Clinical and social factors associated with increased risk for involuntary psychiatric hospitalisation: a systematic review, meta-analysis, and narrative synthesis

Abstract

Background Use of involuntary psychiatric hospitalisation varies widely within and between countries. The factors that place individuals and populations at increased risk of involuntary hospitalisation are unclear, and evidence is needed to understand these disparities and inform development of interventions to reduce involuntary hospitalisation. We did a systematic review, meta-analysis, and narrative synthesis to investigate risk factors at the patient, service, and area level associated with involuntary psychiatric hospitalisation of adults.Methods We searched MEDLINE, PsycINFO, Embase, and the Cochrane Controlled Clinical Register of Trials from Jan 1, 1983, to Aug 14, 2019, for studies comparing the characteristics of voluntary and involuntary psychiatric inpatients, and studies investigating the characteristics of involuntarily hospitalised individuals in general population samples. We synthesised results using random effects meta-analysis and narrative synthesis. Our review follows Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and is registered on PROSPERO, CRD42018095103. Findings 77 studies were included from 22 countries. Involuntary rather than voluntary hospitalisation was associated with male gender (odds ratio 1•23, 95% CI 1•14-1•32; p<0•0001), single marital status (1•47, 1•18-1•83; p<0•0001), unemployment (1•43, 1•07-1•90; p=0•020), receiving welfare benefits (1•71, 1•28-2•27; p<0•0001), being diagnosed with a psychotic disorder (2•18, 1•95-2•44; p<0•0001) or bipolar disorder (1•48, 1•24-1•76; p<0•0001), and previous involuntary hospitalisation (2•17, 1•62-2•91; p<0•0001).Using narrative synthesis, we found associations between involuntary psychiatric hospitalisation and perceived risk to others, positive symptoms of psychosis, reduced insight into illness, reduced adherence to treatment before hospitalisation, and police involvement in admission. On a population level, some evidence was noted of a positive dose-response relation between area deprivation and involuntary hospitalisation.Interpretation Previous involuntary hospitalisation and diagnosis of a psychotic disorder were factors associated with the greatest risk of involuntary psychiatric hospitalisation. People with these risk factors represent an important target group for preventive interventions, such as crisis planning. Economic deprivation on an individual level and at the population level was associated with increased risk for involuntary hospitalisation. Mechanisms underpinning the risk factors could not be identified using the available evidence. Further research is therefore needed with an integrative approach, which examines clinical, social, and structural factors, alongside qualitative research into clinical decision-making processes and patients' experiences of the detention process.

Understanding increasing rates of psychiatric hospital detentions in England: development and preliminary testing of an explanatory model

“…Public attitudes to mental illness also appear to be unchanged or 0.00 1 9 8 8 -8 9 1 9 8 9 -9 0 1 9 9 0 -9 0 1 9 9 1 -9 2 1 9 9 1 -9 3 1 9 9 3 -9 4 1 9 9 4 -9 5 1 9 9 5 -9 6 1 9 9 6 -9 7 1 9 9 7 -9 8 1 9 9 8 -9 9 1 9 9 9 -0 0 2 0 0 0 -0 1 2 0 0 1 -0 2 2 0 0 2 -0 3 2 0 0 3 -0 4 2 0 0 4 -0 5 2 0 0 5 -0 6 2 0 0 6 -0 7 2 0 0 7 -0 8 2 0 0 8 -0 9 2 0 0 9 -1 0 2 0 1 0 -1 1 2 0 1 1 -1 2 2 0 1 2 / 1 3 2 0 1 3 -1 4 2 0 1 4 -1 5 2 0 1 5 -1 6 to have become more positive, based on available data from 1994 to 2014 (Table 1). Men, younger adults (age [18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35] and people from Black, Asian and minority ethnic (BAME) groups are at increased risk of detention in England. 35,36 The proportion of the population in England from all BAME groups has more than doubled between 1988 and 2016, as has the proportion of non-UK-born people in the population.…”

“…(3) Demographic change (increased numbers of those at risk of detention): some demographic groups are at higher risk of detention than others (i.e. men, people from BAME groups and young adults age [18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35]: if the proportion of the population from these groups increases, we would expect higher rates of detention. (4) Increasing rates of mental illness: a proportion of those with mental illness become so unwell that detention is required: higher rates of mental illness lead to more detentions.…”

Factors Associated With Involuntary Psychiatric Hospitalization in Portugal

“…As a result, legal frameworks for involuntary hospitalization have been implemented in different countries [2]. Involuntary hospitalization has been understood as the means to enabling the right to enjoyment of the highest attainable standard of health when a severe exacerbation of illness impairs decision-making capacity [3], and can be lifesaving [4]. However, it represents a deprivation of personal liberty and a suspension of legal capacity [5], and con icts with the right of autonomy and decision about treatment [6].…”

“…At follow-ups, many of the patients view their admission and treatment positively [7,8,13,14], but a substantial percentage of them retrospectively do not feel that the admission was justi ed and bene cial [7,13]. Empirical data suggest that involuntary hospitalization may be experienced as traumatic and stigmatizing [15], lead to low levels of treatment satisfaction [4,16], have negative effects on patient-therapist relationship [17], lead to longterm avoidance of mental health care [4,15,18], and increase the risk of emergency compulsory rehospitalization [19]. Involuntarily admitted people may also be exposed to further coercive measures during the hospital stay, such as seclusion, administration of medication against their will and restraint [6,20,21].…”

A systematic review of PTSD to the experience of Psychosis: Prevalence and associated factors

“…The ongoing development of TIC has the potential to reduce traumatic experiences associated with psychosis, such as the use of coercive practices (16). However, coercive practices appear to be increasing in the UK (44), particularly for people with psychosis (45). In addition to reduced distressing treatment practices, TIC involves services recognizing that the experience of psychosis can be traumatic, screening patients for PTSD, and offering evidence-based treatments (which, NICE guidelines stipulate should commence promptly, 46).…”