Factors associated with involuntary psychiatric hospitalization in Portugal

Abstract

Background Identifying 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. Methods Data 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. Results An increment of involuntary hospitalizations was associated with male gender [exp($$\widehat{\upbeta }$$ β ^ ) = 1.31; 95%CI 1.06–1.62, p < 0.05], having secondary and higher education [exp($$\widehat{\upbeta }$$ β ^ ) = 1.45; 95%CI 1.05–2.01, p < 0.05, and exp($$\widehat{\upbeta }$$ β ^ ) = 1.89; 95%CI 1.38–2.60, p < 0.001, respectively], a psychiatric diagnosis of psychosis [exp($$\widehat{\upbeta }$$ β ^ ) = 2.02; 95%CI 1.59–2.59, p < 0.001], and being admitted in 2007 and in 2012 [exp($$\widehat{\upbeta }$$ β ^ ) = 1.61; 95%CI 1.21–2.16, p < 0.01, and exp($$\widehat{\upbeta }$$ β ^ ) = 1.73; 95%CI 1.31–2.32, p < 0.001, respectively]. A decrease in involuntary hospitalizations was associated with being married/cohabitating [exp($$\widehat{\upbeta }$$ β ^ ) = 0.74; 95%CI 0.56–0.99, p < 0.05], having experienced a suicide attempt [exp($$\widehat{\upbeta }$$ β ^ ) = 0.26; 95%CI 0.15–0.42, p < 0.001], and belonging to the catchment area of three of the psychiatric services evaluated [exp($$\widehat{\upbeta }$$ β ^ ) = 0.65; 95%CI 0.49–0.86, p < 0.01, exp($$\widehat{\upbeta }$$ β ^ ) = 0.67; 95%CI 0.49–0.90, p < 0.01, and exp($$\widehat{\upbeta }$$ β ^ ) = 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]. Conclusions The findings suggest that involuntary psychiatric hospitalizations in Portugal are associated with several sociodemographic, clinical, and contextual factors. This information may help identify high-risk patients and inform the development of better-targeted preventive interventions to reduce these hospitalizations.

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

“…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].…”

“…Non-adherence to (antipsychotic) medication, recognized as one of the most challenging aspects in the treatment of schizophrenia and leading to a greater risk of relapse, hospitalization, and suicide [41], has been associated with a higher incidence of IA [15,20]. The present study found non-adherence to increase risk of IA by a 2.4-fold, whereas other variables (e.g., police escort, use of restraint), which may ultimately be the result of nonadherence and exacerbation of disease, contributed a significantly higher OR.…”

“…Many efforts have been made to address risk factors of IA. Some frequently reported predictors of IA include male gender [15,16], immigrant status [5,16,17], lower socioeconomic status and lack of social support [2,3,15,18], admission outside of regular service hours [2,5,16,19], and previous IA [20]. Comprising between 30% and 50% of involuntarily admitted patients in Europe, one of the most commonly reported predictors of IA is schizophrenia or related psychotic conditions [2,11,15,16,20,21].…”

“…Some frequently reported predictors of IA include male gender [15,16], immigrant status [5,16,17], lower socioeconomic status and lack of social support [2,3,15,18], admission outside of regular service hours [2,5,16,19], and previous IA [20]. Comprising between 30% and 50% of involuntarily admitted patients in Europe, one of the most commonly reported predictors of IA is schizophrenia or related psychotic conditions [2,11,15,16,20,21]. Despite the high prevalence of patients with acute psychosis among INVOLP, limited research has been dedicated specifically on their behalf [15,[22][23][24].…”

Strategic Assessment of Neighbourhood Environmental Impacts on Mental Health in the Lisbon Region (Portugal): A Strategic Focus and Assessment Framework at the Local Level

“…In Portugal, research on the impacts of environmental factors on mental health started two decades ago, driven by research projects such as Health Impact Assessment (HIA) in Employment Strategies (2009)(2010)(2011)(2012)(2013)(2014), SMAILE (2013SMAILE ( -2015, and Mental Health-Crisis Impact (2015-2017). These projects generated insights about the local and economic factors regarding mental health in the context of crisis [54][55][56][57][58][59][60], particularly important and useful evidence to support research and mental health impact assessment during the COVID-19 health crisis [61,62].…”