Clinical determinants of involuntary psychiatric hospitalization: A clinical profile approach

Georgaca, Eugenie; Machaira, Sofia; Stamovlasis, Dimitrios; Peppou, Lily Εvangelia; Arvaniti, Aikaterini; Samakouri, Maria; Stylianidis, Stelios; Bozikas, Vasilis P.; Diakogiannis, Ioannis; Fokas, Kostas; Garyfallos, George; Gkolia, Ioanna; Karpouza, Vassiliki; Nimatoudis, Ioannis; Patsinakidis, Georgios; Sevris, Dimitrios; Vlachaki, Aikaterini

doi:10.1002/jclp.23528

Cited by 4 publications

(1 citation statement)

References 82 publications

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“…These variables were associated with the need for a high-acuity unit in the linear regression analysis. Previous studies pointed out that severe symptoms are associated with high utilization of emergency services ( 9 , 13 , 24 ). To secure the lives of and benefits to such patients, intensive 24-hour care and equipment specific to psychiatric emergencies based on sufficient staff and a high standard of medical care in a high-acuity unit appear to be needed ( 1 , 2 , 15 ).…”

Section: Discussionmentioning

confidence: 99%

Ranking important predictors of the need for a high-acuity psychiatry unit among 2,064 inpatients admitted to psychiatric emergency hospitals: a random forest model

Iwanaga,

Yamaguchi,

Hashimoto

et al. 2024

Front. Psychiatry

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AimsIn order to uphold and enhance the emergency psychiatric care system, a thorough comprehension of the characteristics of patients who require a high-acuity psychiatry unit is indispensable. We aimed to clarify the most important predictors of the need for a high-acuity psychiatry unit using a random forest model.MethodsThis cross-sectional study encompassed patients admitted to psychiatric emergency hospitals at 161 medical institutions across Japan between December 8, 2022, and January 31, 2023. Questionnaires were completed by psychiatrists, with a maximum of 30 patients assessed per medical institution. The questionnaires included psychiatrists’ assessment of the patient’s condition (exposure variables) and the need for a high-acuity psychiatry unit (outcome variables). The exposure variables consisted of 32 binary variables, including age, diagnoses, and clinical condition (i.e., factors on the clinical profile, emergency treatment requirements, and purpose of hospitalization). The outcome variable was the need for a high-acuity psychiatry unit, scored from 0 to 10. To identify the most important predictors of the need for a high-acuity psychiatry unit, we used a random forest model. As a sensitivity analysis, multivariate linear regression analysis was performed.ResultsData on 2,164 patients from 81 medical institutions were obtained (response rate, 50.3%). After excluding participants with missing values, this analysis included 2,064 patients. Of the 32 items, the top-5 predictors of the need for a high-acuity psychiatry unit were the essentiality of inpatient treatment (otherwise, symptoms will worsen or linger), need for 24-hour professional care, symptom severity, safety ensured by specialized equipment, and medication management. These items were each significantly and positively associated with the need for a high-acuity psychiatry unit in linear regression analyses (p < 0.001 for all). Conversely, items on age and diagnosis were lower in the ranking and were not statistically significant in linear regression models.ConclusionItems related to the patient’s clinical profile might hold greater importance in predicting the need for a high-acuity psychiatry unit than do items associated with age and diagnosis.

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Section: Discussionmentioning

confidence: 99%

Ranking important predictors of the need for a high-acuity psychiatry unit among 2,064 inpatients admitted to psychiatric emergency hospitals: a random forest model

Iwanaga,

Yamaguchi,

Hashimoto

et al. 2024

Front. Psychiatry

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Length of hospital stay in involuntary admissions in Greece: a 10-year retrospective observational study

Bakola,

Peritogiannis,

Kitsou

et al. 2024

Soc Psychiatry Psychiatr Epidemiol

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Purpose The treatment of mental disorders has shifted from inpatient wards to community-based settings in recent years, but some patients may still have to be admitted to inpatient wards, sometimes involuntarily. It is important to maintain the length of hospital stay (LoS) as short as possible while still providing adequate care. The present study aimed to explore the factors associated with the LoS in involuntarily admitted psychiatric patients. Methods A ten-year retrospective chart review of 332 patients admitted involuntarily to the inpatient psychiatric ward of the General University Hospital of Ioannina, Northwestern Greece, between 2008 and 2017 was conducted. Results The mean LoS was 23.8 (SD = 33.7) days and was relatively stable over the years. Longer-stay hospitalization was associated with schizophrenia-spectrum disorder diagnosis, previous hospitalizations and the use of mechanical restraint, whereas patients in residential care experienced significantly longer LoS (52.6 days) than those living with a caregiver (23.5 days) or alone (19.4 days). Older age at disease onset was associated with shorter LoS, whereas no statistically significant differences were observed with regard to gender. Conclusion While some of our findings were in line with recent findings from other countries, others could not be replicated. It seems that multiple factors influence LoS and the identification of these factors could help clinicians and policy makers to design more targeted and cost-effective interventions. The optimization of LoS in involuntary admissions could improve patients’ outcomes and lead to more efficient use of resources.

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Area-level factors associated with variation in involuntary psychiatric hospitalisation across England: a cross-sectional, ecological study

Minchin,

Christiansen,

Maconick

et al. 2024

Soc Psychiatry Psychiatr Epidemiol

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Purpose Involuntary hospitalisations for mental health care are rising in many high income countries, including England. Looking at variation between areas can help us understand why rates are rising and how this might be reversed. This cross-sectional, ecological study aimed to better understand variation in involuntary hospitalisations across England. Method The unit of analysis was Clinical Commissioning Groups (CCGs), NHS bodies responsible for delivering healthcare to local areas in England. 205 CCGs were included in the analysis. Demographic, clinical, and socioeconomic variables at CCG-level were extracted from national, open access data bases. The outcome variable was the rate of involuntary hospitalisation for psychiatric care under the 1983 Mental Health Act in 2021/22. Results There was a four-fold difference between the CCGs with the highest and lowest involuntary hospitalisations. In an adjusted analysis, CCGs with a higher percentage of severe mental illness in the population, higher percentage of male population, and higher community and outpatient mental health care use showed a higher rate of involuntary hospitalisation. Depression, urbanicity, deprivation, ethnicity, and age were not strongly associated with involuntary hospitalisation after adjustment. These variables explained 10.68% of the variation in involuntary hospitalisations across CCGs. Conclusion Some demographic and clinical variables explained variation in involuntary hospitalisation between areas in England, however, most of the variance was unexplained. Complex relationships between urbanicity, deprivation, age, and ethnicity need to be further explored. The role of other influences, such as variation in service organisation or clinical practice, also need to be better understood.

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Clinical determinants of involuntary psychiatric hospitalization: A clinical profile approach

Cited by 4 publications

References 82 publications

Ranking important predictors of the need for a high-acuity psychiatry unit among 2,064 inpatients admitted to psychiatric emergency hospitals: a random forest model

Ranking important predictors of the need for a high-acuity psychiatry unit among 2,064 inpatients admitted to psychiatric emergency hospitals: a random forest model

Length of hospital stay in involuntary admissions in Greece: a 10-year retrospective observational study

Area-level factors associated with variation in involuntary psychiatric hospitalisation across England: a cross-sectional, ecological study

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