Factors Associated With Involuntary Psychiatric Hospitalization in Portugal

Abstract

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.

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

“…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).…”

“…The common diagnoses of acute psychiatric inpatients were schizophrenia and dementia (10,11). Other studies have reported that patients with involuntary admission, which represents the majority of admissions to acute psychiatric units, are characterized by the presence of psychosis and a high number of various clinical problems (13). Three qualitative studies examined clinical profiles of patients admitted to acute units in more detail (8,14,15).…”