsThe findings suggest that involuntary psychiatric hospitalizations in Portugal are associated with sociodemographic, clinical, and contextual factors. This information may help to recognize high-risk patients, and to inform the development of better-targeted preventive interventions to reduce these hospitalizations.

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“…Studies have often demonstrated that individuals treated involuntarily under MHAs experience a higher illness acuity or severity, and greater complexity, longer hospitalisations, and are more likely to be readmitted compared to those treated voluntarily [7][8][9][10][11]. Poor medication adherence and lower treatment satisfaction have also been reported [8,12]. Research exploring the use of medication and alignment with clinical practice guidelines for this vulnerable population is limited, however, research does suggest an increased likelihood of experiencing treatment outside of clinical practice recommendations such as polypharmacy (i.e.…”

Section: Introductionmentioning

confidence: 99%

Is higher psychotropic medication burden associated with involuntary treatment under the Mental Health Act? A four-year Australian cohort study

Wheeler

Profitt

et al. 2020

BMC Psychiatry

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Background: Involuntary treatment for individuals who lack sufficient capacity to make informed decisions regarding treatment has been associated with increased rates of injectable antipsychotics, antipsychotic polytherapy, and/or high doses. However, little is known about non-antipsychotic psychotropic prescription, or psychotropic medication burden as a more encompassing approach for people treated involuntarily. The aim of this study was to examine the relationship between Mental Health Act (MHA) status and psychotropic polypharmacy and/or high-dose medication prescribing practices in an Australian inpatient mental health unit. Methods: A retrospective cohort study of 800 adults discharged from a large metropolitan Queensland mental health unit was undertaken. Data was collected for 200 individuals, discharged on at least one psychotropic medicine, at four time periods; Cohort 1 (on or before 31st January 2014), Cohort 2 (2015), Cohort 3 (2016) and Cohort 4 (2017). The number of prescribed medicines and total daily doses were recorded and reviewed for alignment with current clinical guidelines. Participant demographics and clinical characteristics were compared by individual MHA status using chi-square test for categorical variables and analysis of variance for continuous variables. Associations between MHA status and prescribing practices (psychotropic polypharmacy and/or highdose prescribing) were assessed using bivariate and multivariate binomial logistic regression models. Age, gender, birth country, year of admission, admissions in previous 12 months, primary diagnosis, ECT/clozapine treatment, and other psychotropic medications were adjusted as covariates. Results: Regression analysis found that compared to their voluntary counterparts, individuals treated involuntarily were 2.7 times more likely to be prescribed an antipsychotic at discharge, 8.8 times more likely to be prescribed more than one antipsychotic at discharge and 1.65 times more likely to be prescribed high-dose antipsychotic treatment at discharge. The adjusted model also found that they were half as likely to be prescribed an antidepressant at discharge.

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Determinants of compulsory admissions in a state psychiatric hospital–Case control study

Cited by 19 publications

References 18 publications

Identification of risk factors for involuntary psychiatric hospitalization: using environmental socioeconomic data and methods of machine learning to improve prediction

Identification of risk factors for involuntary psychiatric hospitalization: using environmental socioeconomic data and methods of machine learning to improve prediction

Factors Associated With Involuntary Psychiatric Hospitalization in Portugal

Is higher psychotropic medication burden associated with involuntary treatment under the Mental Health Act? A four-year Australian cohort study

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