Factors associated with involuntary admissions: a register-based cross-sectional multicenter study

Abstract

Background Despite the EU recommendations on mental health, involuntary admission has been under researched in Italy for a long time and the overall picture of involuntary admission still appears fragmentary. The aims of this study are to evaluate involuntary admission rates in the Piedmont Region (Italy) and to investigate clinical and service-related variables associated with involuntary admission. Methods This is a cross-sectional retrospective multicenter study involving all psychiatric inpatients units of the general hospitals of Piedmont Region. Data on hospitalizations during 2016 were collected by consulting hospital discharge registers. The analyses were performed on two samples: 6018 patients (data analysis was run on first hospitalization during the study period for those with multiple admissions) and 7881 inpatient episodes. The association between involuntary admission and socio-demographic and clinical characteristics was examined through t-test for continuous variables, and Pearson’s Chi-square test for categorical variables. Multilevel modeling was applied in logistic regression models with two levels: for the first model center and participants and for the second model center and inpatient episodes. Results Of 6018 inpatients, 10.1% were admitted involuntarily at first hospitalization, while the overall compulsory treatment rate was slightly lower (9.1%) in the inpatient episodes sample (n = 7881). The involuntary admission rates ranged from 0.8 to 21% among study centers. Involuntary admissions were primarily associated with younger age, diagnosis of schizophrenia or substance use disorders, longer duration of hospital stay, mechanical restraint episodes, and fewer subsequent hospitalizations during the study period. Conclusions The rate of involuntary admission in the Piedmont Region was lower than the mean rate across countries worldwide. There were noteworthy differences in rates of involuntary admission among psychiatric units, although no relationship was found with characteristics of the psychiatric wards or of the areas where hospitals are located.

Sociodemographic, Circumstantial, and Psychopathological Predictors of Involuntary Admission of Patients with Acute Psychosis

“…In general, (illicit) drug use is associated with impaired judgement, delinquency, and suicide [37]. All of these aspects would presumably contribute to a higher risk of IA [9,16,24,38], however, this was not the case in the present study. A review analyzing the differences in clinical features of substance-induced psychotic disorder (SIPD) in comparison to primary psychotic disorders with concurrent substance abuse found that SIPD correlated with a greater degree of insight, fewer positive symptoms, more depression, and more anxiety [39].…”

“…As patients suffering from symptoms of acute psychosis present a relevant share of INVOLP, a sound understanding of risk factors contributing to IA in this specific group of patients is clinically relevant. Most previously conducted studies examining predictors of IA have focused on the whole subpopulation of INVOLP which has led most researchers to establish that symptoms associated with psychosis and/or a diagnosis of schizophrenia [5,9,16,19,20,32,33] as well as a diagnosis of an organic mental disorder [2,5,19,20] are relevant contributors to IA. Significantly fewer studies have addressed risk factors specific to patients with acute psychosis [15,[22][23][24].…”

“…Their co-occurrence is bidirectional: while patients with psychosis may feel the need to alleviate symptoms by turning to substance use, drug use, especially of illicit drugs, this is commonly associated with the occurrence of psychotic symptoms [34]. Acute intoxication is associated with extreme agitation [9] and may lead to significant alterations of the mind which depending on the substance used affect perception, emotion, cognition, and sense of self [35]. Alcohol intoxication, for example, is associated with violent and criminal behavior [36], whereas the use of psychedelic drugs may result in a wide array of perceptual distortions including hallucinations [35].…”

“…While the use of coercive measures ideally results in a substantial clinical improvement [6] and improved psychosocial outcome [7], IA is also associated with several adverse treatment outcomes such as longer length of inpatient care [6,8,9], lower treatment satisfaction [6,10], rapid readmission [6,11], higher suicide rates [6], post-traumatic stress disorder [12], and lower level of social functioning [6]. Moreover, involuntarily admitted patients (INVOLP) are subject to shame, self-contempt, and stigmatization resulting in potentially detrimental effects on recovery [13].…”

Are Patients Improving during and after a Psychiatric Hospitalisation? Continuity of Care Outcomes of Compulsory and Voluntary Admissions to an Italian Psychiatric Ward

“…A recent review has shown that the highest rate among 22 high-income countries was found in Austria (282 CAs per 100.000 inhabitants), while an almost 20-fold lower rate has been observed in Italy 10 . Even in Italy, noteworthy differences in rates of CAs have been found among psychiatric units of the same Region (Piedmont) 11 . Moreover, rates of CA increased by 36% from 2007 to 2016, considering all countries 10 .…”